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Most people have started a web search for something of interest, and after a few clicks found not only the object of our search, but, off to the side, a list of suggested links to related items.

Packing for a recent Denver Health site visit with a client, I searched for:

“Denver Weather”

<Enter>

A link on the side:     Denver Climatology

<click>

A link on the side:     High Altitude Tips

<click>

“Drink water, dress in layers, eat foods high in potassium”

Interesting. I wasn’t really looking for that, but good information to know.  Maybe I should pack a banana for the potassium.

Why do I need extra potassium? Oh! Where was I?  All I really wanted was the weather forecast for the next two days…

Recently, my wife, a Tokyo native, asked if I had seen any videos of Michio Kaku, an American theoretical physicist of Japanese decent.  On the web you can find many interesting lectures along the lines of Richard Feynman and Carl Sagan.  So we watch a few videos, and then start exploring the links to the side.

You might be interested in:  Quotes by Carl Sagan

<click>

A few clicks later, I find:

“Science is a way of thinking much more than it is a body of knowledge.”

-  Carl Sagan

This quote struck me as very applicable to my Lean healthcare work.

I am often asked how to handle a given problem, “What does Lean healthcare say about Cath Lab scheduling?” (or another similar problem)  A look of anticipation suggests that I am supposed to dip into my “Lean Answers to Everything Book” and reply immediately with “The Profound Answer.”

The quickest answer is, “I don’t know, but let’s find out.”

Lean, like Sagan’s comment on science, is an approach to problems.  It is a way of thinking, not necessarily a collection of answers.  Lean healthcare tools and principles bring a scientific approach to problem solving that allows us to improve based on experiments.

For now, the best countermeasure (not necessarily a single “correct answer”) is a result of our tests in our environment with our people.  Different organizations or departments may even come to different answers given their different contexts:

Organization A: mostly diagnostic tests, with a small percentage of interventions

Organization B: regional cardiac referral center with a high percentage of unscheduled emergent interventions

Surely, there are different needs.  There is no single “Lean Answer.”  By applying a Lean way of thinking, we can define the issue, understand the current state, investigate the root cause and run tests to determine a new method that will improve on the initial problem (A3 Problem Solving, perhaps?).

As we go through these cycles of improvement, we often uncover more problems or opportunities, leading to more questions, leading to more “I don’t know,” more discoveries, more experiments, ad infinitum.

Much like a series of endless links on the web, Lean healthcare is a never-ending endeavor.


Today’s post was written by Richard Tucker, Vice President with HPP.

Richard has served as a coach, facilitator, and project manager for healthcare clients in the training and implementation of Lean Healthcare Tools and Methodologies. Prior to joining HPP, Richard had over sixteen years of business and industry experience in operational and leadership positions.  In addition to his ongoing support of healthcare organizations in their lean journey, Richard is a founding faculty member of Belmont University’s Lean Healthcare Certificate Course. Richard’s educational background includes BS and MS degrees from Tennessee Technological University in Cookeville, Tennessee. Richard has attended formal training courses in Lean Manufacturing, Leadership Development, and Shainin Statistical Problem Solving.

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Among the strategy board games that were stacked on bookshelves in my house as I grew up, I am reminded of one of them often in my work life: the Milton Bradley game Othello.

Lean Healthcare - A minute to learn, a lifetime to master

For those unfamiliar with the game, it’s a two-player strategy game consisting of a board of 64 squares and discs colored green on one side and white on the other. Players are assigned one of these two colors, and take turns placing that color on the board face up. For each turn, any of the discs that are in a straight line and bound by both the disc just played and another of that player’s color are turned over to become that player’s color. The goal is to end the game with the majority of the discs on the board being your color.

It sounds simple. The premise is easy to understand and the game can be picked up quickly; Othello is therefore appropriate for a large span of ages. However, the simplicity of the concept masks sophistication and strategy below the surface.

For me, the big lesson of the game is right on the Othello box: “A minute to learn, a lifetime to master.”

This is a phrase I’ve found useful in describing a lean healthcare transformation journey as well. What makes lean methodology so powerful is that at its core, the concepts are simple. The goal, and even the purpose, is to make the right work easier to do. In only an hour or so, we can teach healthcare professionals the basics, including understanding and recognizing waste, among other concepts.  And with just a few tools in the toolbox, most people have the rudimentary knowledge to work through an impressive range of problems.

