LHTI Cohort Year 1 Registration

Please review the requested information for Lean Healthcare Transformation Initiative’s Lean Cohort Year 1 and then have all information ready ahead of time to cut-and-paste it into this form. This form cannot be saved.

Site Contact

Each organization participating in the Lean Healthcare Transformation Initiative is required to designate a site contact responsible to serve as primary contact for the organization as it relates to logistics, planning, coordination of effort, and primary communication point with their organization. Please designate your site contact below.

Organization Name *

Site Contact Name *

Site Contact Email *

Site Contact Phone *

Working Agreement

A Statement of Work document can be found here. You can fill in the blanks electronically with the name of your organization (three fields) and the site contact’s information. Then print, sign, scan and upload the signed document below.

Upload signed Statement of Work *

Enterprise Strategy Session

PHA lean experts will guide each organization through a Lean Strategy Event. Training will be held in two (2) locations. Organizations will send the six (6) members of their core team to participate in the event. Please register each participant below.

The event will be January 17, 2019, on the Purdue University Main Campus in West Lafayette for Logansport Memorial Hospital, Dekalb Health, and Meridian Health Services.
The event will be held on January 24, 2019, in Tell City for Perry County Memorial Hospital and Southwestern Behavioral Health.

Lean Strategy Event Participants

Participant 1: Full Name *

Participant 2: Full Name *

Participant 3: Full name *

Participant 4: Full Name *

Participant 5: Full Name *

Participant 6: Full Name *

Participant 1: Title *

Participant 2: Title *

Participant 3: Title *

Participant 4: Title *

Participant 5: Title *

Participant 6: Title *

Participant 1: Email *

Participant 2: Email *

Participant 3: Email *

Participant 4: Email *

Participant 5: Email *

Participant 6: Email *

Lean Daily Improvement Training

PHA will train all members of the core team in Lean Daily Improvement (LDI) onsite at each organization during the month of March. The training session will be a two-day event, and the dates will be negotiated between the PHA Coach and Site Leader. We will use registrations for the Enterprise Strategy Session to provide the core team with access to the PHA Direct learning management system so that participants can initiate the training process for LDI.

Next Steps

Thank you for taking the time to register for the LHTI Cohort Year 1. PHA will send verification to all registrants and "cc" the main contact at each site by November 30th. Upon submission of this form, your main contact will receive an email confirming registration and listing your response.

LHTI Cohort Year 1 Registration

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