|1

|2
|3

: /

: +

: Salammaneh.com -

:
.

Hadia667@gmail.com :
|4

...

...

...

.
|5

6 ...............................................................................................

7 .....................................................................................

8 ........................................................................................................................

: 10 ....................................................................................................

: 20 ............................................................................

: 31 ................................................................................................

: 39 ..........................................................................................

: 43 ...........................................................................................................

: 74 ..........................................................................................................

: 90 .......................................................................................................

: 107 ....................................................................................................

: 122 ......................................................................................................

: 153 ......................................................................................................

: 172 ...................................................................................................
6|

In the name of God

Writing a novel about Lean Systems in the style that the book, The Goal was
written a few decades ago, is both a joy to read and effective! Im glad to
acknowledge that Mr. Hadi Aghazadeh has done a nice job doing that!

Finding Muda (7+1 types of waste in any process) and reducing or eliminating it
should be among the regular duties and day-to-day activities of all responsible
engineers, managers or businesspeople. Be it the person, who manages a household
or runs a billion dollar organization!

Now, among all industries, anywhere from manufacturing to food to accounting to

entertainment to aerospace and to healthcare, one of the most important areas that
Lean can really shine is the latter; the Healthcare!

The reason should be quite clear; Healthcare is important, relevant and urgent to all
involved! Additionally, for years the healthcare industry by & large, has not been
responsive to the changing demand or answerable to anyone, when it comes to
patient care, cost-effectiveness, speed and accuracy of the diagnoses and
effectiveness of their process.

This book by Mr. Hadi Aghazadeh, a responsible engineer, will hopefully shed
some light on the Healthcare industry so it too, among other successful sectors of
the economy, can prosper, thrive, serve and most importantly be effective for the
end-users, namely the patients!

May this book cause to have service be seen as our utmost responsibility,
inshaAllah!

May we all achieve Success be at the Service of others, not at their expense!

All the best,

Hormoz Mogarei
|7

( 7+1 )
.
.

.
.
:
.

-


.
.

|8

. .

.

-

!
!

|9

.!

.
 | 10

:
 | 11

.
.
.

.
1
17 13 .

14 :

! : . .

- 1
- 2 .
.
.
 | 12

15
.

( 70 .
). .

Enter
...

...

....

....

***

 | 13

***

17 - 94

.



5 . .

.
 | 14

(
)
.

. 12
.

.
.

. ( )
.

. 12.

.
 | 15

...

:
. .

. 400

.
. .

.


. .

.
. .
 | 16

. .

3
.

.
.

. .

***

21 94

.

.

. . .
.
 | 17

...
-
.

! . .

.
.

4 . 7 (
)

.


.

.
 | 18

.
. .

!
!

***

. .

- -
. .

.
.

.
 | 19

. .

- 3 ( )
. 20
 | 20

:

 | 21

.!

***

-
.

. . .
.

 | 22

.
.

.

. 2 4
.

.
 | 23

.
.

***

4
- .
 | 24

. .
.

.
.


.

.
.

.

 | 25

. .



.

70 .
.

. 2008
.

.

.

***
 | 26

.
.

.

.

. /
( )Cost/Benefit (
)

. .

.
.

...

.
 | 27

.

...

***

95
.
177 .

5
85 .

:

.

22


.

.
 | 28

:!

22
750
.
35 .
12
.

98
440
.
.

( )Health Delivery
.

.
80 .
 | 29

.
40
.

.

.
.

.

.

.

.

.


.
 | 30

.
 | 31

:
 | 32

.

.

TRIZ5 .

.

.

.

.

20

- 5 . .
 | 33

.
 | 34

.
.

.

Contribution ...

.

.
.

.
 | 35

.
.
 | 36

.
 | 37

.

!

!

.

.
. .
 | 38

.

.

.
. .

.

.


.

. .

.
 | 39

:
 | 40

/ ()

.

.

-
.
 | 41

3

.

3
.

.
.

. :

/ ...
 | 42

. .

...
 | 43

50
.

.
.

.
 | 44

.
.

. .

!
.

. .

.
 | 45

. .

: ...

. .

75
.

.
 | 46

...

.
. . .

- -
.

.
.

!!
.

2
.

.
 | 47

Lock
. .

5
.

19.5
.

:
!

. .

.
.

.
 | 48

N8 - .

.
.

. !

.
 | 49

. .

.
!

.
.

50
.

...

