美国的医疗体系是个巨无霸，即使里面的小个头（指：医疗集团）都能吓死人，这远比一般的跨国公司复杂，但是他们仍然在努力的从组织和管理上推进绩效改进。
System Appleton Medical Center and Theda Clark Medical Center, both part of ThedaCare, a 5-hospital health care system with 40 sites and 5,500 employees serving approximately half a million people in northeastern Wisconsin.
Key Innovation: Collaborative Care, a model of general acute care. Lean methodology was used to redesign and reconfigure clinicians' roles, all acute care processes, and the physical setting to make them more efficient, effective, and patient-friendly.
System UPMC Health System (formerly known as the University of Pittsburgh Medical Center), a not-for-profit, integrated delivery system in western Pennsylvania with 20 hospitals, 2,700 employed physicians, 400 physician offices and outpatient sites, and a health insurance division.
Key Innovation: The Patient and Family Centered Care performance improvement program, housed at the Innovation Center at UPMC, in Pittsburgh. At eight of UPMC's twenty hospitals, working groups are redesigning health care processes by viewing all care experiences through the eyes of patients and their families.
source：doi: 10.1377/hlthaff.2011.0087 Health Aff March 2011 vol. 30 no. 3 422-425
doi: 10.1377/hlthaff.2011.0139 Health Aff March 2011 vol. 30 no. 3 400-403
