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Perfecting Patient Journeys
by Judy Worth, Tom Shuker, Beau Keyte, et al.

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Shingo Research and Professional Publication Award recipient

Healthcare in the United States, and around the world, is facing a crisis brought on by a combination of rising costs, lack of transparency and accountability, and preventable medical errors. Applying lean thinking to improve care is one way that healthcare organizations can engage employees in solving problems in order to deliver better and more efficient care.

Perfecting Patient Journeys is a guide for leaders of healthcare organizations who want to implement lean thinking. Readers will learn how to identify and select a problem, define a project scope, and create a shared understanding of what's occurring in the value stream. Readers will also learn to develop a shared vision of an improved future, and how to work together to make that vision a reality.

Over the past eight years, the authors of this book have helped healthcare organizations learn how to make real and sustainable change using the value-stream improvement method. Implementing lean thinking has helped healthcare providers develop an adaptive, problem-solving culture with stunning results:

  • Reduced annual staff turnover by 20%
  • Average length of stay (LOS) in a large emergency department was reduced by 30%
  • The number of patients who left without being seen (LWOBS) dropped by 60% in the same hospital
  • Customer (patient) satisfaction increased by 73%
  • Operating room changeover time was reduced, which increased the number of surgical procedures performed by 20%

Rather than rely on huge training budgets or teams of consultants, the method described in this book focuses on solving real organizational problems, and helps healthcare organizations and those who labor within them to daily provide safe, effective, efficient, and timely patient care.

Publisher:  Lean Enterprise Institute, Inc.
ISBN-13:  978-1-934109-36-6
SKU:  9366
Publication Date:  January 29, 2013
Number of Pages:  161
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James (Beau) Keyte Beau is President of The Keyte Group. In this role, Beau teaches, coaches, and facilitates on two important transformation fronts: changing the work processes and changing the roles and responsibilities of leadership to support new work processes. This work keeps him happy as he guides systemic learning and change. Teams learn how to understand, prioritize, and solve performance problems while management learns how to coach the staff in a way to develop them into better thinkers and employees. His operational excellence focus began in 1986 and his work has expanded to include support in healthcare, financial services, and manufacturing. Beau also has been active in designing ways to help organizations learn in highly leveraged collaborative models, including working with 62 emergency departments across Michigan to simultaneously improve patient outcomes. He has two Shingo Prize-winning publications: The Complete Lean Enterprise and Perfecting Patient Journeys. In addition to being on LEI’s faculty, he is a contributing author to Huffington Post and an adjunct faculty member of Ohio State University’s Masters of Business in Operational Excellence program.
Tom Shuker Tom is a 30-year veteran in various manufacturing environments within General Motors Corporation. Tom has also spent two-years at New United Motors Manufacturing Inc. (NUMMI), the GM-Toyota joint venture, working within the Toyota Manufacturing System and performing lean assessments of Toyota facilities in Kentucky and Japan. Tom has co-authored two books on Lean, Value Stream Management and Value Stream Management for the Lean Office, both published through Productivity Press, Inc. Tom is also a co-author of Mapping to See – A Value-Stream Improvement Kit for Office and Service, published by the Lean Enterprise Institute. He has a Bachelor of Science degree from Michigan State University, and an MBA from Western Michigan University. He currently aids companies implementing lean through an investment group that purchases small manufacturing firms and helps turn them around and as a member of the consulting group Lean Transformations Group.
Judy Worth Judy Worth got her first introduction to lean from one of her business partners, who left their company in Lexington, KY, to work at the start up of Toyota’s first North American plant in Georgetown, KY. She got additional exposure to the value-stream mapping tool when she served as instructional designer for LEI’s Mapping to See Kit for lean in office and services. For the past nine years, Judy’s focus has been on implementing lean in healthcare. She has extensive experience facilitating value-stream mapping workshops in healthcare organizations, including hospitals and primary care and has also provided training and coaching services for healthcare in-house lean facilitators. Judy is the co-author of the LEI publication, Perfecting Patient Journeys, a step-by-step guide for moving from value-stream mapping to sustainable continuous improvement. She is also co-author of a white paper on lean competencies, “Building Capability for Success with Lean: The Critical Competencies.” She currently aids companies implementing lean through the Lean Transformations Group.
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Praise for Perfecting Patient Journeys

"Few healthcare leaders have been trained to understand the existing state of care processes in their hospital or clinic. Perfecting Patient Journeys describes the team-based, value-stream improvement method that allows frontline healthcare staff to standardize and improve care processes. We have found in healthcare organizations throughout North America that this approach unleashes the talent and creativity of thousands of workers all focused on solving problems every day.

"Given the worldwide problem of declining value in healthcare, I cannot think of a more timely and practical resource for pursuing perfect healthcare delivery."

- John Toussaint, MD, author of On the Mend and Potent Medicine, CEO emeritus of ThedaCare and CEO of the ThedaCare Center for Healthcare Value

"Perfecting Patient Journeys is the perfect field guide for leading self-directed improvement teams in healthcare. It is the Learning To See for healthcare providers and lean coaches. Our work at Martin Health Systems now follows the value-stream mapping and PDCA methodology outlined in the book, and we recently initiated a major Inpatient Service Line Value Stream Improvement Strategy applying the same process. Having buy-in from multiple stakeholders and structured follow-through on small rapid improvement events is critical to learning the concepts and maintaining progress."

- Roger Chen, Corporate Director of Performance Excellence, Martin Health Systems

"In healthcare it is difficult to see the entire process in one’s own department, never mind fully understand what the patients and families experience as they receive care throughout the hospital.  Like many companies, hospitals are set up in separate and distinct departments so a patient must enter and exit these distinct vertical silos even for a simple doctor’s visit and face even more fragmentation for an inpatient stay.

"This book helps one to 'see' across the silos of an organization by teaching you a way to visualize the current flow (or antiflow) of patients as they navigate their way to better health and, in turn, makes obvious the waits and delays, the handoff issues, the redundancies, and the pain our patients experience so that you can design a much better system of care delivery. Perfecting Patient Journeys provides a step-wise approach that is practical and clear and will jump-start efforts of your process improvement teams."

- Alice Lee, Vice President of Business Transformation, Beth Israel Deaconess Medical Center

"Perfecting Patient Journeys is a practical guide to anyone conducting a value-stream improvement project in healthcare. It gives healthcare professionals a methodology for the overall project as well as targeted advice for every step along the way. Using this book will help healthcare organizations understand and improve the processes they use to deliver care, while also developing team members as problem solvers."

- Jeanne Kin, Special Projects Manager, University of Michigan Medical School

"Two thumbs up. Perfecting Patient Journeys is a book with a wealth of knowledge to understand the value-stream improvement method."

- Lori Kauflin and Bashir Rawas, TechSolve's Lean Healthcare Blog

"Perfecting Patient Journeys offers a simple approach that includes tools, illustrated examples from groups that have already “gone there,” and most important, a starting place ... Project after project, it's good to have a guidebook like Perfecting Patient Journeys to refer to."

- Patricia Moody, Blue Heron Journal

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