Most discussions of Lean transformation focus on what happens inside a single organization. The leadership behaviors. The daily management system. The model cells. The cultural conditions that determine whether the methodology takes hold. All of this is essential, and all of it gets substantial attention in the Lean healthcare literature.
What gets far less attention is what happens between organizations. Specifically: how organizations on similar Lean journeys can accelerate each other's learning through structured peer collaboration -- and how that lateral exchange, when done well, produces transformation faster than any single organization could produce on its own. This webinar from John Toussaint and Paul Pejsa of Catalysis is the strongest treatment of this topic available in webinar form.
Toussaint opens with an observation that has become his signature framing on the subject: "If you've seen one Lean transformation, you've seen one Lean transformation." The line acknowledges what every experienced practitioner already knows. Transformations don't transfer cleanly between organizations. The specific countermeasures that worked at one health system rarely produce the same result when copied to another. The culture, the leadership, the starting conditions, and the operational realities are different enough that direct replication fails almost as often as it succeeds.
The implication isn't that peer learning doesn't work. It's that peer learning works differently than most organizations assume. Toussaint's preferred framing for what does work: "copy and kaizen" rather than "copy and paste." Take what another organization learned. Adapt it to your context. Test the adaptation. Learn from the result. The exchange is between practitioners doing the work, not between organizations exchanging finished templates.
This webinar makes the case that this kind of lateral exchange is the single biggest accelerator available to organizations pursuing Lean transformation -- and that the rarity of structured forums for it is one of the reasons most Lean efforts plateau.
John Toussaint, MD is CEO and Founder of Catalysis, originally formed as the ThedaCare Center for Healthcare Value in 2008 and based in Appleton, Wisconsin. He is recognized as one of the pioneers in applying Lean principles to healthcare delivery. Before founding Catalysis, Dr. Toussaint served as CEO of ThedaCare, where he led one of the earliest and most well-known Lean healthcare transformations in the United States. He is the author of three Shingo Award-winning books -- On the Mend, Potent Medicine, and Management on the Mend -- and continues to help healthcare leaders rethink care delivery, leadership behavior, and organizational design through Lean thinking.
Paul Pejsa is Director of the Healthcare Value Network at Catalysis, where he leads the planning, operation, and continuous improvement of the peer-to-peer learning community. He brings more than 25 years of experience in healthcare operations to the role, along with credentials as a Six Sigma Black Belt and Master Black Belt. Before joining Catalysis in October 2015, he served as Executive Director for Continuous Improvement at the BloodCenter of Wisconsin, where he led the development and deployment of Lean systems including strategy deployment, visual management, and daily problem-solving. Earlier in his career, he was Director of LEAN Strategy Deployment in the Healthcare Division of General Electric, where he implemented Lean strategies for the global supply chain business.
This session was hosted by Mark Graban, then VP of Improvement and Innovation Services at KaiNexus.
Toussaint opens the substantive content of the webinar with the Catalysis "transformation house" -- a framework that lays out what an organization needs in place to sustain Lean transformation rather than treating it as a project with a beginning and an end.
The framework includes five elements:
Clear purpose and True North metrics. Organizations that sustain Lean transformation have answered the question "what are we actually trying to accomplish?" with enough specificity that the answer can guide daily decisions. True North metrics translate that purpose into measurable terms -- safety outcomes, quality outcomes, patient experience, staff engagement, financial sustainability -- and make the gap between current state and aspirational state visible.
Defined values and guiding principles, including Shingo principles. The Shingo Model offers a structured framework for the cultural foundation Lean transformation requires. Without explicit principles, organizational behavior drifts toward the default patterns that existed before the transformation started.
Scientific problem-solving and integrated support functions. The methodology isn't an HR initiative or an operations initiative. It's an organizational discipline that requires finance, HR, IT, and clinical functions to operate from the same problem-solving framework. When support functions remain outside the system, they become bottlenecks that constrain what frontline improvement can produce.
A Lean management system that changes leadership behavior. This is the element most commonly underweighted. Tools and methodology can be deployed without changing how leaders spend their time, what they pay attention to, and how they respond to problems. When leadership behavior doesn't change, the tools produce temporary results that erode within months.
The warning Toussaint issues most strongly is against the "inch deep, mile wide" pattern -- attempting to spread Lean across the entire organization simultaneously without deep practice anywhere. The alternative is "inch wide, mile deep" model cells. Choose a specific area. Practice deeply enough that the cell becomes a reliable exemplar of what the methodology looks like at maturity. Use that cell as the basis for spreading to adjacent areas with adapted practices rather than copied templates.
The distinction matters because most organizations default to the inch-deep-mile-wide pattern. It produces visible activity and the appearance of momentum. What it doesn't produce is the depth of practice required for the methodology to actually change outcomes. The model cell approach is slower at the front but produces durable change.
