The Healthcare Manager's Playbook

In manufacturing, quick changeover is studied in detail to reduce the time and effort required to switch from producing one product to another. While healthcare is very different, there are still lessons we can use from manufacturing to make transitions between patients smoother and more efficient.

Below are four quick changeover tips for inpatient therapy to improve the transition from working with one patient to the next.

1. Know the Schedule

Before starting treatment, check whether you will pick up your patient in their room, therapy gym, or another location. Knowing where to find them reduces wasted time spent walking the unit or searching for patients.

Also, look ahead to see whether the patient has another therapy session immediately after yours. If they do, it is often more efficient to leave them in the gym rather than returning them to their room. This helps prevent the dreaded scenario of taking a patient back to their room, only to have the next therapist arrive just as the patient settles into bed and finds their favorite television show. It is less disruptive for the next therapist to pick up the patient in the gym.

2. Integrate Patient Needs Into Treatment

If treatment begins in the patient’s room, prepare the room for their eventual return at the beginning of the session instead of at the end. Work with the patient to move the tray table, position the call bell, place the phone within reach, secure the charger, discard trash, refill water, and organize any other items they will need. When these tasks are completed early, the end of the session becomes much smoother for both you and the patient.

These are many of the same tasks they will eventually need to perform at home, making them valuable treatment opportunities rather than interruptions. Look for opportunities to teach, coach, and problem-solve. Discuss safety strategies, demonstrate more efficient techniques, practice the proper use of mobility devices, and introduce adaptive equipment when appropriate.

3. Ask About Bathroom Needs

Before leaving the room or beginning therapy, ask whether the patient needs to use the bathroom. Otherwise, you risk bringing them to the gym, transferring them onto a mat table, setting up an activity, and then hearing, “I need to use the bathroom.”

A good rule of thumb is to ask when they last used the restroom. If it has been more than an hour or so, consider starting with toileting. Even if they do not actually need to go, practicing another toilet transfer and clothing management sequence provides valuable functional training.

4. Build in a 10-Minute Wind Down

Don’t wait until the final minute of treatment to ask about patient needs. Instead, begin winding down about 10 minutes before the session ends.

Let patients know you want to leave enough time to meet their needs before treatment is over. Ask whether they need to use the bathroom and whether they plan to return to bed or remain in a chair. Planning ahead helps avoid unnecessary time pressure.

When clinicians feel rushed, valuable teaching opportunities are often the first thing to disappear. The focus shifts from educating and coaching the patient to simply trying not to be late for the next appointment. Rushing can also increase frustration for both the patient and the therapist. Telling a patient to “just hit the call bell” because you’re out of time is rarely the best experience for either person.

Finally, rushing increases the likelihood of simple but important mistakes, such as forgetting to place the phone within reach, position the call bell, or activate the bed alarm.

While we care for people—not products—we can still benefit from borrowing good ideas from other industries. Small improvements in how we transition between patients can reduce wasted time, decrease stress, and create more opportunities for meaningful patient care. Ultimately, better transitions don’t just improve efficiency—they improve the patient experience as well.

About the Author: Shane Haas serves as the National Director of Outpatient Services at Ernest Health, a leading provider of inpatient and outpatient rehabilitation. He enjoys learning and sharing leadership and management principles. His backgrounds in Physical Therapy (UF ’96) and Industrial Engineering (TTU ’02) provide a balanced heart and head perspective that shapes the Healthcare Managers’ Playbook.

References:

Shingo, S. (2018). Quick changeover for operators: The SMED system. Productivity Press.

One of the biggest challenges for managers in healthcare is dealing with variation. For most hospital-based clinical departments (nursing, therapy, pharmacy, etc.), no two days are the same. One day may bring a surge of new admissions, while the next brings multiple call-ins or an unusually high number of medically complex patients. Staffing, patient demand, and scheduling can all change from one day to the next.

If not managed well, variation leads to friction, inefficiency, and frustration. Rather than hoping variation will go away, a better approach is to become better at managing it. Variation is part of hospital-based healthcare. Census will ebb and flow. Staffing will fluctuate. Don’t become frustrated by these realities—become skilled at responding to them.

Whenever you find a response that works well, write it down. Over time, these successful responses become your playbook. Instead of solving the same problems from scratch every time they occur, you simply refer back to what has worked before. Like a football coach calling a familiar play during a game, you can confidently call that play again when the same situation presents itself. A good playbook saves time, reduces decision fatigue, and helps create more consistent outcomes.

Recognizing Variation

The first step in managing variation is recognizing how it impacts your department. Before making adjustments, ask one simple question: Will this increase demand on the department or decrease it?

The answer immediately narrows the list of potential responses (examples in table below):

Examples of ↑ Increased Demand	Examples of ↓ Reduced Demand
Staff vacation days	Too many staff scheduled for the day
Late call-ins	Fewer admissions than expected
Open positions	Patient medically unable to participate
Unexpected admissions	Patient did not show as expected
Delayed discharges	Patient called to cancel appointment
Work injury restrictions or absences	Discharge moved forward
Patient appointments (dialysis, consults, etc.)	Patient refused treatment
Modified patient schedules or care demands
High number of medically complex patients
Computer or technical issues

Once you’ve identified the type of variation, the next step is making adjustments. The sooner those adjustments are made, the less disruptive the variation will be.

Responding to Increased Demand (↑)

When demand suddenly increases, the goal is not simply to ask everyone to work harder. Instead, look for ways to create additional capacity while avoiding unnecessary stress. Most of the time, one solution is not enough. Several small adjustments often restore balance much more effectively than one major change.

Below are examples from an inpatient therapy department.

Potential Response	Why It Helps
Manager treats patients or leads a group.	Immediately increases clinical capacity. One group of four patients can provide four treatment hours in a single hour.
Therapists add group treatments.	Groups increase clinical capacity. Be careful not to overuse them.
Utilize available time earned from previous weekends (if patients completed two long treatment days).	Taking an earned short day creates additional treatment minutes without adding staff.
Push treatment time to an upcoming weekend (when weekend staffing allows).	Taking an early short day or day off creates additional treatment minutes during the workweek., however, they will need to made up on the weekend.
Add or extend PRN hours. Ask individually rather than through group texts.	Individual requests are often more successful than group texts and may result in a few extra hours rather than requiring a full shift.
Move therapist days off when possible.	Levels staffing across the week. A common example is moving a Friday off to Monday while still giving staff a three-day weekend.
Extend technician hours.	Provides additional therapist support and creates more opportunities for concurrent treatment.
Utilize similarly skilled staff from other departments.	Shifting resources between departments helps meet the overall needs of the organization. The mindset is that everyone is working toward the same goal.
Offer overtime or extra-shift bonuses.	Increases staffing capacity and rewards employees for helping. Monitor for staff fatigue if used frequently.
Split evaluations across two days.	Prevents evaluations from overwhelming an already stressed schedule.
Prioritize minimum regulatory requirements during high-demand periods.	Internal standards are often higher than regulatory minimums. Temporarily focusing on minimum requirements can help restore capacity during unusually busy periods.
Limit check-backs and schedule changes.	When treatment is refused, temporarily reducing repeated check-backs or frequent schedule changes frees up valuable therapist time.
Add small increases to everyone’s workload.	Small increases add up quickly. For example, if each therapist provides one additional 30-minute treatment and you have 12 therapists, you’ve created six additional treatment hours for the day.

While it is impossible to eliminate the stress associated with variation, knowing your options makes responding much easier. A well-maintained playbook helps leaders respond thoughtfully instead of emotionally.

Responding to Reduced Demand (↓)

Reduced demand presents a different leadership challenge. Instead of asking, “How do we get everything done?” the question becomes, “How do we best use the capacity we now have?”

These situations create opportunities to improve efficiency, reduce unnecessary labor costs, invest in staff development, and provide additional value to patients.

Potential Response	Benefit
Reduce or cancel PRN hours.	Lowers labor costs by matching staffing to demand.
Offer staff the opportunity to take vacation time or move a workday to an upcoming weekend.	Balances staffing across the week. For example, a therapist may take Monday off and work the upcoming Saturday instead.
Reduce PRN technician or non-clinical staff hours.	Better aligns support staffing with patient volume.
Offer staff to assist other departments.	Sharing resources across departments helps meet the overall needs of the organization.
Complete same-day evaluations.	Patients begin treatment sooner, allowing earlier intervention and quicker identification of safety concerns. Whenever possible, additional capacity should benefit patients first.
Increase treatment time when clinically appropriate.	Provides additional opportunities for patient progress.
Add co-treatments.	Gives patients access to the expertise of multiple clinicians while making productive use of available staff.
Complete documentation, audits, chart reviews, or mentoring.	Improves compliance while investing in staff development.
Work on skill acquisition or performance improvement initiatives.	Strengthens the department for future success.
Hold one-on-one meetings or staff meetings.	Uses otherwise idle time to develop staff, improve communication, and strengthen team performance.

One of the most common leadership mistakes is failing to respond when demand decreases. Extra capacity is valuable. If it isn’t managed intentionally, it is often wasted. Instead of patients benefiting, staff growing, or the department becoming stronger, opportunities are lost. A well-maintained playbook helps leaders respond appropriately during slower periods and continually improve the performance of the department.

Key Takeaways

The goal is not to eliminate variation—it is to become exceptionally good at responding to it.

The best managers are not those who experience fewer challenges; they are the ones who recognize changing conditions early and make thoughtful adjustments. Over time, a well-developed playbook reduces decision fatigue, improves operational consistency, and gives leaders confidence that they can handle whatever the day brings.

Variation is inevitable. Being prepared for it is a choice.

About the Author

Shane Haas serves as the Director of Clinical Informatics at Ernest Health, a leading provider of inpatient and outpatient rehabilitation. He enjoys learning and sharing leadership and management principles. His backgrounds in Physical Therapy (UF ’96) and Industrial Engineering (TTU ’02) provide a balanced heart and head perspective that shapes the Healthcare Managers’ Playbook.

If you are planning a major investment in rehabilitation technology (RT) — and “major” is the operative word, as many systems cost between $50,000 and $200,000 — it is important to also invest in its rollout. RT includes advanced rehabilitation tools such as robotic assisted gait trainers, FES cycles, and virtual reality systems, to name a few. When used effectively, RT can provide meaningful benefits for patient recovery and, over time, more than justify the expense.

However, do not expect RT adoption to be easy. You cannot simply place a new device in the gym and assume therapists will naturally begin using it. The complexity of RT — screens, logins, harnesses, electrodes, knobs, switches, buckles, adjustments, and buttons — makes adoption very different from adding a new set of parallel bars or pulleys. As an owner or leader, it can be frustrating to make a significant investment in RT only to watch it collect dust.

To help prevent your RT investment from becoming an expensive coat rack, consider the following tips:

1. Start EARLY

Begin talking about the RT long before it arrives. Add it as a standing agenda item during staff meetings. Share information through multiple modes, including videos, emails, texts, newsletters, and one on one meetings. The goal is to build familiarity and acceptance through repetition. Aim for at least five to ten touchpoints before the RT arrives. Early and frequent communication helps reduce intimidation and uncertainty.

2. Include the WHY

Explain the driving force behind the investment. Highlight the potential benefits for patients, such as quicker gains, better engagement, improved outcomes, and higher satisfaction. Therapists have different personalities and motivations, so vary how you present the information. Some may connect with patient success videos, others with detailed case studies, and some with research evidence. Plan to present it all.

3. Give SUPPORT

Learning RT can feel intimidating, especially since many therapists were not exposed to these technologies in school. Adoption requires time, energy, and a willingness to develop new treatment habits. This is where leadership involvement matters most. A word of encouragement, visible interest, and timely support can go a long way. During the early stages of adoption, provide extra time, mentorship, and hands on help. The goal is to build competence and confidence through repetition and support.

4. Provide RESOURCES

Most RT systems come with initial training, which is a great starting point. However, once the trainers leave, there is often a drop off in confidence and use. Plan ahead by building ongoing support systems. Schedule ahead practice sessions. Review training videos regularly. Create opportunities for peer learning through virtual groups, in person collaborations, or train the trainer programs. Surround new users with the tools and resources they need to succeed.

5. Eliminate OBSTACLES

Spend time identifying and removing barriers to adoption. Some therapists may be skeptical of RT, especially those who are skilled in manual techniques and patient handling. These clinicians may benefit from targeted education showing how RT can complement their treatments rather than replace them. Another common concern is the perception that RT takes longer to use than more traditional therapy approaches. While this may be true during the learning phase, efficiency often improves significantly with training and repetition. For example, what previously required three to four staff members to help a patient stand and walk may now be accomplished with one therapist using robotic gait assist technology. In addition, RT can help patients spend more time standing, take more steps, and participate in longer periods of high intensity training, all of which are important for recovery. The goal in eliminating obstacles is to make using the RT easier, more effective, and ultimately more beneficial than avoiding it.

6. Share SUCCESSES

Every change effort has early adopters, and RT is no different. Recognize and encourage these early adopter therapists. Additionally, do not let early patient wins go unnoticed. Share stories of meaningful progress, improved function, and successful outcomes. Highlight before and after examples, patient testimonials, and measurable improvements from pre and post testing. Positive momentum creates energy, builds buy in, and encourages others to join in.

7. MEASURE and give FEEDBACK

It has often been said that what gets measured gets improved. Find a consistent way to track utilization and plan to share weekly or monthly data. Having meaningful data will help you provide better feedback. For facilities or therapists with higher utilization, provide recognition and encouragement to continue. Lower utilization should prompt supportive conversations focused on improvement. If therapists are avoiding the RT, ask why. Revisit the “why” behind the investment, reinforce available support and resources, and work alongside staff to remove obstacles. Consistent feedback and follow up help keep adoption moving forward.

8. Integrate into CULTURE

Over time, RT can become part of your department’s identity and reputation. It can help differentiate your program from competitors. When RT becomes embedded into daily operations, sustaining high levels of utilization becomes much easier. To help support this level of integration, consider incorporating RT competencies and participation into annual reviews and department goals.

Rehabilitation technology can play an important role in helping patients achieve their goals and improve outcomes. However, there is often a significant adoption curve that, if underestimated, can undermine even the best RT investment. Hopefully these tips will help you better prepare for a successful RT rollout. Change can be challenging, but when it helps patients improve their lives, it is well worth the effort.

About the Author: Shane Haas serves as the Director of Clinical Informatics at Ernest Health, a leading provider of inpatient and outpatient rehabilitation. He enjoys learning and sharing leadership and management principles. His backgrounds in Physical Therapy (UF ’96) and Industrial Engineering (TTU ’02) provide a balanced heart and head perspective that shapes the Healthcare Managers’ Playbook.

A process map is a step by step diagram that shows how a good or service is delivered. In healthcare, a process map focuses on how patient care is provided, such as an office visit, therapy appointment, or lab draw, to name a few examples. The process map above came from an emergency room (ER) project I was part of. The goal of the project was to reduce wait times. To help achieve this goal, we needed to see, step by step, how patient care was actually being delivered in the ER.

Unfortunately, process mapping is often overlooked in healthcare. Clinicians are already busy and stretched by patient care responsibilities. As a result, process improvement projects often rush toward implementing solutions before fully understanding the process itself. When this happens, gaps in understanding develop, mistakes are made, and improvement efforts eventually lose momentum. What remains are inefficiencies, frustration, and missed opportunities to improve care.

Process mapping offers a better way forward. By taking the time to understand how work is truly being performed, opportunities for improvement become easier to recognize. In the ER example above, process mapping made it easier to see that once all treatment rooms were occupied, wait times increased dramatically. It also highlighted that many patients remained in rooms while simply waiting for tests or results. This created a bottleneck that limited the ER’s ability to continue seeing new patients. Once the process was redesigned so appropriate patients could wait in an intermediate waiting area instead of occupying treatment rooms, patient flow improved and wait times decreased.

If process mapping is new to you, below are a few tips for getting started.

1. Go to the gemba. In order to gather the most accurate information, spend time at the actual place where the work is occurring. Plan to observe several patients moving through the process from beginning to end. Look for differences in how care is delivered. Make note of inefficiencies, delays, and points of stress or strain for both patients and staff. For example, building the ER process map above required time onsite during both day and night shifts while observing stable walk in patients as well as patients arriving by ambulance in need of immediate medical attention.
2. Identify beginning and ending points of the process. In the ER example, the process began when a patient arrived either by personal transportation or by ambulance. The endpoint was discharge home, admission to an inpatient bed, or transfer to the operating room. Clearly defining the beginning and ending points helps establish the boundaries of the process and prevents important steps from being overlooked.
3. Create separate boxes for each step in the process. In the ER example, the steps included triage assessment, nursing care, diagnostic testing, physician evaluation, and discharge. When documenting each step, include key details such as who is performing the task and how long the task takes to complete. Observe at least five cycles of the process to determine whether variation is a factor. In healthcare, variation between patients, staff members, and shifts can significantly affect how well a process performs.
4. Show how each step connects to the next. How does information flow throughout the process? Is communication electronic, verbal, or paper based? How does patient movement occur between steps? Are patients waiting in chairs, beds, or hallways between stages of care? Measure the waiting time and delays between steps. Doing so provides a more complete picture of the total processing time from the patient’s perspective.
5. Look for inefficiencies and waste. Take advantage of having fresh eyes and perspectives and note inefficiencies, frustrations, delays, and rework. It is often easier for new observers to see problems that others have gradually accepted as normal. Refer to prior post on 8 wastes for more information on common examples of waste in healthcare.

Process mapping is a powerful tool for understanding and improving how work happens. It is often one of the first steps toward helping patients receive the care they need in a timely manner, with less frustration, less waste, and at a reasonable cost. That sounds like a map worth following.

About the Author: Shane Haas serves as the National Director of Outpatient Services at Ernest Health, a leading provider of inpatient and outpatient rehabilitation. He enjoys learning and sharing leadership and management principles. His backgrounds in Physical Therapy (UF ’96) and Industrial Engineering (TTU ’02) provide a balanced heart and head perspective that shapes the Healthcare Managers’ Playbook.

References:

Rother, M., & Shook, J. (2003). Learning to see: Value stream mapping to add value and eliminate muda (1st ed.). Lean Enterprise Institute.

This post digs deeper into the “set in order” step of 5S by introducing kanban. The term kanban comes from Lean/TPS principles and refers to a system for managing inventory. In this post, I use an operating room (OR) as an example of how kanban can help manage inventory effectively. The benefits of kanban include avoiding stockouts (which lead to frustration and delays) and preventing excess inventory (which leads to added expense and wasted space). While this example focuses on an OR, kanban can be applied to any department that manages and maintains supplies.

One of the strengths of kanban is its reliance on visual controls and real-time consumption to trigger reorders. The goal is to order only what is needed, in the quantities needed, at the time it is needed. Making the system visual helps avoid missed reorders and reduces the risk of stockouts. Examples of visual controls include empty containers (bins, boxes, or shelves – photo A below), reorder lines (photo B), and reorder cards (photo C). As containers are emptied, visual signals are revealed indicating it is time to reorder.

In many applications, kanban can be simple and straightforward. A two-bin system is often all that is needed for effective inventory control. For example, surgical gloves come in boxes. By stocking two boxes, the system works as follows: when one box is emptied, it serves as the signal to reorder another box. When the new box arrives, it is stocked behind the current open box, and this cycle continues. This two-bin system works well when items are easy to order, quick to restock, and consistently delivered on time.

Not all applications, however, are this straightforward. In an OR supply room—with thousands of items—factors such as cost, ordering complexity, and variability in usage often require a more structured approach.

For more complex kanban applications, consider the following areas:

• Usage rate includes how fast items are used and how much variation or spikes may occur. For example, based on a review of last year’s orders, suture A1 is used at an average rate of 10 per day with minimal variation.
• Container size refers to both the size and shape of the storage location. Larger, box-like items are ideal for stacking on open shelves (photo D). Narrower or flatter items typically store better side-to-side (like books on a shelf (photo F)) or front-to-back (like files in a cabinet (photo E)). Smaller or irregularly shaped items are usually better suited for bins (photo G). In this example, suture A1 comes in boxes containing 40 individual sutures and is easily stored on open shelves. Based on usage and ordering patterns, two boxes are kept on the shelf at any given time.

