Spain's Mercadona supermarket chain is able to offer the lowest prices in the country while out performing comparable Spanish and foreign chains. In 2008, Mercadona's sales per square foot was 60% higher than that of France's giant Carrefour, and more than twice that of an average U.S. supermarket. The key is a relentless focus on continuous product and process improvement. And that, reports Harvard Business School, requires treating employees and customers differently than most retailers.

Most Toyota plants produce more than one vehicle, but the company strayed from this practice, based on a forecast of a booming economy, when it opened its plant in San Antonio in 2006 to build Tundra full-size pickup trucks.  When the economy cratered less than two years later, the plant never reached its capacity for 200,000 vehicles. In July 2010, Toyota began making the smaller Tacoma truck at San Antonio after the GM-Toyota joint venture at NUMMI, which had been making Tacomas, ended. (San Antonio Express-News)

Pixar, famus for animated hits such as "Toy Story," “Finding Nemo,” and “Cars,” based at least part of its managemetn system on Toyota's lean management practices. Inspired by Toyota's attention to soliciting employee feedback, Pixar directors executives decided to have employees show unfinished work to each other at daily meetings.  The idea is to surface and solve problems before they become crises. Directors are not obliged to act on the feedback, however, peer review contrbuted to the story line of the hit “Up.”

Q&A with John Toussaint, MD, and Roger Gerard, PhD
authors of On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry

Q: Lean originated in manufacturing; how does it apply to healthcare?
Like lean manufacturing, lean healthcare strives to increase value to patients by taking the waste out of processes and improving quality. Nationwide, there is a growing emphasis on continuous quality improvement, cost reduction, and increased patient value — the same type of principles originally applied in manufacturing.

Manufacturers that have diligently and thoroughly applied lean thinking have reaped steady productivity gains while reducing errors and improving the customer and employee experience. Imagine the results that similar improvements could bring in healthcare.

Read the rest of the Q&A with authors John Toussaint and Roger Gerard.

An excerpt from On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry

Chapter 2: Focus on the Patient

It was just after dinner on a bitterly cold night in March 2007 that Myrtle Bellis took a turn for the worse. Her skin grew pale and clammy, her heartbeat skipped and fluttered; she could not catch a full breath. As Myrtle lost and regained consciousness, her daughter Cindy telephoned for an ambulance and gathered up their coats.

Read the entire chapter from On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry.

Foreword from On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry

"Across the world for nearly a century, managers and front-line workers have been steadily learning about the power of rigorous processes to create more value for customers with less waste of every sort – time, defects, human effort, capital investment, injuries. The most accomplished practitioner of these methods through much of the past 60 years has been the Toyota company, but recently many organizations in a wide range of industries far beyond manufacturing have applied rigorous process management—often called lean thinking—to their core activities. When customer value is clearly understood and managers and employees at every level are creatively engaged in dramatically improving traditional processes, the results are invariably highly positive."

"Curiously healthcare, with its strong base in the scientific method of rigorous experiments, was largely absent from this movement until recently."

Introduction to the book On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry

"In the hospitals and clinics of the ThedaCare medical system in Wisconsin’s Fox River Valley, we have learned that every medical act is a series of steps that can be examined and improved. By investigating these steps, and the path that patients take through our hospitals and clinics, we have learned to identify value from the patient’s point of view and to start getting rid of the waste that clogs the system of healthcare delivery."

Read the full introduction to On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry.

See the Table of Contents from the book On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry