The Pittsburgh Way to Efficient Healthcare: Improving Patient Care Using Toyota-based Methods
The debate is over: we know how to improve the quality, safety, efficiency and cost of American health care. Proof started coming in when, in 2001, a small Pittsburgh nonprofit persuaded regional hospitals to experiment with ideas from the world’s most efficient company—Toyota.
Applying industrial principles to healthcare sounded unorthodox, until hospital after hospital began to post dramatic, sustained improvements. The Pittsburgh experiment proved the case for Lean in healthcare. This book describes the nitty-gritty of how Lean looks at the frontline, in real hospitals.
Listen to Naida's interview about the link between aviation and patient safety, with Lean expert Mark Graban
The "Pittsburgh experiment" revolutionized healthcare -- by giving a whole region the motivation and tools to prevent patient harm and deaths. Grunden describes the successes and challenges with insight and passion. Her book takes us under the hood to see how things really worked. It is chock full of pearls, useful tools, and inspiring stories of people and organizations who made quality improvement concepts and principles spring to life. Read it, and then create a similar experiment in your part of the healthcare world.
–Robert M. Wachter, MD
Professor and Associate Chairman, Department of Medicine University of California, San Francisco
Chief of the Medical Service UCSF Medical Center
Editor, AHRQ WebM&M and Patient Safety Network
Co-author, Internal Bleeding: the Truth Behind America’s Terrifying Epidemic of Medical Mistakes
The Pittsburgh Way to Efficient Healthcare explains that America’s deadly hospitals have management problems, not medical, technology, or financial problems or careless doctors and nurses. It reports how managers— without more money or federal action—can use Toyota management principles to create an environment where it is difficult to make a mistake and people can take joy in work and deliver better and better patient care.
Producer, "Good News: How Hospitals Heal Themselves"
Co-author, The Nun and the Bureaucrat: How They Found an Unlikely Cure for America’s Sick Hospitals and Thinking About Quality: Progress, Wisdom and the Deming Philosophy.
At a time when we are overwhelmed by the staggering evidence that health care systems that we depend on for care when we are most vulnerable too often fail us, here is book that captures the power of real transformation. Grunden tells stories of people who struggle every day on the front lines of health care to overcome the impact of broken systems. Instead of working around the problems that lead to unnecessary patient death and harm, health care providers have been taught a new way of thinking about and solving problems that for too long have trapped them in a dysfunctional system of medical care. An inspiration and a guide for anyone concerned about fixing our broken health care systems.
Producer, PBS Series, “Remaking American Medicine”
The Toyota-based discipline of Perfecting Patient Care, which itself relies on observation, standardization, testing and data has not yet had the conceptual break-through it needs to become our new guiding principle. Enter now Naida Grunden and her book The Pittsburgh Way: Case Studies in Healthcare Improvement. The question is, Can The Pittsburgh Way become synonymous with the Toyota Way as it applies to improving the quality and safety of medical care in our country? Naida Grunden has taken the amazing work done by her colleagues at the Pittsburgh Regional Health Initiative (PRHI) and translated it for a broader audience; an audience who will recognize the power of this book to deliver what I envision to be the definitive map on our journey toward quality and safety.
–David Nash, MD, MBA
The Dr. Raymond C. and Doris N. Grandon Professor of Health Policy and Medicine, Jefferson Medical College of Thomas Jefferson University in Philadelphia
Founder and Director, Office of Health Policy and Clinical Outcomes, Jefferson University Hospital.
What exactly is “workflow re-design?” Can it really make the health care experience safer and more effective, efficient, and rewarding for patients and providers? Ms. Grunden answers these questions through dozens of fascinating examples which really happened in Pittsburgh’s hospitals and are replicable virtually anywhere. These chapters offer a primer on American ingenuity, as dramatic patient care improvement often results from surprisingly simple industrial techniques, for example, asking “Why?” five times in succession to seek root causes of problems, designing simple checklists to gather actionable information completely and uniformly, displaying colored flags to shunt collegial effort where and when it is most needed, posting creative reminders to orchestrate and reinforce desired behavioral protocols, and encouraging vocal gumption to democratize vigilance and foster ongoing commitment to improvement.
Naida Grunden is the sole proprietor of Naida Grunden LLC, specializing in Lean consulting in the healthcare arena. Services include author, teaching and speaking about the practical, on-the-ground application of Toyota-based principles in health care settings. All rights reserved. Contact: