Population health lean

For transforming organizations and communities, the San Francisco Department of Public Health, Population Health Division has embraced population health lean—a transdisciplinary management system for learning, adaptation, innovation, and continuous improvement based on the Toyota Production System (lean), collective impact and other methods. Our training focus is on lean thinking. Our core values include respect for people (humility, dignity, equity, and compassion) and continuous improvement (challenge, “go and see” to understand [genchi genbutsu], and teamwork).

Humans have three core cognitive-behavioral processes: deciding, acting, and learning. These processes—mediated by emotions—are fundamental to all human activities, and form the basis for innovation and continuous improvement (think D-A-L-E!).1 Adaptation comes from adjusting our decisions and actions based on what we learn. Improvements are adaptations that make things better.

To become a learning organization, we must ensure:

  1. decision quality (decisions, supported by data science)
  2. strategic execution (actions: project and portfolio management)
  3. performance improvement (learning: improved processes lead to improved results)
  4. positive and safe environments (emotions: emotional, physical, environmental, and cultural safety)

Population health is “a systems framework for studying and improving the health of populations through collective action and learning.” Lean practice is “systematically developing people to solve problems and consuming the fewest possible resources while continuously improving processes to provide value to community members and prosperity to society.” Population health lean (PHL) is a transdisciplinary management system for continuous learning, adaptation, innovation, and improvement based on lean thinking and practice, the PHL leadership philosophy, and complementary frameworks.

Figure 1. Population health lean: transdisciplinary management system for learning, adaptation, innovation, and improvement

Population health lean leadership philosophy

The leadership philosophy is a framework (Figure 2) to promote and support lean

  1. values, mindset (principles), skillset, and toolset,
  2. behaviors,
  3. people development,
  4. scientific problem-solving,
  5. daily management, and
  6. leading change.
Population health lean leadership philosophy is a framework to promote and support (a) values and principles (mindset), (b) behaviors, (e) people development, (d) scientific problem-solving, (c) daily management, and (f) leading change.

Read full document here:

Aragón TJ, Garcia BA. We will be the best at getting better! An introduction to population health lean. eScholarship.org; 2017. Available from https://escholarship.org/uc/item/825430qn (Dropbox)


  1. Think D-A-L-E! DALE is a cyle and can start at any step. Learning comes from observation, reasoning, and reflection. This triggers emotions that influence decisions that lead to actions. This can also be translated into the cognitive-emotional-behavioral model where “cognitive” includes decision-making and learning. DALE also aligns with the “crucial conversations” model called Path to Action: See and hear $\rightarrow$ Tell a story $\rightarrow$ Feel $\rightarrow$ Act. ^