Pejsa explains the operational mechanics of how Catalysis supports the lateral learning Toussaint advocates. The Healthcare Value Network began as an experiment in peer learning when Catalysis was founded in 2008 and has grown into a substantial community of healthcare organizations committed to Lean transformation.
At the time of the webinar, the network included more than 70 member organizations across North America. Membership cost $25,000 per year and included access to about 20 on-site visits at member health systems per year, a two-day annual conference, structured peer-to-peer connections, and ongoing access to the broader community of practitioners.
The benefits members report fall into four categories Pejsa names directly:
Accelerated transformation through shared learning. Organizations new to Lean transformation can compress what would otherwise be years of trial and error by learning from members further along the journey. The compression isn't from copying templates. It's from understanding what worked, what didn't, and why.
Reduced implementation costs by avoiding others' mistakes. Every Lean transformation involves mistakes. Peer networks make it possible to inherit the lessons from other organizations' mistakes without paying the full cost of making them yourself.
Honest sharing of both successes and failures. The membership culture rewards transparency about what didn't work. The candor is operationally valuable because it surfaces the patterns that get sanitized out of public case studies and conference presentations.
Strong peer connections among CEOs, physician leaders, and improvement leaders. The network connects practitioners at multiple levels, not just CI specialists. CEOs learn from other CEOs. CFOs from CFOs. The peer connection at the senior level is one of the most cited drivers of sustained engagement.
Pejsa names what he sees as the structural reason peer networks work better than the alternatives. CEOs and senior leaders learn most effectively from other CEOs and senior leaders. The learning relationship between peers at the same organizational altitude carries credibility that the same content from a consultant or an internal change agent doesn't. When CEOs see other CEOs leading Lean transformation visibly and producing results, they become more willing to lead similarly in their own organizations.
The other framing Pejsa returns to: "Where we see Lean transformation fail is lack of engagement from the most senior leadership." Peer networks address this directly by creating relationships and accountability between senior leaders that don't depend on internal champions to maintain.
The first of three stories Toussaint and Pejsa share illustrates what peer learning looks like when an organization deliberately brings in expertise from outside healthcare.
HealthEast wanted to design a future-state ambulatory clinic. Rather than working only with their internal teams and traditional healthcare architects, they partnered with HGA (an architecture firm), Herman Miller (a furniture company widely known in Lean circles for its own production system), and Epic (their electronic health record vendor). They used 3P design principles -- the Production Preparation Process from the Toyota tradition -- to think through the clinic design from a value-stream perspective rather than from a "how do we organize the same departments we already have" perspective.
The team started with a blank warehouse space and built mock-ups of the clinic as they iterated. The work produced specific quantifiable outcomes: a 20,000 square foot original design reduced to just over 13,000 square feet while improving patient flow. The cost savings on the smaller footprint compounded across the lifecycle of the building, but the operational benefit (faster patient flow, shorter walking distances for staff, better adjacencies) was the more substantial outcome.
The a-ha moment Toussaint draws out: bringing in expertise from outside healthcare accelerates innovation that healthcare alone has not yet developed. The partner companies brought decades of disciplined production system thinking that the healthcare design tradition has not absorbed at scale. The collaboration wasn't healthcare consultants helping HealthEast solve a healthcare problem. It was practitioners from multiple traditions helping HealthEast think about ambulatory care delivery in a way none of the participants could have produced alone.
The second story illustrates peer learning between organizations facing the same operational challenge from different angles.
Both Cleveland Clinic and Intermountain Health were dealing with revenue cycle pressures common across the healthcare industry. A simple conference call between leaders at the two organizations turned into reciprocal site visits, deeper structured collaboration, and ultimately the creation of a finance model cell at Cleveland Clinic.
The model cell mattered because of what it represented. Cleveland Clinic chose to deploy Lean management practices in revenue cycle work -- finance, billing, claims, collections -- led by senior leaders rather than delegated to a CI specialist team. The senior leadership engagement was the variable that distinguished this experiment from previous attempts to apply Lean methodology to finance work. The peer learning relationship with Intermountain accelerated the design and reduced the cost of the experiment because Cleveland Clinic didn't have to discover from scratch what Intermountain had already learned about applying Lean management to revenue cycle problems.
The a-ha moment: peer learning combined with "go and see" produces faster results than working alone. The combination matters. Peer learning by itself, conducted through phone calls and webinars, produces understanding but not the same depth of change. Site visits produce the visceral understanding that comes from watching the work in its actual context. The two practices together compound.
The third story illustrates what happens when peer learning organizes itself locally without formal infrastructure.
Five Healthcare Value Network members based in the Indianapolis area noticed that they were traveling to national conferences and member events to learn from peers, while potentially missing the opportunity to learn from peers in their own city. They started a monthly Lean Coffee -- an informal structured discussion format that lets participants raise topics, vote on priorities, and discuss what's most relevant to the group.