However, this still is just barely scratching the surface of the time, understanding, and intensity required in a lean healthcare transformation; if the learning stopped there, the “transformation” would not occur. There are additional tools and concepts, as well as the supporting management systems and development of a culture of continuous improvement, all the while trying to work with leadership to internalize the concepts and determine how to best spread throughout the organization.

Still, none of the concepts above are particularly complicated on their own (at least the theory behind them; the implementation might be another story). But taken as a whole, it is a lengthy and difficult (and worthwhile) journey. The ideal state may be “mastery,” but even the best of us know achieving the ideal is impossible. A culture of continuous improvement dictates that there is always more to learn, and therefore, no end point. Striving to get there, however, brings us closer.


WilsonJamieRSToday’s blog was written by Jamie Wilson, Senior Manager with HPP.

Jamie has more than 10 years of healthcare experience, spanning management consulting, hospital administration, business development, and hospital operations performance improvement. She currently leads Lean Healthcare transformations and performs specialized consulting for HPP.  Jamie received her B.A. in Sociology with a dual concentration in Health and Medicine, Deviance and the Sociology of Law, graduating Summa Cum Laude from University of Pennsylvania. Additionally, Jamie received a M.S. in Healthcare Management and Policy from the Harvard University School of Public Health.

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We’ve previously discussed leadership standard work (LSW) and employee engagement. Now it’s time to get personal: what can you do to facilitate change in your organization?  It has been demonstrated that the simple (not necessarily easy) act of leaders going to gemba and engaging employees in reviews and coaching of their improvement accelerates positive change.  We have advised, encouraged, cajoled and at times preached (when zeal and frustration overcome sound coaching principles) this simple yet powerful leadership methodology.  Yet when LSW is introduced to leaders, there is often a reluctance to fully embrace it.

Simply sharing or teaching the concepts of gemba walks and coaching is insufficient.  For leaders to truly embrace the discipline, often they have to shift their underlying assumptions of how they lead. This shift of underlying assumptions that inform who they are, as defined by themselves, and how they behave (well-tuned habits) is a significant challenge to an organization’s adoption and inculcation of Lean philosophy and discipline.  It can be too great a risk to abandon old ways that led to previous successes, though it is easy to ask subordinates to adopt new ways of doing things.  Comfort zones are powerful barricades to personal change.

In the book “Leadership on the Line: Staying Alive through the Dangers of Leading,” authors Heifetz and Linsky describe an approach to identifying the habits that hold us in check as standing on the balcony, looking down on the dance floor[gemba].  This is the deliberate process of observing oneself within the act of leading. Very few of us naturally come to this. It is a discipline.  By observing ourselves and those we are interacting with in the moment provides powerful insights into our habits and behaviors as leaders, uncovering our blind spots and comfort zones.

So how do leaders get on the balcony?  One approach is to accept coaching from someone outside of the leader’s circle of influence.  A Lean Healthcare coach can observe the leader in action and reflect in a positive, constructive manner what has been observed.  The leader, receiving this feedback, can then make adjustments, often times incrementally, going back to the dance floor to test personal changes and Lean leadership practices. To receive coaching, the leader must, at a minimum, be open to the feedback and at least be willing to risk doing things differently.

Allow me to make an essential point to this approach.  Even if a leader sees anew how current habits and behaviors are impeding positive change, the true change occurs by doing.  The adage “behave your way into a new way of thinking” is essential and can be successful and less risky with a coach by the leader’s side.


KirkwoodBillRSToday’s post was written by Bill Kirkwood, Ph.D., Director at HPP.

Bill has 30 years healthcare leadership experience in both system and individual hospital settings in the Mid-West and North-East, and oversight of change management activities and Lean Transformation engagements.  This experience includes serving in an executive capacity in Quality, Operations and Human Resources. 

He holds a Masters in Health Administration from Xavier University and a Doctorate of Philosophy in Organizational Behavior from the Union Institute and University. 

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Lean Healthcare Staffing RatiosWhen beginning a Lean Healthcare journey, two questions commonly arise:  First:

“Do we need a dedicated Lean team?”  If so: 

“What is the appropriate size of the team to facilitate us to transformation?

