ABSTRACT
This chapter describes how just-in-time teams and U-shaped cells are connected in a system using pull. Pull is a method for creating a system of production in which a downstream process producing to takt time signals to an upstream process that it is ready for the next patient, product, or other unit of work. Pull systems control the production of healthcare services. In healthcare, patients are frequently not stable, which means that their respective conditions may change unexpectedly, requiring new diagnoses and new treatments. In contrast, the traditional push production systems often used in healthcare depend on seeing patients, performing tests, and moving medicines and supplies according to separate, predetermined schedules. Pull systems are very responsive to changes in demand, and they eliminate many forms of waste including waiting for care and excess inventory. A typical kanban system uses four main types of kanban cards or devices: production kanban, rooming or restock kanban, move or supplier kanban, and exception kanban.