• Order details include ordering frequency, fill time, variation, and minimum order quantities (MOQ). In this example, sutures are ordered once per week, take approximately 5 days to arrive, have minimal variation in delivery time, and have a MOQ of one box. Overall, the ordering process is predictable and reliable.
• Safety stock is the additional inventory held to protect against stockouts. It is influenced by the consequences of running out (e.g., canceled surgery), variation in usage or lead time, and risk of expiration. In this example, suture A2 can substitute for A1, A1 is not expensive, and expiration is not a concern (4+ years). Because of this, safety stock is determined to be nominal and built into ordering frequency and box size.
• Reorder point (ROP) is the inventory level at which a new order should be placed. The goal is to reorder early enough to avoid stockouts, but not so early that excess inventory builds up. ROP is driven by usage rate, lead time, and safety stock. In this example, with minimal variability and substitution available, the reorder point is set at 1 box.
• Visual controls create clear, easy-to-see signals that make it unlikely to miss reorder points. Examples include empty bins, bare shelves, red lines, or cards. In this example, a empty box is used to indicate the reorder point for suture A1.
• Maintenance. Sustaining the system requires standardized work and clear ownership. A specific role or individual should be responsible for placing orders, maintaining stock levels, and replacing reorder signals as needed. Regular check-ins by supervisors can help ensure consistency and reinforce accountability.

Whether using a simple two-bin system or a more structured approach, kanban helps reduce the frustrations associated with stockouts while also preventing overstocking and wasted resources. The goal is to give clinicians confidence that the supplies they need will be available when and where they need them. With fewer concerns about inventory, clinicians can focus more energy on patient care and outcomes.

About the Author: Shane Haas serves as the National Director of Outpatient Services at Ernest Health, a leading provider of inpatient and outpatient rehabilitation. He enjoys learning and sharing leadership and management principles. His backgrounds in Physical Therapy (UF ’96) and Industrial Engineering (TTU ’02) provide a balanced heart and head perspective that shapes the Healthcare Managers’ Playbook.

Additional Resources:

Rother, M., & Shook, J. (2003). Learning to see: Value stream mapping to create value and eliminate muda (Version 1.4). Lean Enterprise Institute.

Womack, J. P., & Jones, D. T. (2003). Lean thinking: Banish waste and create wealth in your corporation (2nd ed.). Free Press.

Liker, J. K. (2004). The Toyota way: 14 management principles from the world’s greatest manufacturer. McGraw-Hill.

If you have ever spent more than five minutes searching for a wheelchair, you have experienced waste.

Not the kind of waste that shows up on a report, but the kind that pulls you away from a patient, breaks the rhythm of your treatment, and adds unnecessary frustration to your day.

One of the most practical ways to reduce waste is through workplace organization. 5S is a simple, effective framework used to organize physical workspaces such as storage closets, cabinets, and therapy gyms. The goal is straightforward: spend less time searching and more time caring for patients.

The benefits of 5S are easy to see and feel. An organized workplace leads to less hassle, less wasted time, and more time at the bedside. Fewer frustrations mean greater focus on treatment. In a rehabilitation setting, that time and attention directly translate to better patient care.

This post explores 5S through a real-world example: organizing our wheelchair storage room.

This project was selected based on staff feedback. One example coming from a PRN therapist: “Equipment issues are extremely frustrating. A lot of time is being wasted hunting down an appropriate size wheelchair or locating working parts. The wheelchair room often only has two to three chairs available, and most of the time they are there because they are broken or missing parts. Many times parts are on a cart, and it is unclear whether they are clean or dirty.”

Feedback like this should not be accepted as the status quo. Everyone deserves to work in an organized environment. In our case, disorganization had gone on too long. We needed to do better, and 5S was the solution.

5S stands for Sort, Set in Order, Shine, Standardize, and Sustain. While straightforward in theory, implementation can be challenging. Each step is outlined below, along with common obstacles.

1. Sort is the starting point. The goal is to eliminate clutter and make it easier to find what is needed. Remove anything that does not belong. In the wheelchair room, this included broken chairs, mismatched leg rests, damaged accessories, outdated equipment, and general clutter. If something cannot be repaired in a reasonable time, it should be removed. A common obstacle is hesitation to throw things away. A helpful rule is this: if you cannot remember the last time it was used, it likely does not need to stay. For example, we cleared out an entire shelf of outdated bed trapeze poles that had not been used in years. When in doubt, create a temporary holding area. Items stay there until the end of the week. If unclaimed, they are discarded.
2. Set in Order focuses on organizing what remains. Every item should have a defined location. When everything has a home, clinicians know exactly where to go. Time spent searching drops significantly. In the wheelchair room, shelves were reconfigured so wheelchairs could be folded and stored underneath. Dividers were installed to keep leg rests in matching pairs. Cushions, trays, and accessories were labeled and stored on designated shelves.
3. Shine goes beyond basic cleaning. It is about maintaining both the space and the equipment. Cleaning under and behind shelves is important, but so is routine inspection. Processes should be in place to ensure wheelchairs and accessories are checked regularly. We adopted the mindset that patients spend a significant portion of their time in a wheelchair. If it does not look good or function properly, it reflects poorly on the hospital. Clean, well-maintained equipment became part of delivering a high-quality patient experience.
4. Standardize creates clarity and consistency. This includes visual cues and defined routines. One example from the wheelchair room was adding a red vinyl stripe to all right leg rests, making it easy to identify matching pairs at a glance. Storage areas were labeled and divided so every item had a clear home. Cushions, arm troughs, trays, and accessories were stored in the same location every time. Checklists were created, and specific times were established for daily review and maintenance. As technician responsibilities shifted with patient care demands, these expectations were built into end-of-day routines. Every wheelchair was returned clean, intact, inspected, and placed in its assigned location.
5. Sustain is about reinforcing behavior and maintaining accountability. It answers a simple question: are we actually doing what we said we would do? To support sustainability, monthly inventory checks and weekly audits were implemented. Results were reviewed, feedback was provided, and expectations were reinforced during performance reviews. Without sustainment, even the best organized space will gradually return to disorder. Sustain is what prevents standardization from becoming a one-time effort.