Inevitably, leaders want reassurance that they have enough Lean resources to appropriately support the organization’s transformation, without becoming over-reliant on dedicated resources to perform improvement work that rightfully belongs to managers and staff.

The answer to the first question is a resounding yes.  Toyota, whose production system forms the foundation of Lean improvement, has been diligently improving their production system for more than 60 years, and to this day they have dedicated resources to facilitate ongoing improvement.  If Toyota needs dedicated Lean resources, so does your organization. However, this begs the question:

“What is the ideal level of staffing that should be dedicated to Lean improvement?”

In his book “Leading the Lean Enterprise Transformation,” George Koenigsaecker provides the highest staffing ratio recommendation I have seen. His recommendation is for three percent of the total population of a company to be dedicated to facilitating Lean activity (roughly one dedicated resource for every 33 staff members).  He elaborates that this is achievable by reinvesting a portion of the savings from improvement activities to fund these resources.  I agree that all Lean resources and activities can be self-funded by the benefits achieved from Lean improvements and transformation activities.  I also believe that the Lean resources within an organization should capture the value they are generating, both direct and indirect, as part of a balanced scorecard.

I have yet to encounter a Lean team that feels it is “big enough.”  Most teams readily name staff positions they yearn to add and activities that could be undertaken if only they had a larger budget.  My experience has shown that although the ideal staffing ratio for resources varies from one organization to another, achieving significant gains and successfully transforming an organization can occur with a much lower ratio of Lean resources to staff than 1:33.  On the high end, one hospital I have worked with has a ratio of one resource for every 200 staff members.  On the low end, another hospital I have worked with has one resource for every 700 staff members.  On average most hospitals pursuing a Lean Healthcare transformation have staffing ratios around 1:500, which is a ratio I recommend.

One caveat to this recommendation is that the number of resources should decrease as an organization matures with its Lean Healthcare transformation.  If one of the goals of your transformation is to turn staff members into problem solvers and managers into Lean leaders, then it seems reasonable to anticipate a reduced need for resources as your transformation spreads.  In the ideal scenario, every part of your organization will be continuously improving and a Lean department will not be needed.  But as was mentioned earlier, even Toyota continues to employ dedicated resources to facilitate Lean improvements.


Today’s blog was written by Aaron Fausz, Ph.D., Director at HPP

Aaron has twenty years of experience helping organizations align and improve their personnel and technical systems to accomplish strategic business objectives.  He has consulted with leading healthcare organizations across the country and has proven success guiding organizations through strategically driven changes and enhancing business performance.  Aaron also has significant experience in needs assessment, best practice analysis, performance measurement, process improvement, and behavioral change management.  

Aaron holds a Ph.D. in Industrial/Organizational Psychology from the University of Tennessee with a minor in Industrial Engineering.

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This blog is written in the format of SBAR:  situation, background, assessment, recommendation.  The SBAR framework was developed by Michael Leonard, MD, Physician Leader for Patient Safety, along with colleagues Doug Bonacum and Suzanne Graham at Kaiser Permanente of Colorado.  It was designed to give clinicians an easy-to-remember and standardized method of communicating in an efficient and focused manner.  It has been widely adopted across health systems as a way to foster teamwork and a culture of safety.

SITUATION:

In world of scorecards, typically red is bad and green is good.

BACKGROUND:

Lean Healthcare ScorecardMany organizations use color coding on dashboards or scorecards to indicate the acceptability of performance on indicators.

Green indicates that performance is good.  We are meeting targets and standards. Most typically green means we can relax.  We feel good.  We get paid bonuses.  Smiles and high fives are all around.

Red indicates the reverse:  performance is not up to par.  We try to avoid red at all costs but when we can’t we become frenzied.  We try as quickly as possible to explain why the data is wrong or to hunt down and blame those who caused the red.  We feel angry, embarrassed, and desperate.  We go home and kick the cat.

And how do we approach deciding what goes on our scorecards in the first place?  I submit as evidence a quote from a healthcare executive.  “It’s time to select our corporate scorecard indicators for next year.  Let’s find all the ones we know will stay green for the year!”