Initial attendance was the five HVN members. Over time, the gathering expanded as participants invited colleagues from their own organizations and others. By the time of the webinar, attendance had grown to 50 to 60 participants per session, drawing from healthcare organizations and from other industries pursuing Lean methodology.
The a-ha moment: you likely have peers nearby facing the same challenges. The barrier to local peer learning is usually not the absence of peers but the absence of a forum that brings them together. The Lean Coffee format is intentionally lightweight precisely so that organizing it doesn't require a substantial commitment from any single organization.
The story illustrates a broader principle: peer learning infrastructure can be national (the HVN), regional (an Indianapolis Lean Coffee), or local (within a single organization's facilities). All three layers reinforce each other. Organizations that sustain Lean transformation tend to participate at multiple layers rather than relying on any single one.
Toussaint and Pejsa close the webinar with a three-step action plan that any organization can begin regardless of where they are in their Lean journey.
Know thyself. Understand your current Lean maturity and your specific gaps. Honest self-assessment is the prerequisite for productive peer learning. Organizations that pretend to be further along than they are can't ask the questions that would help them most. Organizations that pretend to be earlier than they are miss opportunities to teach.
Build your network. Create a rhythm of collaboration locally, regionally, or nationally. The specific form matters less than the consistency. Quarterly site visits with one peer organization can produce as much learning as monthly conference calls with ten peers, if the depth of exchange is right.
Practice yokoten. Create forums to share successes, failures, and translated improvements both within your organization and across organizational boundaries. Yokoten is the Japanese term for the lateral spread of best practices -- the discipline that distinguishes organizations that learn from their own work from organizations that re-solve the same problems in parallel across departments and facilities.
The third step is the one Toussaint and Pejsa emphasize most. The most successful organizations explicitly recognize and celebrate translated improvements -- particularly when frontline staff coach peers in adopting new practices. The recognition reinforces the cultural value of teaching others rather than hoarding knowledge, which is the foundation that makes peer learning at every scale possible.
The session is primarily methodology-focused rather than platform-focused, but several specific practices Toussaint and Pejsa name are substantially supported by the platform.
The lateral spread of improvements -- yokoten -- depends on visibility. When a successful countermeasure exists in one department or facility, the lateral spread to other areas only happens if those other areas can see it. Physical improvement boards and spreadsheets are inherently local. A shared platform where all improvement work across the enterprise is visible, searchable, and categorized makes deliberate replication possible in ways that depend on infrastructure rather than on people happening to mention their work to the right colleagues.
The knowledge repository function is particularly relevant for peer learning. Translated improvements -- where a successful countermeasure from one area has been adapted for another with documented results -- are exactly the kind of organizational asset that should be preserved durably and made discoverable to other teams facing similar problems. Without a system that holds this knowledge, it leaves with the person who developed it.
For organizations participating in peer learning networks like the HVN, the platform also supports the discipline of capturing what's learned during site visits, conferences, and structured exchanges with peer organizations. The learning has substantially more value if it gets translated into specific improvement work in the home organization. Without a system to capture and track that translation, peer learning produces inspiration without sustained behavior change.
The model cell approach Toussaint advocates -- inch wide, mile deep -- benefits from a system that holds the depth of practice within the cell. The visual management, the daily problem-solving, the leader standard work, the metrics tracking are all artifacts that benefit from being preserved and accessible across the project lifecycle. As the methodology spreads from the model cell to adjacent areas, the platform supports the deliberate adaptation rather than copy-paste replication that Toussaint describes as "copy and kaizen."
The platform doesn't substitute for the methodology or for the peer relationships. The disciplines Toussaint and Pejsa teach -- the leader behavior, the model cell depth, the yokoten practice, the peer learning relationships -- are practitioner disciplines that no system can perform on its own. What the system does is hold the artifacts of the work in a place where they remain visible, accessible, and connected to the broader organizational improvement portfolio.
What is the Catalysis Healthcare Value Network?
A peer-to-peer learning community of healthcare organizations across North America committed to Lean transformation. The network began as an experiment in peer learning when Catalysis was founded in 2008 as the ThedaCare Center for Healthcare Value, and has grown to include more than 70 member organizations. Members participate in structured site visits, an annual conference, peer connections at multiple organizational levels (CEO, CFO, physician leadership, improvement leadership), and ongoing access to the broader community of practitioners. The network is built on the premise that healthcare organizations pursuing Lean transformation learn faster and more durably from each other than from working in isolation.
What does Toussaint mean by "If you've seen one Lean transformation, you've seen one Lean transformation"?
