How Kanban Saved a Salvation Army Hospital in Indonesia with Marcus Hammarberg

Marcus Hammarberg from Salvation Army Health was asked to help an Indonesian hospital get back on its feet after 5 years of decline, and he used Kanban boards as a core structure to the success they had.

Their operating permit was in temporary status, they weren’t making enough money to cover costs, and they were underpaying their staff. The roof was gone, and they had hit rock bottom.

He used the principles and foundation of kanban to help the hospital focus on what was important, and was the format for his presentation

  • Start where you are – avoid blame of why they were in this bad position, focus on where they needed to go next
  • Visualize – focus on getting more patient services performed in the hospital, from 70 to a target of 134 with a breakeven point of 120. Visualization must be big, easy, trending, with targets and updated at least weekly
  • Limit Work-In-Process (WIP) – Remodeled only some sections of the hospital, rearranged rooms to add more beds
  • Manage Flow – Reviewed data at morning prayer (huddle),
  • Make Process Policies Explicit – Established structure for content, communication and schedules, formalized requests to general manager
  • Initially, respect current roles, responsibilities and job titles – no one was fired
  • Implement Feedback Loops – Broke 120 services for 1st time about 2 weeks, and hit target of 134 after one month, and averaging over target after six months, implemented balanced scorecard
  • Improve collaboratively, evolve experimentally – implemented hypothesis driven business principles
  • Agree to pursue evolutionary change – embedding the principles into the culture, even after he left

You can order his book, “Salvation: The Bungsu Story: How Lean and Kanban saved a small hospital in Indonesia” at

You can watch his presentation below, or watch at