.
:
.

.
 | 50

.
.

. .

...

. .
 | 51

.
.

94
.
.

95
.

.
 | 52

.
.

.
.

50 10

(
)
.

.
.

( )TRIZ .
 | 53

. . .
.

.
.

...

. ()PokaYoke
.

.
.
.

( )TRIZ
.
 | 54

.


.

.
.

.
.

.
.

***

.
 | 55

.

.

50

***

.

.

.

.

( )
.
 | 56

. ...

1300
700 .

(

)
.

: .

.
 | 57

.
...

-
. .

.
 | 58

. (
) (
)
.

.
.

5
...

.
 | 59

.

.

.
.

...
 | 60

( )

() .

.

.


.

.

.
.

 | 61

.
7

.

.
.
.
.

.
.
.
.

7
-
 | 62

70.

20 .

20
.

.
 | 63

.

.

5S
.

.
.
 | 64

PDCA
.

. ( ) ()
.

.

.

: Just In Time
.
.
.
....

SMED
3 4
10 .

.
 | 65

80
.

.
 | 66

Cross Functional Team.

. .

. .

. .
. .

.
 | 67

.

.

.
.

.

.

.
 | 68

...

.
 | 69

***

...
.

-

.
 | 70

19 .

( )Big Data
.

( )Mayo Clinic

.

. 1
5 .

Thedacare
10
:
 | 71

2014 Centers for Medicare & Medicaid Services

Bellin ACO
.

- 2004 -
2009 .

A-Aa-
.

2014 best practice 9

.

...

- - .
 | 72

.
.

. .

.
 | 73

.
.

.
...

. .
 | 74

. .

.
.

5 . .
.

. ...

.
.

! . .
.

.
 | 75

.
.

***

. .

. .
.

.
 | 76

.
 | 77

50
. .
.

. .

.
 | 78

.
. .
. .

.

.

.

RGB

-. .

Quality
Function Deployment ( )QFD

.

...

.
 | 79

.

.

...

.
.

:

( )Fee For Service .
Value Based Healthcare
.

.
.

.

.

. .

.
.

!
 | 80

- .

.
. .

. .

.
.

.
. .

. . L
(
) .

.
 | 81

. !

...

......

. .

. .

. .

.
.

. .
 | 82

.
.

. .

.
.

.
.

.
.
 | 83

. .

: .

. .

.
 | 84

(
) .

. .

.
.

.
.

.
 | 85

.

.

15 25
.

.


.

.

 | 86

.
.

.
.

.



.

-
: ....

.
.

.
 | 87

... .

/ .

.
.

.
 | 88

.
 | 89

8 .
.

.
.

x-Ray .
.
.

.
 | 90

x-Ray .
... .

.
.

.

.

.
.

.
.

: .
 | 91

. .

.! .

.
.
.

.
 | 92

.
.

.
.

.

.

.

.

:
.

.
 | 93

84 .
.

84

:
.

:
.

:
-
...
 | 94

. .
.

.
.
...

.
 | 95

: .

.

.
.

.

.
. .

29
.
 | 96

.


... .

.
...

.
.

...

.
 | 97

***

x-ray .
.

. . .

. !

.
.
 | 98

.
. .
!

. .

.
.

20 .

.
.

. ...

.
 | 99

.
.

.
.

. .
.

. .

.
.
.

 | 100

.
.

. .
. .

! .

.
 | 101

.
.

.
.

...

.
.
.

84
.

.
 | 102

2 27 .
:
. .
1424 27 24 11 .

( )27-2=25


.

.

.

:
3 10
 | 103

10
.

()
-



.

.
.



.

. .

17 80
.

20/80 .

.
 | 104

.

.

. .

.
.

***

.


.
20 1.5
.
 | 105

.

...

***

...

.

.

.

.
.

.


.
 | 106

. .
.

.

. .

. .

 | 107

8
.
.

.
.
... .




.

.
45 .
.

.
. .

.
.

.
 | 108

.

.

.
.

.
.

. .
84 .
. . .
.

.
. .

.

20 .

. 20
 | 109

.

.

.
.

. 9:45 10:30 .

. .
13 .
.

.
.

.
.
.

.

. .

***
 | 110

. .
.

-1
-2 .

.



999 .

8
.
. .

.
. .
.

.

.

5 - .
.
!

-
 | 111

. .

5 .
4
.
.

. ..

/
 | 112

. .

.
.

.

