Date of Graduation

Fall 12-15-2017

Document Type

Restricted Project/Capstone - USF access only

Degree Name

Master of Public Health (MPH)


School of Nursing and Health Professions

First Advisor

Dhrubajyoti Bhattacharya

Second Advisor

Courtney Keeler


Access to care and healthcare expenditure remain top tier priorities within several domains of population health, impacting Safety Net Hospitals in particular, and affecting a need to optimize care to meet systems and individual care needs, while operating under ever increasingly limited resources. Prior to 2015, Zuckerberg San Francisco General Hospital, a Level 1 Trauma Center, Safety Net, and Academic Hospital held no explicit strategic plan, no standard expectation for leadership to understand daily organizational performance, nor an effective management system, all the while, holding multiple reporting forums to satisfy governing bodies & regulations. To resolve these gaps, and in the wake of aforementioned concerns, ZSFG set out to deploy a system that would facilitate strategic planning & principle-based leadership, to align and enable the workforce to produce improved systems & results. Thus, ZSFG underwent a Lean Transformation. In a cross-sectional implementation study, the elements by which ZSFG was able to enable organizational change was evaluated through observations, unstructured interviews with questionnaire data, with particular focus on the widely deployed lean practice of A3 Thinking. Results demonstrated that, with A3 Thinking alone, a high level of alignment was able to be achieved, and that continuous improvement and leadership remain integrated principles at ZSFG. Alignment can still be improved upon, and further study is required to assess the level by which other Lean tools that ZSFG has deployed has been successful in enabling and engaging the workforce, such as: Daily Management System, Value Stream Mapping, Rapid Improvement Events, and Personal Development Plans, given constantly changing populations and healthcare policies.

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