The "Training Within Industry" program was a U.S. government program during World War II that focused on ramping up war production. The methodology for creating job instructions, managing continuous improvement, and training employees became the foundation for Toyota's approach to Standardized Work as it was taught to them after the war.

The TWI approach was also used in healthcare during the war. The approach is being utilized today in a growing number of hospitals as that history is rediscovered.

The TWI Institute has resources and historical documents about TWI in healthcare.

Toussaint writes about the improvements that ThedaCare has made using an improvement methodology based on "lean" and the Toyota Production System.

The article describes improvements and results in areas such as:

• Heart attack care
• Newborn delivery
• Primary care ("collaborative care")

Toussaint shares results from ThedaCare's work and makes recommendations about how public policy and encourage this type of innovation rather than punishing quality and cost improvement from a financial standpoint.

This article highlights hospitals that are eliminating waste in healthcare. The author writes: "Researchers believe there is 30 percent "quality waste" in U.S. health care; that is, unnecessary costs due to care that is inappropriate, inefficient or unsafe." The CEO of Heartland Health, Lowell Kruse, said: "You have to build a culture that relentlessly attacks broken business processes; for example, standardizing a confusing welter of surgical supplies. And, of course, your physicians and employees have to regard these activities and countless others as a benefit to patients rather than a threat to profits." In Appleton, Wisconsin, Dr. John Toussaint insists that "quality waste" adds up to a stunning 40 to 50 percent of costs. Until recently Toussaint ran ThedaCare, whose systematic efforts to improve care and lower costs were profiled in a case study by Harvard Business School superstar expert Michael Porter. The column also makes allusion to the partnership between the LEI and the ThedaCare Center for Healthcare Value.

This article documents improvements in the British Columbia health system in cataract surgery. Lean methods were applied to reduce waste and improve patient care. One documented savings in the story was a $450k reduction in unnecessary anesthesia expense, using local sedation when full anesthesia was not really necessary (a good example of eliminating the waste of "overprocessing"). There are a number of quots from surgeons and hospital leaders, as well as some discussion of improving flow through the emergency department value stream and improvements in a nursing station.

These cases include topics such as: patient safety alerts, community health clinic improvements, operating room cleanliness and productivity improvement, improving handoffs, laboratory redesign for lean, improving on-time surgical starts, nurse protocols to shorten length of stay, improvements in myocardial infarction care, MRSA infection rate reduction, and reducing patient waiting times in primary care.

The article is an overview of how Lean applies in healthcare and what some of the leading organizations are accomplishing with Lean. The article features ThedaCare (including the story of how a manufacturing, Ariens, helped get them started), Denver Health, and Elkhart General Hospital.

Results cited include:

• ThedaCare has reduced "door to balloon" time from 91 minutes to 37 minutes
• Post-cardiac-surgery length of stay was reduced from 6.2 days to 4.8 days at ThedaCare
• Denver Health generated an additional $520,000 since 2007, using Lean to create more capacity
• Denver Health boosted revenue by $2.3 million by improving processes so they billed for all of the care they provided
• Denver Health has reduced costs by a total of $28.6 million