What if your department needs to function more efficiently, but cost prohibits hiring a Lean consultant in the near future? You can make progress in spite of this obstacle, because as the saying goes, low hanging fruit is easy to pick. We discuss the aspects of Lean you can implement internally.


Process mapping helps teams visualize workflow. A process map clarifies linear processes, dependent processes, process loops, and delays. It can help team members understand the domino effect of their role within the larger patient journey. And anyone can create one. (For a 5 minute overview, see Julianna Wescott Process Mapping)

We suggest that you start by assembling a diverse team of frontline staff to collectively map the process as the patient experiences it from start to finish. At a minimum, the team should include someone in the check-in / registration function, a nurse, a physician, and a tech. It should also incorporate staff members from different shifts. Working from the patient’s viewpoint is critical, because it provides a structure for the conversation to focus the group. And, make sure to map what really happens, not what is supposed to happen.

Spend as much time as necessary to hear each team member’s opinions, thoughtful comments, and constructive criticism. What? That’s right – listen. It is a hindrance to creativity and collaboration if someone on the team, particularly in a leadership role, approaches the exercise with their mind made up and has pre-determined the conclusions.

Once you have mapped the entire patient experience through the department, you can focus on individual aspects of the overall patient experience (such as the registration process) that are linear, cumbersome, time consuming, or just unnecessary.

The following clues in the diagram reveal suboptimal aspects of the process:

  • There is one long chain of events. Linear processes are usually slow. Can you remove some of the steps? Can you shorten individual tasks? Can multiple processes happen in parallel instead?
  • Patient waits.” Can you remove those? Or move the patient along the treatment continuum?
  • Can you move decisions (diamond shapes) upstream? If you reach a decision faster, does that improve the patient situation?

You know the process mapping exercise works when staff argue with each other to “get it right” or say things like “You do what? Why?”  You now have a baseline for understanding your operations, and can begin to streamline them.


Assign a team to tackle the most unnecessarily long and linear portion of the process. The team should consist of a few original team members plus a handful of new staff who specialize in the area of focus. Alternatively, multiple teams may each work on a different “trouble spot.” When team members hold differing views, always return to the needs of the patient as the basis for decision making.

Identify the most relevant and appropriate metric that relates to the selected process, such as LOS, D2P, or TAT, and establish an achievable goal time. Develop an alternative workflow that reduces the number of steps in the process, allows tasks to occur in parallel, removes waiting time, and advances the patient through their journey faster.


The Hawthorne Effect is a phenomenon whereby measuring a system will affect that system, because individuals improve or modify an aspect of their behavior in response to their awareness of being observed. (Sounds diabolical, but here you will subject yourself to it too.) To apply this principle, we recommend that you track and share measurements with staff on a daily basis. Establish a discussion forum in which you educate staff on the metric and its associated goal, share daily times in comparison to the goal, and discuss the contributing factors to the daily improvement (or lack thereof).

As staff acclimate to the success inherent to this methodology, you can initiate subsequent process improvement efforts in the same manner. It is critical to keep your department and the team members moving forward: complacency is a killer, but regular check-ins will ensure progress toward the goal.

One person on your team has a paramount role in the success or failure of “DIY Lean on a Dime.” Management advocacy ensures success, but improvement can happen at a grassroots level as long as the initiative has a champion. A champion not only possesses recent front line experience in conjunction with a broader view of the process, they also promote the changes internally, relentlessly keeping them top of mind with staff on a daily basis.