In practice, 5S is not about cleaning a room once. It is about creating an environment where problems are visible and easy to address. It is about making the right way the easy way.

In a clinical setting, this has direct implications for safety and patient positioning. Something as simple as a missing cushion or support can reinforce poor posture, such as hip or shoulder internal rotation, and negatively impact recovery, especially for patients recovering from stroke.

The impact on patient care is real. When equipment is easy to find, in good working order, and ready to use, therapists spend less time away from patients and more time doing what matters most: helping patients get better. That is where the real value is. Time spent helping patients is never a waste. 5S simply helps ensure that more of our time is spent doing exactly that.

About the Author: Shane Haas serves as the National Director of Outpatient Services at Ernest Health, a leading provider of inpatient and outpatient rehabilitation. He enjoys learning and sharing leadership and management principles. His backgrounds in Physical Therapy (UF ’96) and Industrial Engineering (TTU ’02) provide a balanced heart and head perspective that shapes the Healthcare Managers’ Playbook.

Additional Resources:

1. Graban, M. (2016). Lean hospitals: Improving quality, patient safety, and employee engagement (3rd ed.). Productivity Press.

In a prior post, I discussed how value in healthcare should be viewed from the patient’s perspective and usually centers on helping patients feel better. The goal is to do this while also minimizing frustration, improving recovery time, and doing it at a reasonable cost. Process improvement, at its foundation, is about increasing value. It means emphasizing and improving what helps patients get better and reducing or eliminating everything else. Any effort, step, or resource that does not contribute to value is considered waste and should be reduced or eliminated.

To better understand waste, James Womack defines it in Lean Thinking as any activity that does not create value for the customer. He illustrates this with a simple soda example. The value of soda is in quenching thirst and satisfying taste. The time spent enjoying that value is minimal compared to the time required to produce and deliver it. Traditional processes such as mining, forming, printing, filling, packaging, storing, and shipping can take months, while the customer experiences only minutes of value. When those steps are reduced, as seen with a fountain dispenser, the same value is delivered with less time, less effort, and lower cost.

If reducing waste is the goal, then understanding the different types of waste is essential. Less waste leads to less frustration, lower cost, and a better experience for both patients and clinicians. When clinicians are able to focus their time and energy on meaningful work instead of navigating inefficiencies, performance improves and engagement follows.

1. Mistakes are one of the most visible forms of waste. These are the errors that require correction, rework, or replacement. In a healthcare setting, this may include missed charges, incorrect documentation, or treating the wrong patient due to a scheduling error. While these issues are often addressed after they occur, strong systems focus on preventing them in the first place through standardization, automation, and simple safeguards.
2. Overprocessing occurs when more work is done than necessary. This often shows up in healthcare as redundant documentation, repeated questions, or interventions that do not meaningfully impact outcomes. While these steps may feel thorough, they often add burden without adding value. Simplifying workflows and focusing on what truly matters to patient care helps reduce this waste.
3. Overproduction is doing work before it is needed or in greater quantity than required. Preparing materials too far in advance or scheduling too far out can lead to rework when plans change. Completing work at the right time, rather than as early as possible, improves efficiency and reduces unnecessary effort.
4. Waiting is one of the most common and costly forms of waste in healthcare. It occurs any time people, information, or equipment are not ready. Whether it is a delayed start to a session, a slow system, or unavailable equipment, waiting disrupts flow and reduces productivity. Addressing waiting requires better coordination, reliable systems, and consistent access to resources.
5. Underutilization is often overlooked but highly impactful. It occurs when the full capabilities of people or equipment are not used. This can include avoiding beneficial technology, limiting clinician input in decision making, or burdening skilled staff with tasks that do not require their level of training. When teams are empowered and tools are fully utilized, outcomes improve.
6. Motion refers to unnecessary movement by clinicians during their work. This includes searching for patients, locating equipment, or moving throughout the facility inefficiently. While each instance may seem small, these moments add up over the course of a day. Improving organization and workflow design can significantly reduce this burden and increase the time spent with patients.
7. Transport is the unnecessary movement of patients or equipment that does not add value. In rehabilitation settings, this often appears as repeated transfers, moving patients back and forth between locations, or storing equipment far from where it is used. These inefficiencies not only consume time but also contribute to fatigue for both patients and staff. Coordinating care and thoughtfully designing workflows and spaces can reduce this waste.
8. Inventory waste includes excess supplies, equipment, or information that is not immediately needed. This creates additional cost and often hides underlying inefficiencies. Examples include unused equipment, backlogs of documentation, or overstocked supplies. Managing inventory effectively ensures resources are available when needed without creating excess.

