Stay fresh on your terminology

Learn more about commonly used lean healthcare and other PI terms.

5S  The name of a workplace organization method that describes how to organize a work space for efficiency and effectiveness. The five S’s include the following tasks.

1. Sort: Remove all unneeded items from the workplace.

2. Set in Order (also Straighten): Make a place for everything and put everything in its place.

3. Shine: Thoroughly clean and inspect everything in the work area (preventative cleaning also applies).

4. Standardize: Maintain the improvements through discipline and structure.

5. Sustain: Continue to support 5S efforts through auditing, job descriptions that include maintenance of the system, management support and expectations, etc.

6 Sigma  A scientific, data-driven approach for achieving six standard deviations between the mean and nearest specifications limit. Six Sigma methods can be applied to virtually any form of work or processing.

8 Wastes  Specific forms of waste that decrease the value that an organization provides to a customer.  The 8 wastes follow.

1. Defects:  Work that contains errors, rework, or omissions.

2. Over-production:  Producing more than the customer needs.

3. Waiting:  Idle time when material, information, people, or equipment is not ready.

4. Not Clear (Confusion):  When workers do not know the best way to perform tasks.

5. Transport:  Transport of patients, equipment, supplies, or specimens when it does not add value.

6. Inventory:  Stocking more inventory than is necessary to do the work.

7. Motion:  Movement of material, information, people, or equipment that does not add value.

8. Excess Processing:  Redundant work or extra effort that does not add value.



The European term for a paper standard which is close in size to American 11" x 17" paper.  This large piece of paper is used for several kinds of improvement documents and is intended to confine projects and issues to a manageable size by containing the related information on a single sheet of large format paper. There are several kinds of A3 reports:  for solving problems, for reporting project status, and for proposing policy changes. 

A3 Problem Solving 

A structured approach to problem solving. It drives users to attack problems of manageable size by using a single sheet of A3 paper to document the current state problem, root causes of the problem, desired future state, potential solutions, and tests of change. 


Any visual indicator signaling that a team member has encountered an abnormal situation which cannot be resolved without preventing a work stoppage. Poor quality, lack of a part, paperwork, information or equipment may cause an abnormal condition. The key to effective andons is that they be visual and visible. 


The step in a process line that limits the throughput of the entire process flow. 

Breakthrough Improvement (Kaikaku) 

A major, significant improvement that occurs after many small, incremental improvements (kaizen). Kaikaku comes naturally after completing many (sometimes hundreds) kaizens


The maximum results that can be attained in a system based on limitations inherent in the system design. 


The maximum amount a process, system, or machine can produce. 

Catch Ball 

A participative approach to decision-making in which information and ideas are thrown back and forth, up and down throughout the organization. The purpose of catch ball is to ensure that expectations are realistic, people who do the work have expressed their ideas and concerns, and barriers to get the work done effectively are surfaced. 

Cause-and-Effect Diagram

A problem-solving tool that graphically illustrates the relationship(s) between various process elements which prepares problem solvers to assess the impact of variation from standard. 

Current State Map 

A depiction of the current or existing view of a workflow. 

Cycle Time 

The actual time it takes to complete a process from start to finish to produce one unit (one cycle of an operation). 

Failure Mode and Effects Analysis (FMEA) 

An analysis technique used to assess risk and potential failure points in the design of a process or a product. 

Five Why’s 

A method of evaluating a problem or question by asking “why?” five times. The purpose is to get to the root cause of the problems instead of addressing the symptoms. 

Future State Map 

A depiction of a desired and improved workflow. 


The Japanese term for actual place or the place where work occurs. In a healthcare environment, the gemba may refer to nursing units, emergency departments, laboratories, pharmacies, or anywhere else work takes place. 

Hoshin Kanri 

A strategic decision-making process that focuses resources on the critical initiatives necessary to accomplish the organization’s business objectives. By using visual matrix diagrams, key objectives are selected while all others are clearly eliminated. The selected objectives are translated into specific strategies and deployed down to the implementation level in the organization. Hoshin Kanri unifies and aligns resources and established clearly measurable targets against which progress toward the key objectives is measured on a regular basis.

Just in Time (JIT) 

A strategy that strives to improve a business return on investment by reducing in-process inventory and associated carrying costs. JIT concentrates on delivering what the patient or other customer needs, when they need it, in the quantity they need.


