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CRC Press

Quality Insider

From a Physician’s First-Hand Experience: Sustaining Lean in Healthcare

How to ensure ongoing physician participation in lean implementation

Published: Tuesday, August 2, 2011 - 11:02

(CRC Press: Boca Raton, FL) -- Dr. Michael Nelson has written one of the first books to focus on physician engagement in creating a lean culture, Sustaining Lean in Healthcare: Developing and Engaging Physician Leadership (CRC Press, 2011).

The book begins with the basics of lean (including quality methods such as value stream maps, kanban, heijunka, gemba walks, standard work, kaizen, and more) followed by clinical decision making and the plan-do-study-act cycle.

Next, Nelson describes how to create a physician engagement plan, including its vision and goals, a reward and recognition plan, selecting and developing physician champions, how to approach and engage frontline physicians, and the physicians’ role in sustaining improvements and maintaining the lean culture.

Nelson devotes a chapter on the senior leader’s role and duties, in which he explains determining the right destination and creating the vision of the lean transformation, selecting the right people and defining their roles, providing training and resources, investing in infrastructure, frequent and clear communication, strategic alignment, the deployment plan, and how active leadership is essential to effective deployment, establishing measures for success, and project spread and sustainability.

In the following roll-up-your-sleeves chapter, “Analysis and Preparation,” learn about business needs assessment and operational impact; the likelihood of financial, quality, or satisfaction improvements; resources; architecture; readiness; the preparation phase; and stakeholder analysis.

Tools and approaches for before-and-during implementation are provided along with a typical implementation timeline and a cross-training matrix.

Nelson explains what to look for when judging lean success and includes numerous examples that demonstrate how to sustain success over the long term. He gives tips for spotting the danger signs that might indicate your plan is off course. He also provides a methodology for establishing shared expectations of success with your medical team early in the process, as well as a proven framework for simultaneous lean deployment across multiple locations.

About the author

Practicing pediatrics for 28 years, Nelson has devoted increasingly more time during the last 13 years to quality improvement in health care. For the last five years of employment with Presbyterian Healthcare Services, he worked full-time in quality improvement and was a physician leader for lean systems implementation. Nelson is credited with:
• Creating a health and chronic disease management system resulting in national benchmark performance in diabetes care
• Developing a curriculum and teaching more than 200 clinicians and senior leaders advanced tools and techniques in quality improvement
• Implementing elements of the advanced medical home
• Creating a patient-centered care environment through the creation of patient and family advisory councils in PMG clinics
• Leading and supporting successful lean implementations resulting in dramatic improvements in ambulatory clinics and inpatient settings


Nelson currently owns a lean consulting business, Blue Corn Professional Services LLC, and is a physician coach for the Studer Group. He is also a certified lean Six Sigma Black Belt.


About The Author

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CRC Press

CRC Press is a premier global publisher of science, technology, and medical resources. It offers unique, trusted content by expert authors, spreading knowledge and promoting discovery worldwide. Its aim is to broaden thinking and advance understanding in the sciences, providing researchers, academics, professionals, and students with the tools they need to share ideas and realize their potential. CRC Press is a member of Taylor & Francis Group, an informa business.