Understanding waste is not just a theoretical exercise. It is a practical skill that helps leaders identify where time, effort, and resources are being lost. The goal is not perfection, but progress. As waste is reduced, time is returned to where it matters most. More time can be spent helping patients stand, walk, and recover. That is the work that creates value, and time spent helping patients is never a waste.

About the Author: Shane Haas serves as the National Director of Outpatient Services at Ernest Health, a leading provider of inpatient and outpatient rehabilitation. He enjoys learning and sharing leadership and management principles. His backgrounds in Physical Therapy (UF ’96) and Industrial Engineering (TTU ’02) provide a balanced heart and head perspective that shapes the Healthcare Managers’ Playbook.

References:

Womack, J. P., & Jones, D. T. (2003). Lean thinking: Banish waste and create wealth in your corporation (Revised and updated ed.). Free Press.

Sharing real world examples is one of the most effective ways to learn. In my previous post, I outlined 10 tips for managing change more effectively in healthcare. In this post, I want to bring those ideas to life through a case study. This example focuses on implementing a new patient scheduling application across 30 rehabilitation hospitals. While the process was not perfect, it highlights how applying the fundamentals of change management can reduce challenges and frustration and improve overall adoption.

The goal of this project was to move all hospitals to a single, secure scheduling platform. Prior to this, hospitals used a wide range of processes involving either dry erase boards or spreadsheets. This variation led to inconsistent workflows and introduced risk related to access, ownership, and cybersecurity. Continuing with the current state meant accepting ongoing inefficiency and exposure to risk. At the same time, the benefits of change were clear. Standardization would improve visibility, reduce confusion, and create a foundation for long term improvement. As discussed in my previous post, creating a sense of urgency and clearly stating the benefits of change are essential. In this case, both needed to be consistently communicated to gain traction and alignment across hospitals.

Before rollout, the project team spent time understanding current workflows in detail. This step is often overlooked, but it is critical. You cannot design an effective future state without first understanding the current one. Scheduling processes were reviewed across hospitals to identify variation and common challenges. Pilot testing was conducted internally and with two very different hospitals. This helped identify gaps, improve functionality, and strengthen training materials. It also allowed the team to identify potential barriers early, including workflow differences, training needs, and technology limitations. This aligns directly with two of the earlier principles: understanding the change in detail and identifying barriers before full implementation.

The feedback gathered during pilot testing was especially valuable. Many of the suggested improvements were practical and directly tied to ease of use, such as adding visual separators for mealtimes, simplifying data entry, improving navigation, and enhancing communication features like notes and comments. These types of refinements may seem small, but they play a significant role in adoption. When systems are easier to use, resistance decreases. This reinforces the importance of involving end users early and often in the process.

Once testing was complete, the change was introduced during a directors only meeting. The team demonstrated how the system would work, explained what would change, and outlined a clear rollout timeline. Implementation was structured across five groups over a fifteen week period to reduce disruption and allow for focused support. Communication was intentionally layered and repeated. Staggered emails were sent leading up to go live, training videos were created to demonstrate key functions, and live virtual sessions were held to walk through the system step by step. These efforts align closely with the principle of clearly defining how work will be done after the change. People are far more likely to adopt a change when they can clearly see what it will look like in practice.

The communication strategy also reinforced another key point from the previous post: there is no such thing as overcommunication during change. A series of structured emails supported the rollout, including early awareness messages, training invitations, reminders about preparation steps, and day of go live communication. These emails helped set expectations, reinforce urgency, and maintain momentum. They also created multiple touchpoints for questions and feedback, which is critical during times of transition.

Directors were responsible for leading implementation within their hospitals and training front line clinicians. This was a critical part of the strategy. Change is not driven by a central team. It is driven at the local level. Leaders were expected to understand the change, communicate it clearly, and reinforce why it mattered. Their level of belief and confidence directly influenced how their teams responded. This reflects another key principle: sharing why you believe in the change. When leaders demonstrate confidence and commitment, it builds trust and increases the likelihood of adoption.

Several common causes of failed change efforts were intentionally addressed throughout the process. Communication was frequent and delivered in multiple formats. Expectations were clearly defined, and timelines were structured to be realistic. Support was available through live sessions, check ins, and recurring office hours. Senior leadership also played an important role by providing the necessary resources, including software, hardware, and new displays across facilities. These actions helped avoid many of the common pitfalls outlined previously, including lack of communication, insufficient support, and poor follow through.

