An introduction to 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 and practice. Our values include respect for people (humility, compassion, equity, and dignity) and continuous improvement (challenge, “go and see” to understand, kaizen, 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)

Performance improvement using lean

The San Francisco Department of Public Health has embraced lean for performance improvement. The Population Health Division has adapted lean to accommodate community health and human-centered improvement and design methods (collective impact, Results-Based Accountability, design thinking, etc.).

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.

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

The Figure 1 (above) and Figure 2 (below) summarizes the key organizational components of lean:

  1. Values: the embodiment of values, especially the universal values of humility, compassion, equity (fairness), and dignity, that transform culture. Universal values apply to everyone and everywhere on earth. We strive to embody these values everyday and in every decision, action, and conversation. When we witness the serious violations of these values, we stand with a courageous and compassionate heart, and we speak out to right wrongs. And, we feel supported and validated by our organizational culture and leadership.
  2. Mindset: the lean principles that drive behaviors that enable people, improve processes, and align activities to transform systems and deliver results.
  3. True North metrics: a balanced scorecard to ensure organizational value pillars (respect for people and continuous improvement) are transformed into real world results (metrics), and that our activities are well balanced, healthy, improving, and sustainable.
  4. Mission: What we do and the results that matter.
  5. Vision: Our aspirational impact for ourselves and San Francsico.
Population health lean: read from the bottom up
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. leadership 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.; 2017. Available from


  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. ^
Tomás J. Aragón
Health Officer, City & County of San Francisco; Director, Population Health Division