.

. .
.

.
.

. .
.

- .
.

.
.

. .
! . .
.
 | 113

. .
. .

.
2
.

...

. .

.
 | 114

. .

. .
.

***

. .
.
 | 115

. .

- .
: . .
.

.

.

.
.

.

.

.
.
 | 116

.
. .

.

. .

. . .

. .

.
.
15
. ...

.
.

...

.
 | 117

. .

. .

.
.

. .
.

.
.

.
. .

.
.

.
.

.
.

.
 | 118

. .

. . .

: .
. .

. .
.

.
. .

.

.

.
.
 | 119

.
. .

.
.

. .

.

.

...

.
...

.

.

.

.

.

 | 120

.
 | 121

.

.

- .

. .

.
. .
.
 | 122

. .

.
.

.
.

.
.

. .

.
.

.
.

. .

.
 | 123

:
.

. .
.
.

.
.

.
.

. .

.
.
 | 124

.
.

.
.

-
-
.

Social network analysis graph based

clustering

.
. .

.
.

5 5 .
FTP Flash Memory
 | 125

5 10 .
: 5

2 20
.

12 .

.
. . .

***

.
. .

.
.

. .

.

2 .
 | 126

. .
. ...

.
.
.

.
.

90 -
.

-
.

. .

***

. .

.

.
10 40 .
.
.
 | 127

. .
.
.
30
90
.
7 4
.
10 .
.

5 .

 | 128

.
.

.

5 4 3 2 1

4 7 5
7 5 8 4 5
17 15 22 25 18
215 85 20 150 40
3 40 25 33 35
10 25 18 17 13
17 30 23 19 22
24 28 29 27 32
80 95 105 75 90

89 28 22.2 1. 33.8 150 19.4 5.8 5.
()

. .

.
 | 129

.
.

.

:

.

.

( )
( ) .
 | 130

. .
.

.

.

.

. .
 | 131

.
.

 | 132

.
:
 | 133

10
15
15
30
5
5
28
5

. .

T= 5.6 T= 5.8 T= 19.4 T= 150 T= 33.8 T= 16.6 T= 22.2 T= 720 T= 89

O= 2 O= 2 O= 4 O= 3 O= 1 O= 10 O= 1 O= 3 O= 3
=
90 10 15 15 30 5 5 28 5
5.6 5.8 19.4 150 33.8 16.6 22.2 720 89 =

 | 127

.
.

. .

.
.
.
.

( ) (
) (
 | 128

) (
) (
) ( )
(
) ...

. CT-Scan
.

***
 | 129

9 9
.

( )T
( )O .

Timeline
.

.1

.2
.

.3 .

.
 | 130

.1
.
.2 ( 8)

125 85
1200

.

5
95

.

8
- .
 | 131

%5 %95

9 4
.

- 5 .

.


.

:
 | 132

()

203 1

.
5. 2

5.8 3
.

19.4 4
.

150 5

.
33.8

1. 7

.
22.2 8
.

720 9

89 10
 | 133

.1
.2
.3
.4
.5
.

***

. 5
. 12
.

12 :
 | 134

1
2

.1
-


.
.2 .
.


.

-95.

.
.
 | 135

.
.

query
:

1200 1110

1000

800

600 484 476

400

200 79 69 77
0

20/80 . 30
.

.
 | 136

5 4
.

.
.

19

10

26

15

0 5 10 15 20 25 30
 | 137

8 .

.
.

400 378
356
350 312 307
300
254 253 251
250 229

200
150
100
50
0

292.5 .

8 :
 | 138

200
178
180 163 160
160 144
140 129 126
115
120
95
100
80
60
40
20
0

( )

.

( )




.

.
.
 | 139

4
.

( ) ( )
.

400
350
300
250
200
150
100
50
0

)( Log. )( Log.

. ..

 | 140

Drill Down .

.

-

.

95 .
 | 141

8 7 5 4 3 2 1

25 22 14 22 19 0 0 25

1 15 14 13 12 11 10 9

0 25 23 12 15 9 0 22

24 23 22 21 20 19 18 17

0 10 2 18 9 10 0 0

31 30 29 28 27 2 25


0 2 9 5 9 25 22

4
.
 | 142

120
106 108
102
100

80
62
60

40

20

.

