The Lean Way: How California Public Hospitals Are Embedding a Culture of Improvement

Ruth Brousseau
Melissa Ramos


California’s public hospital systems are under pressure to increase capacity, enhance patient experience, improve care, and reduce costs. To ensure continuing progress toward these goals, a number of public hospitals are taking part in CHCF’s Embedding Lean initiative, which has provided several rounds of funding.

Lean management is an improvement methodology developed by Toyota in the 1990s and later adapted to health care organizations. In contrast to improving hospitals function-by-function, Lean creates a culture of continuous improvement directed toward maximizing value to patients and minimizing waste in systems. Needed changes are identified, tested, and implemented by the people actually doing the work.

The five hospitals most recently engaged in Embedding Lean are Alameda Health System, Contra Costa Regional Medical Center, Harbor-UCLA, San Francisco General Hospital, and San Mateo Medical Center. Their major activities and accomplishments to date are itemized in the report, which is available below.