"In healthcare, understanding value to the patient customer is too often limited to reviewing patient satisfaction survey scores. ... Not that we think such scores have no value. However, patient satisfaction surveys are only one tool for defining customer value. Another tool we'd like to see doctors, nurses, and hospital administrators use on a regular basis is following a typical patient's journey end to end." [...] What we are talking about here is an end to end focus on healthcare delivery processes, which we call value streams, from the patient arrival at an Emergency Department (ED) to discharge or admission to the hospital, from the doctor's decision to schedule a patient for surgery to hospital discharge of the patient to a rehabilitation facility, from application of a patient for admission to a skilled nursing facility to discharge home, from receipt of an appointment reminder to completion of a routine physician office visit. It can also include a focus on the processes supporting delivery of care such as purchasing, replenishment of medication and supplies, and hiring staff. Why the insistence on an end-to-end focus on workflows or value streams when focus on improving isolated problems, sometimes called point kaizen, has saved thousands of healthcare dollars and improved quality of care? We'll answer with an example from one of our first ventures into healthcare."