Perfecting the Repetitive Process

We lived next door to a very talented young pianist.  She practiced continually and would rarely play a piece from start to finish.  Instead, she would repeat over and over the difficult parts of the music to get them just right.  It took a great amount of study until she would play a piece through.  And even then, she was constantly making adjustments.

Health care providers can benefit from the same type of discipline.  By studying and perfecting a repetitive process, providers can increase productivity, increase revenue, enhance the patient experience, improve flow, and reduce errors.

This can be done through a 4 step process of:

  1. Study
  2. Visualize
  3. Mock-up
  4. Roll out.


Select an area or a process to focus on.  Gather stakeholders to provide input.  Conduct interviews and question what works and does not work about the process.  Observe and photograph the process in question.  Review existing examples of the process.  Do time motion studies or “string tracing” to identify flow.  John Black, in his book “The Toyota Way to Healthcare Excellence” identified seven critical healthcare flows:

Flow of patients

Flow of clinicians

Flow of medication

Flow of supplies

Flow of information

Flow of equipment

Flow of process engineering (simplicity of the work process)

Pulling strings or tracing lines for each movement or travel performed will quickly illustrate the paths an item takes in a process.


Envision a better process and sketch concepts of change. Plan for varying scenarios.  Develop a multimedia model of the process—preferably in a three-dimensional format.  This can be done relatively simply in Google Sketchup, a free graphic program available through the internet.  Model the existing conditions and develop models of the proposed changes.  Critique with focus groups.


If time and space allow, construct a physical facsimile of the proposed solution.  Test all seven flows based on access to the area, location of equipment, position of each individuals, access to technology, etc.  Pull strings in the mock-up to see if flows have improved.


Take what you have learned and implement the suggestions in the clinical setting.  Train staff as necessary for the new system or layout.  Observe if objectives were reached over a period of time, and if successful, push the changes out to other locations.

This not a linear exercise.  It has a circular flow.  New solutions require constant evaluation.  Study follows roll out.  As with our young neighbor, the process was rarely complete, yet the performance improved with each time at the piano.


-Written by David Daining



Black, John, and David Miller. The Toyota Way to Healthcare Excellence. Chicago: Health Administration Press, 2008. 9-10. Print.