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Perfecting Patient Journeys is about improving the delivery of service at operational level by applying the value-stream method.  The book addresses key steps to improving efficiency and thus delivering better services. These steps include:

  1. Identifying and agreeing on a problem
  2. Collaboratively developing a set of potential solutions to the problem
  3. Experimenting in order to find the best solution to address the problem
  4. Communicating, sharing, and learning from the results

The authors have authority in helping healthcare organisations use the value-stream improvement approach to sustain change.  Perfecting Patient Journeys originated from the authors’ work at the Michigan Hospital Association, over a three-year period.  The authors were responsible for implementing lean management over 65 Emergency Rooms over a 7 month period.  The 65 rooms collaborated with each other.   The value-stream improvement method was the approach used to lead the lean transformation.

A key principle repeated throughout the book was to define value and map value from the patients’ perspective, rather than the healthcare professionals’ perspective.   The book is very specific, addressing one methodology – the value-stream improvement method – extensively, and the book retains this focus throughout.

Of great benefit, is the book’s value-stream metrics.  It is designed with healthcare in mind, focussing on addressing issues faced in the sector, with insight into specific complexities that are different to other industries.  The book is a practical guide, and clinical people reading it will find value in being able to apply principles at work immediately.

The book’s focus on a specific methodology means that it is not surprising that they do not focus on other practices.  However given the authors’ practical experience it would have been insightful to read about how they dealt with the human or cultural aspects (looking at how people reacted to the change in management system and how it affected the work culture), when implementing lean in these hospital environments. The authors’ use of the word ‘socialisation’ seems to refer to the human aspect/ work culture of the hospital; however the word is not defined in the context that it is used, and there is limited information on how to execute the ‘socialisation’.  For anyone managing a lean transformation or any big process change, being able to read advice on how to approach staff resistance to such change is always of significant value.

Despite these gaps, this is a great book for anyone who wants to do value-stream mapping, including people working outside of healthcare.  It is a compulsory read for people within healthcare who are planning, or who have recently started, a lean transformation journey.

Perfecting Patient Journeys is a brilliant overview of the value-stream improvement method and it will stimulate thinking, and should inspire action.  For some further insight into the book and its authors, here is a brief clip of two of the authors having an interview with Lean Enterprise Institute.

You can order the book through Lean Institute Africa. Contact us on 021 406 1477 or

Book details:
Title: Perfecting Patient Journeys
Authors: Judy Worth, Tom Shuker, Beau Keyte, Karl Ohaus, Jim Luckman, David Verble, Kirk Paluska and Todd Nickel
Publisher:  Lean Enterprise Institute, Inc.
ISBN-13:  978-1-934109-36-6
SKU:  9366
Publication Date:  January 29, 2013
Number of Pages:  161

Review written by Charmaine Cunningham