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BACKGROUND AND LEAN JOURNEY In 2007, a 4-hospital community health care system located in the East Metro area of St. Paul, Minnesota, started a system-based residency program that began with a single resident and later expanded to 2. In 2013, the program was modified and expanded to 3 site-based postgraduate year 1 (PGY1) residencies. This was done to help grow the residency programs and secure pass-through funding to financially support the resident positions within the organization. One of the sites is a 230-bed acute care facility with an average daily census of 190 patients. Twenty full-time equivalent clinical staff pharmacists are employed to manage over 11,000 admissions annually. In late 2012, the health system began its process improvement journey to implement the Toyota Production System (ie, lean) across the enterprise. This initiative is called value-based improvement (VBI) and involves everyone in the organization, from frontline contributors to senior leadership. A key to the Toyota Production System is the implementation of the frontline management system (FMS), which engages the employees who do the work in the problem-solving and improvement process. Leaders coach and are "barrier busters" for improvement work done by frontline staff as part of FMS. This model puts the ownership of the change in the hands of those who are closest to the work. Worth et al define lean as a set of concepts, principles, and tools used to create and deliver the most value from the customer's perspective while consuming the fewest resources by fully utilizing the skills and knowledge of those who do the work. 1 In a lean system, frontline staff drive the majority of process improvement. A successful lean program improves

No abstract

BACKGROUND AND LEAN JOURNEYIn 2007, a 4-hospital community health care system located in the East Metro area of St. Paul, Minnesota, started a system-based residency program that began with a single resident and later expanded to 2. In 2013, the program was modified and expanded to 3 site-based postgraduate year 1 (PGY1) residencies. This was done to help grow the residency programs and secure pass-through funding to financially support the resident positions within the organization. One of the sites is a 230-bed acute care facility with an average daily census of 190 patients. Twenty full-time equivalent clinical staff pharmacists are employed to manage over 11,000 admissions annually.In late 2012, the health system began its process improvement journey to implement the Toyota Production System (ie, lean) across the enterprise. This initiative is called value-based improvement (VBI) and involves everyone in the organization, from frontline contributors to senior leadership. A key to the Toyota Production System is the implementation of the frontline management system (FMS), which engages the employees who do the work in the problem-solving and improvement process. Leaders coach and are "barrier busters" for improvement work done by frontline staff as part of FMS. This model puts the ownership of the change in the hands of those who are closest to the work.Worth et al define lean as a set of concepts, principles, and tools used to create and deliver the most value from the customer's perspective while consuming the fewest resources by fully utilizing the skills and knowledge of those who do the work. 1 In a lean system, frontline staff drive the majority of process improvement. A successful lean program improves