The line acknowledges that Lean transformations don't transfer cleanly between organizations. The specific countermeasures, tools, and management practices that produced results at one organization rarely produce the same result when copied to another. The culture, the leadership, the starting conditions, and the operational realities are different enough that direct replication often fails. The implication isn't that peer learning doesn't work. It's that peer learning has to be done differently than copy-paste replication. Toussaint's preferred framing is "copy and kaizen" -- take what another organization learned, adapt it to your context, test the adaptation, learn from the result.
What is the difference between "inch deep, mile wide" and "inch wide, mile deep"?
The two patterns describe how organizations deploy Lean methodology across the enterprise. Inch deep, mile wide attempts to spread Lean across the entire organization simultaneously -- every department, every facility, every team. The pattern produces visible activity and the appearance of momentum, but it rarely produces the depth of practice required for the methodology to actually change outcomes. Inch wide, mile deep takes the opposite approach: choose a specific area, practice deeply enough that the cell becomes a reliable exemplar of what the methodology looks like at maturity, and use that cell as the basis for spreading to adjacent areas with adapted practices rather than copied templates. Toussaint advocates the second approach.
What is a model cell?
A specific area of the organization where Lean management practices are implemented with sufficient depth and discipline that the area becomes a reliable exemplar of what the methodology looks like at maturity. Model cells include the full Lean management system: leader standard work, visual management, daily problem-solving, structured huddles, and continuous improvement work. The cell serves multiple purposes -- it produces results in its own right, it builds the organization's capability to run Lean management, and it provides a learning environment for leaders from other parts of the organization who will eventually spread the methodology. The Cleveland Clinic finance model cell mentioned in the webinar is one example of a model cell deployed in a function (revenue cycle) where Lean management is rarely applied.
Why does senior leadership engagement matter so much?
Without active senior leadership engagement, Lean transformation reverts to a tool-based or project-based approach that doesn't sustain. Pejsa's framing: "Where we see Lean transformation fail is lack of engagement from the most senior leadership." The reasons are structural. Senior leaders set the priorities that the rest of the organization responds to. If they don't visibly do their own improvement work, attend huddles, go to the gemba, and lead by example, the message to the rest of the organization is that Lean is something other people do. Peer learning between senior leaders accelerates this engagement by creating relationships and accountability between senior leaders across organizations.
What is yokoten and how does it differ from copy-paste?
Yokoten is a Japanese term for the lateral spread of best practices across an organization or across organizations. The Toyota Production System uses the term to describe the discipline of taking what was learned in one place and applying it elsewhere. Yokoten differs from copy-paste in that the destination is expected to adapt the practice to its own context rather than implement it identically. The framing Toussaint uses for what yokoten looks like in practice: "copy and kaizen" rather than "copy and paste." The practice depends on a culture where teaching others is rewarded rather than treated as giving away competitive advantage.
Can peer learning work outside healthcare?
Yes. The methodology Toussaint and Pejsa describe was developed in healthcare and has substantial roots in the Toyota Production System, but the underlying principle -- that organizations pursuing similar improvement journeys learn faster from each other than from working in isolation -- applies in any industry. The Indianapolis Lean Coffee story illustrates this directly: the gathering expanded from five HVN members in healthcare to 50 to 60 participants from multiple industries, all pursuing Lean methodology in their own contexts. The peer learning infrastructure is industry-agnostic. What changes between industries is the specific practices being shared and the relationships that enable the sharing.
How do you start a peer learning network if you don't have one?
Start small and locally. The Indianapolis Lean Coffee began with five HVN members who started a monthly gathering. The format was lightweight enough that organizing it didn't require substantial commitment from any single organization. Over time, the gathering expanded as participants invited colleagues from their own organizations and others. The barrier to local peer learning is usually not the absence of peers but the absence of a forum that brings them together. A monthly coffee meeting, a quarterly site visit exchange with one peer organization, or a small regional gathering can produce substantial value before scaling to anything more ambitious.
What is the Production Preparation Process (3P)?
A design methodology from the Toyota tradition used to think through the design of a new process, product, or facility from a value-stream perspective rather than from an "extend what we already have" perspective. The HealthEast Clinic of the Future story illustrates 3P in action: the team started with a blank warehouse space and built physical mock-ups of the clinic, iterating on the design before committing to construction. The methodology produces designs that account for value flow, staff movement, patient experience, and adjacencies from the beginning rather than discovering these constraints after the building is already constructed.
How do you measure whether a peer learning network is working?
The most direct measure is whether the improvement work in your own organization accelerates as a result of participation. Pejsa and the HVN team track member outcomes -- safety metrics, quality outcomes, patient experience, financial sustainability -- as one indicator. The more practitioner-level indicator is whether site visits, peer connections, and shared learning translate into specific improvement work that wouldn't have happened otherwise. Organizations that participate in peer networks without translating the learning into action get inspiration but not durable change. The translation is the variable that determines whether the investment in peer learning pays off.
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