Local Improvement Teams

  • Heather Freeman
  • Andrew Young Shin


Improving how we safely and efficiently care for patients is a paramount issue for health care organizations. Yet, most institutions struggle with how to systematically achieve a continuously learning and improving program. Lack of organization, variability in clinical care, insufficient resources and competing agendas are common contributing factors to poor sustainability in quality improvement efforts.

Local Improvement Teams (LITs) are unit or patient population-based teams that apply structured problem solving methodologies to improve care processes toward achieving the Institute of Medicine’s 6 aims: safe, timely, effective, efficient, equitable, and patient-centered care. LITs represent a fundamental aspect in creating an intelligent enterprise: the maturation of a frontline interface that connects the organization’s core competency with the needs of the patient. Team structure, process, training and launch strategies are described in this chapter along with tactics to develop standard work, daily accountability process and standard work for leaders.


Improvement Teams Lean Management System Clinical Microsystems A3 Thinking 8-Step Problem Solving 


  1. 1.
    Committee on Quality of Health Care in America, Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: The National Academies Press; 2001.Google Scholar
  2. 2.
    Kohn LT, Corrigan JM, Donaldson MS, Committee on Quality of Health Care in America, Institute of Medicine, editors. To err is human: building a safer health system. Washington, DC: The National Academies Press; 2000.Google Scholar
  3. 3.
    Nelson EC, Batalden PB, Huber TP, Mohr JJ, Godfrey MM, Headrick LA, et al. Microsystems in health care: part 1. Learning from high-performing front-line clinical units. Jt Comm J Qual Improv. 2002;28(9):472–93.PubMedGoogle Scholar
  4. 4.
    Akao Y. Hoshin Kanri: policy deployment for successful TQM. Cambridge, MA: Productivity Press; 2004. 248 p.Google Scholar
  5. 5.
    Nelson EC, Batalden PB, Godfrey MM. Quality by design: a clinical microsystems approach. Lebanon/San Francisco: Center for the Evaluative Clinical Sciences at Dartmouth; Jossey-Bass/Wiley; 2007.Google Scholar
  6. 6.
    Godfrey MM, Nelson EC, Batalden PB. Assessing, diagnosing, and treating your inpatient unit [Internet]. Trustees of Dartmouth College; 2001. Available from:
  7. 7.
    Nelson EC. Value by design developing clinical microsystems to achieve organizational excellence [Internet]. 2011. [cited 2013 Jun 21]. Available from:
  8. 8.
    Rother M, Shook J, Womack J, Jones D. Learning to see: value stream mapping to add value and eliminate MUDA. Version 1.4 Oct 2009 edition. Cambridge, MA: Lean Enterprise Institute; 1999.Google Scholar
  9. 9.
    Shook J. Managing to learn: using the A3 management process to solve problems, gain agreement, mentor and lead. Cambridge, MA: Lean Enterprise Institute; 2008.Google Scholar
  10. 10.
    Deming WE. Out of the crisis. Cambridge, MA: MIT Press; 2000.Google Scholar
  11. 11.
    Without standards there can be no kaizen [Internet]. The Lean Thinker. [cited 2013 Jul 6]. Available from:
  12. 12.
    Tuckman BW. Developmental sequence in small groups. Psychol Bull. 1965;63(6):384–99.PubMedCrossRefGoogle Scholar
  13. 13.
    Systems thinking [Internet]. Wikipedia Free Encycl. 2013 [cited 2013 Jul 5]. Available from:
  14. 14.
    Leach LP, Leach LP. Lean project management: eight principles for success. Boise: Advanced Projects, Inc.; 2005.Google Scholar
  15. 15.
    Project Management Institute. A guide to the project management body of knowledge (PMBOK Guide). Newtown Square: Project Management Institute; 2008.Google Scholar
  16. 16.
    Cohn M. Succeeding with agile: software development using Scrum. Upper Saddle River: Addison-Wesley; 2010.Google Scholar
  17. 17.
    Jellison JM. Managing the dynamics of change the fastest path to creating an engaged and productive workforce [Internet]. New York: McGraw-Hill; 2006. [cited 2013 Jul 6], Available from: Scholar
  18. 18.
    Liker JK, Meier D. Toyota talent: developing your people the Toyota way. New York: McGraw-Hill; 2007.Google Scholar
  19. 19.
    Blancett SS, Flarey DL. Reengineering nursing and health care: the handbook for organizational transformation. Gaithersburg: Aspen Publishers; 1995.Google Scholar
  20. 20.
    Mann D. Creating a lean culture: tools to sustain lean conversions. New York: Productivity Press; 2010.CrossRefGoogle Scholar
  21. 21.
    Marksberry P, Bustle J, Clevinger J. Problem solving for managers: a mathematical investigation of Toyota’s 8-step process. J Manuf Technol Manag. 2011;22(7):837–52.CrossRefGoogle Scholar
  22. 22.
    Institute for Healthcare Improvement: Science of Improvement: Testing Changes [Internet]. [cited 2013 Jun 21]. Available from:
  23. 23.
    Liker JK, Franz JK. The Toyota way to continuous improvement: linking strategy and operational excellence to achieve superior performance. New York: McGraw-Hill; 2011.Google Scholar
  24. 24.
    Training USWMCB of. Job Instruction: Sessions Outline and Reference Material … Training within Industry Service, Bureau of Training, War Manpower Commission; 1944. 76 p.Google Scholar
  25. 25.
    Halamek LP. Simulation-based training: opportunities for the acquisition of unique skills. Virtual Mentor. 2006;8(2):84–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Landrigan CP, Parry GJ, Bones CB, Hackbarth AD, Goldmann DA, Sharek PJ. Temporal trends in rates of patient harm resulting from medical care. N Engl J Med. 2010;363(22):2124–34.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  1. 1.Performance ImprovementLucile Packard Children’s Hospital at StanfordPalo AltoUSA
  2. 2.Cardiovascular Intensive Care, Division of Pediatric Cardiology, Department of PediatricsLucile Packard Children’s Hospital, Stanford University Medical CenterPalo AltoUSA

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