In this module we will be discussing the manufacturing principles of the Toyota Production System. The concept of value stream or work flow diagrams will be introduced. The well known 80/20 rule in manufacturing will be applied to patient care. The 8 ways waste can be reduced in health care will be explored, and finally the problem of push medicine and how patients can guard against this all too common problem will be covered.

Teamwork is critical in modern healthcare. We will explore the state of healthcare teamwork in most healthcare systems. The 5 resources required for effective teams will be reviewed, and we will discuss how athletic principles can be used to encourage teamwork, improve efficiency and increase the quality of patient care. We will review how to launch and coach a team, and how to manage the complex dynamics of teams. Finally we will discuss how to create a self-improving team.

This module will be discussing the consequences of medical errors, and you will learn from Sorrel King's loss of her daughter, Josie, and from my personal experience that preventable injuries not only cause death but also can lead to permanent life changing injuries. Sitting around and doing nothing is not an option. However we all need to understand and use three key tools to determine the causes of medical errors and to fix them, Root cause analysis, Driver Diagrams, and PDSA cycles. Finally we will discuss the issue of small errors and our tendency to ignore and workaround them. Unfortunately this approach to small problems is one of leading causes for the continued high rate of preventable injuries and deaths in our hospitals and clinics. It is time to fix the little things.

This module introduces you to the famous W. Edwards Deming red bead experiment that illustrates the tyranny of random variation, and introduce the use of run charts to differentiate random or common cause from specific cause variation. Next we will introduce you the concept of reliability and will illustrate why we need to dramatically improve the reliability in health care. Strategies for reducing human errors are reviewed, and the effectiveness hierarchy of different interventions discussed. We end with a discussion of how health systems and providers should be treating patients and families who they have inadvertently harmed.

In this module, we will be discussing the need in healthcare for distributive leadership that is adaptive. The complexity of healthcare prevents one leader from micromanaging a healthcare system, and leadership must be encouraged on the front lines of care. Effective leaders are good listeners, empathetic, follow their principles (North Star) and are courageous. Adaptive or innovative leaders are a necessity for improving the quality and safety of healthcare. The strategies for controlling emotional disequilbrium will be addressed, and specific analogies presented to assist students in understanding how to practice leadership that will bring about change.

Change requires those on the front lines to embrace new approaches to care and to work across department barriers. This session will use our Founding Father Samuel Adams to exemplify the approaches that have been used for decades to encourage others to come together to bring about change. Samuel Adams campaign led to United States independence from Great Britain and these methods if applied throughout the world can lead to a revolution in healthcare delivery. One-one techniques, personal narrative, creation of leadership teams, and the creation of effective strategies and tactics to bring about action will all be covered. You can make a difference.

In this final module we will review why many of us fail to change our viewpoints and behavior. We will discuss how you can overcome your natural immunity to change. Next we will review the key points from each of the past 7 module, and then outline a general plan of action that will allow you to create your personal plan to fix one component of your healthcare system. Your learning has just begun. Now you will be able to apply what you learned, you will achieve greater and greater understanding by doing.

This is the final exam.