Incremental and continuous improvement. 

Kaizen Event (also known as a Rapid Improvement Event or RIE)  

A focused, short-term event to make immediate improvements.


A visual signal to restock an item, typically a re-order card or container that triggers the restocking of parts or supplies to a specific quantity. 

Leadership Standard Work

Defined leadership activities that keep leaders actively engaged at the gemba.  Key components of leadership standard work include determining if standard work at the front line is being maintained, if the workforce is actively engaged in improvement activity, and if progress toward strategic goals is being made. 


A practice that considers using resources for anything other than the creation of value for the end customer to be wasteful. Working from the perspective of the customer who consumes a product or service, value is defined as any action or process that a customer would be willing to pay for. 

Lean Management System 

A system of leadership practices designed to maintain and sustain a lean organization.  A lean management system includes the following.

  • Strategy deployment
  • Deployment and management of standard work
  • Deployment and management of continuous improvement and problem solving including A3
  • Visual management including daily management
  • Leadership standard work 

Mistake-Proofing (also known as Error-Proofing or poka-yoke) 

Any mechanism in a lean process that helps people avoid making mistakes or quickly identify and mitigate mistakes if they are made.  

Non-Value Added 

Any process step or output for which a customer is not willing to pay. 

Non-Value Added but Necessary 

Any process step or output for which a customer is not willing to pay but must still be completed or produced.  Regulatory requirements are an example of non-value added but necessary items. 

Pareto Chart 

A graphical tool for ranking causes of problems from most significant to least significant. Pareto Charts often suggest most effects (or results), come from relatively few causes: 80% of effects come from 20% of the possible causes.  This is known as the 80/20 rule or the Pareto principle.

Plan-Do-Study-Act (PDSA) 

The cycle for continuous improvement based on the scientific method.  Once a hypothesized improvement is selected, the PDSA cycle is used to plan a test, do a test, study the results of the test, and act based on the results of the test.  The earlier form of this approach was known as PDCA for plan-do-check-act.  The difference between PDCA and PDSA is semantic and not substantive.

Process Map 

A work flow diagram which depicts the elements of a work flow often using time, people, and machine information to illustrate tasks and results. 

Production Leveling (also known as Load Leveling or heijunka) 

Distributing the workload so that peaks and valleys in throughput are minimized and workflow is more consistent. The goal is to produce goods and services at a constant rate so that work may be carried out at a constant and predictable rate.

Pull versus Push  Two diametrically opposite scheduling philosophies. Push schedules are dictated by a formal schedule where new work is pushed into the first step of the process. With a pull system, a patient/customer order triggers the start of new work. 

Pull Scheduling 

Starting a new process with an order from a patient/customer. 

Rules in Use 

The four organizational and structural underpinnings identified as keys to the Toyota Production System (TPS).

  • Rule 1: Activities are highly specified in terms of content, sequence, timing, location and outcome.
  • Rule 2: Connections between workers are standardized, direct and unambiguous.
  • Rule 3: Pathways through which products and services flow are simple and standardized.
  • Rule 4: Improvements are made by workers close to the process using the scientific method (A3) 

Spaghetti Diagram 

A floor plan of the path taken by a person, part or set of information as it travels through an organization.  Its name derives from the fact that the route typically looks as disorganized as a plate of spaghetti. 

Standard Work 

The best current method for how work tasks are done with the least amount of waste. Standard work includes the amount of time needed for each task. Standard work focuses on the employee, not the equipment or the materials. 

Standard Work Map 

A visual depiction of the standard work including the location, outcome, content, sequence, and timing of activities.

Takt Time 

The rate at which a customer uses a product or service. It is calculated by dividing the total daily available production time by the total daily customer demand. 

Target Condition 

The proposed next step in improvement from the current condition as a stepping stone toward the desired ideal state. 

Throughput Time 

The time required for a product or service to go through a process. 


What the customer is willing to pay for in a product or service or the processing of that product or service. 

Value Added 

Any process step or output for which a customer is willing to pay.

Value Stream Map (VSM) 

A graphic depiction of the value-added tasks needed to transform inputs into outputs needed by a customer.  A VSM is used to analyze, improve, and design processes. 

Visual Management 

The use of visual controls and displays used to assess, maintain, and improve performance at a glance.


Activity that consumes resources but creates no value.