.
 | 143

30

26
25 25 25 25 25
23
22 22 22 22
20
19
18
15 15
14
12
10 10 10
9 9 9 9

5 5
2
0
1 4 5 6 7 8 9 11 12 13 14 15 19 20 21 22 23 25 26 27 28 29 30

.
22 15 8 1 2 .
.

.
.

.
 | 144

8 7 5 4 3 2 1

5 24 8 7 15 0 11

1 15 14 13 12 11 10 9

0 2 12 25 5 13 15 0

24 23 22 21 20 19 18 17

1 0 0 0 0 2 1 7

31 30 29 28 27 2 25

0 0 22 11 24 2 18

.
 | 145

100 93
90
80 76
70
70
60
50
40
30
20 12
10
0

( )
.

( )
( )Pulling
9.

9
- Hijunka
 | 146

30
25
24 24
25 22

20 18
16
15 15
15 13
12
11 11
10 8
7 7
6
5 5
5 2 2 2
1
0
1 3 4 5 6 7 8 10 11 12 13 14 15 17 18 19 24 25 26 27 28 29

27 13 29
.

.
 | 147

60

50

40

30

20

10

0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

8 25
/
. 20
i .
 20
19
18
17
| 148

1
15
14
13
12
11
10
9
8
7

5
4
3
2
1

 | 149

.

:

SIPOC 5 .

.
 | 150

(Suppliers ( Inputs ) ( Process) ( Outputs ) ( Customers

) )
.1 .1 .1 .1 X-Ray .
.2 .4 .2 .
.3 .3
...
.5
.4 .2
.
.3
.5 .4 .7
.5
. .8
.7 .
.8 X-Ray .7
.9
.8
.10
X-Ray
.9
.11
 | 151
 | 152

***

.

.

.
.
 | 153

: /

.
.

.

 | 154

3 .

-
.

.1
.2
.3
.4
.5
.

95 .
.
-
.
.
292.5.
( ) 145 .
.
.
.
 | 155

.
.
.

.



.

.

.

.
 | 156

.
:

30
25
25 24 24
22

20 18
16
15 15
15 13
12
11 11
10 8
7 7
6
5 5
5
2 2 2
1
0 0 0 0 0 0 0 0 0
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

11.5 .

25 .

5 .
 | 157

44

5


.

. .

10

.

1 0
- Takt Time
 | 158

( )

.

***

.
 | 159

( )
.

.1 5
.2

20
5 11
2 5
.

12 .

.



.

- 11
. for .
- 12 Kanban
.
 | 160

20 5
8 150 170 20

.
.

150 170
.

:
 | 161

5


5

5

5

OXOX

20

10
15
5 28 5

T=5.6 T=5.8 T=19.4 T=120 T=16.6 T=22.2 T=360 T=20

O=2 O=2 O=4 O=3 O=10 O=1 O=3 O=3

= 87.
20 10 15 15 20 5 28 5

5.6 5.8 19.4 120 16.6 22.2 360 20 = 4

 | 162

2 .

.1 5

.2

8 150 170

.

5
.
 | 163

5 .

5 2 ( 20

20 2
).
.

120 5
.

5 170
)First in First out( FIFO
.

FIFO

.

5 5
.

2
.

.
 | 164

120 2
.

.

5

.
.

.

.

... .

.
 | 165

125
87. .

(
) .

87.
125 .

5 10 .

45 .

95 . 44
.

( 5
) .

.
 | 166

***

50
.

.
12 15
.

20
.
 | 167

. .

.

-
: .

.

.

.

.
.

.
.
 | 168

13.

: .
.

9 :
4 .



.

- 13
 | 169

.
2 .

.
 | 170

Total Quality Management

.

.
.

***
 | 171

.
.
.

.
.

. .

.

.
.
 | 172

/ ...

.
.

1 .
 | 173

:
.

.

.

-
.

.
.

.
.

.

.
.

First Impression 4
.
.
.
 | 174

.
.

***

When You Are Young, Work for Learn, not to Earn14

- 14
 | 175

.
.

.

. . 19:30
19:20 .

.

.

.
 | 176

.
:

. . .

:
.

. 5 .


.

.
.
.

: .

.

.
 | 177

. .
.
4
.

. .

21:30 -
.

BRT . .

BRT .

-
-
-

-

:
 | 178

. .

.


.

.
.
 | 179

15

. .
. . .
. .
.
.

.
. 99.99999999999999
.


.

- 15
( ) . 21
 | 180

-
.

***

.
.
.

.


.

.
.
.

.

 | 181