Adoption was monitored throughout the rollout, and feedback was provided when usage lagged. Early successes were shared to help build momentum and demonstrate what effective use of the system looked like in practice. Highlighting these short term wins helped reinforce progress and build confidence across teams. At the same time, resistance did occur. One hospital attempted to continue using their old system while entering placeholder information into the new one. This is not uncommon. As noted previously, some individuals will strongly resist change. The key is how this resistance is addressed. Expectations must remain clear, and not changing cannot remain an option. Consistent follow up and accountability are necessary to sustain progress.

Time was also intentionally created for questions and discussion. Not everyone is comfortable asking questions in a group setting, so multiple opportunities were provided through office hours, one on one conversations, and follow up calls. This directly reflects the importance of leaving time for questions and answers. In many cases, these smaller conversations provide the clarity and reassurance needed to move forward.

Looking back, this experience reinforced a simple but important truth. Successful change is not driven by a single action or initiative. It is the result of consistently applying the fundamentals. Understanding the change in detail, clearly defining the future state, creating urgency, communicating benefits, leading with belief, identifying barriers, supporting teams, reinforcing wins, addressing resistance, and maintaining accountability all play a role. None of these are particularly complex on their own, but together they create the conditions for successful adoption.

Change management is easy to understand in theory and much harder to execute in practice. Hopefully this practical example will help you better manage your next change effort. As this case study shows, success comes from consistently doing the basics well.

About the Author: Shane Haas serves as the National Director of Outpatient Services at Ernest Health, a leading provider of inpatient and outpatient rehabilitation. He enjoys learning and sharing leadership and management principles. His backgrounds in Physical Therapy (UF ’96) and Industrial Engineering (TTU ’02) provide a balanced heart and head perspective that shapes the Healthcare Managers’ Playbook.

At first pass, the definition of value in systems management appears straightforward. However, as this post will discuss, identifying and adding value is not always easy, particularly in healthcare. Jim Womack, author of Lean Thinking, explains that value should be defined from the perspective of the customer. Specifically, value is what the customer wants and what they are willing to pay for.

Womack uses air travel to illustrate the concept of value. As customers, we want to get from point A to point B, and we are willing to pay an airline such as Southwest to get us there. From our perspective, value is arriving at our destination safely, with minimal hassle, and at a reasonable price.

In healthcare, the patient is the customer. From a patient’s perspective, value often centers on feeling better. For example, an individual with a cold seeks medical care and treatment. The value is relief from symptoms such as congestion and discomfort.

More broadly, value in healthcare is restoring health as efficiently as possible while minimizing hassle and frustration. As a director of therapy, our definition of value included interventions that helped a patient recover in the shortest amount of time and with the least amount of difficulty. Exercises, educational efforts, manual techniques, and training sessions that helped a patient achieve their goals efficiently were considered value added tasks.

Examples of value added tasks in rehabilitation include:

• Strengthening muscles at the correct intensity to improve a patient’s ability to stand
• Teaching a patient how to effectively use a sock aid so they can dress independently
• Reducing stiffness and pain with manual therapy to improve mobility
• Training a patient to safely use a walker on a curb so they can return home with confidence

Over time, we made it a priority to find better ways to support value added tasks while also reducing or eliminating tasks that did not contribute to patient outcomes. Activities that directly supported patient needs were prioritized, and systems were improved to allow this work to occur with as little friction as possible. A fundamental goal of systems management is to continuously improve value added work so that patients receive the greatest possible benefit while also helping to control or reduce costs.

Examples of efforts to increase value added work include:

• Reducing the time it takes to schedule patients
• Organizing storage closets and work areas to reduce time spent searching for items
• Standardizing the flow of information so clinicians have key patient details when needed
• Reducing new admission paperwork to decrease hassle and frustration

Focusing on improving value added tasks helps patients receive better care, and it also improves the clinician experience. When time and energy are directed toward meaningful work instead of unnecessary tasks, frustration is reduced and outcomes improve for everyone involved.

Unfortunately, value in healthcare has historically been defined from the perspective of the hospital or health system. The focus is often on using facilities, clinicians, and equipment in the most cost efficient manner for the organization rather than for the patient. This approach has contributed to systems that are difficult to navigate, confusing insurance coverage, high costs, and significant frustration and waiting for patients.

Healthcare is complex, and trying to make improvements can feel intimidating. A practical place to start is by learning to see value. View processes from the patient perspective. Follow a patient through your facility from admission to discharge and observe each step. Take note of which activities add value and which do not. Focus on strengthening and supporting value added work, and work to reduce or eliminate tasks that do not contribute to patient outcomes.

There is no perfect time to begin improving value. I would encourage you not to delay, patients are already waiting.

About the Author: Shane Haas serves as the National Director of Outpatient Services at Ernest Health, a leading provider of inpatient and outpatient rehabilitation. He enjoys learning and sharing leadership and management principles. His backgrounds in Physical Therapy (UF ’96) and Industrial Engineering (TTU ’02) provide a balanced heart and head perspective that shapes the Healthcare Managers’ Playbook.

References:

Womack, J. P., & Jones, D. T. (2003). Lean thinking: Banish waste and create wealth in your corporation (Revised and updated ed.). Free Press.

Rother, M., & Shook, J. (2003). Learning to see: Value stream mapping to add value and eliminate muda (Version 1.4). Lean Enterprise Institute.