With a good grasp of the LEAN basic curriculum, students explore the advanced concepts of LEAN including pull systems, demand analysis and flow engineering

Organizations are composed of value streams supported by supply chains. Each value stream can be mapped and used as a framework to structure process improvement activities. Gains are typically impressive as real organizational change fundamentally transforms the organization. This transformation occurs when the interrelationships between value streams is understood and used as the vehicle for strategy deployment and business measurement systems.

This course examines the progression of value stream analysis from simple single stream mapping, through interconnected stream mapping and on to organization wide value stream analysis. The student learns the fractal nature of value streams and how each level can be used as a live, lean management system yielding Key Performance Indicators which reflect the true nature of activities in the new organization


The BR Transformation System is based on the balance between four primary value streams:

- Care Delivery

- Demand Management

- Financial Viability

- New Service Introduction and QI

This course investigates each stream, and the dependencies that affect operations. A generic practice business model is constructed, which is used throughout BR Transformation methodology. 


A3 problem solving is a powerful methodology for resolving issues, and building skills in the workplace. A3 works best when it is embraced by everyone, who takes initiative to instigate and run their own A3's.

A3 methodology has another side though - that of a management system for both resolving issues and developing people. This course takes students through the management process which enables A3 system mechanics to function and flourish resulting in a truly agile, problem solving organization


Optimization of any delivery system is effective in reducing waste within that system, but is entirely meaningless in the context of supply and demand. The ability to process patients faster is no advantage if there are no patients waiting. 

Demand Analysis takes the robust toolset of Statistical Process Control and applies it to the outside world to evaluate the output of that world forming the demand on your delivery system. This course examines the concepts behind demand analysis including systems thinking theory. data gathering, manipulation and analysis will form a bed rock of practical applications in the healthcare delivery system


Patient demand varies day to day, hour to hour. A practice handles this by scheduling provider time in blocks. Demand Analysis shows us methods to manage this variation effectively for patients presenting with "like" conditions. A cell system can be used to manage these patients more effectively, reducing waste for patient and practice alike with no loss of quality of care. 

Students will learn the techniques of service family segregation, value stream design, cell system design and measurement. At the conclusion of this course, students should be comfortable evaluating demand, deciding on the appropriate service delivery layout, implementing it and running it to accommodate both normal demand and special cause demand


The Healthcare environment is built on examples of "push" systems, where people, inventory or time resources are sent forward in any given process, regardless of the next steps capability of receiving and processing them. In such cases, a pull system is desirable and can eliminate many aspects of waste. PS201 teaches the methodology and tools of Pull Systems / KanBan, using practice specific examples. 

Attendees will emerge with an understanding of how pull systems can improve patient flow, patient throughput and both patient and provider satisfaction, and a network of contacts and references to call upon when the time comes to make those possibilities a reality, and access to the BR learning network and online learning resources.