ASSESSMENT:

In the world of red is bad and green is good, we shortchange our organizations and our customers.  We settle.  We cease to dream, cease to strive, and cease to push ourselves toward excellence.  We fail ourselves.  We fail the patients.

RECOMMENDATION:

Celebrate red.  Use red to spur thoughtful focus on process improvement and problem solving.  See red as a way to demonstrate that we all have room to learn, grow and improve.  And, when everything is green, turn it all red by raising the standards so we continue to strive for the ideal.

QUESTIONS TO PONDER:

  • What would be the impact on your organization of viewing red as good?
  • What would it take in your organization to view red as good?  What systems and behaviors would have to change?
  • Which of your indicators is green today that you can turn red today by raising the standard?

 


Today’s blog was written by Blair Nickle, Sr. Manager at HPP.
 
For over 20 years Blair has dedicated her career to the improvement of processes, quality, safety, patient satisfaction, employee engagement, physician satisfaction, and financial vitality in healthcare organizations.  Her content areas of expertise include performance measurement and improvement methodologies, information systems implementation,strategic planning and deployment, project management, and human resource development.
 
Blair holds both a Master of Business Administration degree and a Master of Science in Library and Information Science degree from the University of Tennessee.  Her undergraduate work was performed at Emory & Henry College. 

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In a Lean Healthcare transformation, as problems are identified and the right tools are chosen to improve the problems, the right teams need to be selected to design and implement effective solutions.  Today I want to focus on team construct for a popular, yet often incorrectly-used tool: Kaizen.

For most three- to five-day Kaizen, or rapid improvement, events, a team should have 6 to 12 cross functional members. They should be focused on a problem that impacts most if not all of the team members.  It should also include a team leader and a sponsor who ultimately own the results and ongoing implementation.

It is easy to want to over-size a team to include many participants to support a given project, but this can be just as detrimental to the success of the team as not having enough participants involved.  Teams that are too large or have an improper mix are difficult to keep engaged.  Members get frustrated or bored and end up disengaged, causing disruption and delay.  A poorly constructed or defined team will not have time to implement many identified improvements during the week and will probably lose momentum in the following days and weeks.

It falls upon your sponsor and team leader to ensure this common problem is avoided:

Sponsor: Champion the improvement activity.

Avoid selecting sponsors just to get more people involved in sponsorship.  The sponsor should own the process that needs to be improved or should be a customer or supplier of the problematic process.  Sponsors also provide many of the resources needed to support the improvement activity and have the most to gain by having the problem improved.

Sponsors can provide support by spending time with the team.  They should review the problem and goals for the project and follow-up to insure the team is not struggling to progress.  Some teams stifle themselves when developing solutions for fear that it will not be well received by either leadership or co-workers.  The sponsor should assist with alleviating their fear and urge them to try their ideas.

Here are some no-no’s:  I’ve seen sponsors review a team’s progress and publicly voice that an idea is “stupid.” I’ve also heard team members state, “I wish they would just tell us what the answer is and I will go do it.”  A good sponsor will not determine the solutions for the team but make them feel their ideas are of value.  This also promotes culture change and the spread of continuous improvement throughout the organization.

Team Leader: Implement and sustain the results of the improvement activity.

A team leader, identified by a sponsor, typically serves as a direct report to the sponsor.  The team leader must have direct responsibility for the specific process that is to be improved.

A good team leader participates in an entire event.  They listen more than talk, ask questions to understand issues and avoid telling the group what should be done.  They also delegate responsibility and coach the team to ensure the completion of action and communication plans. They are careful not to take on the majority of the action items.

Four to six weeks prior to the start of the event, the sponsor and team leader should agree on the initial scope for the event along with the expected goals and possible team composition.

Good team members actively participate throughout the week identifying problems and solutions.  They take responsibility to complete action items and support the team’s decisions on what solutions will be tested or implemented to co-workers outside the team.

When composing the team, avoid adding members based solely on their availability or perhaps because they are a commonly used, known “good team member.”  Also, minimize team members whose motivation is to learn about Lean in order to check a box on a performance evaluation.

The best tool I’ve found for building a team is SIPOC (Supplier-Input-Process-Output-Customer). It is a great planning tool since it identifies the beginning, end and scope of the project along with the suppliers and customers of the process.  It also reveals additional information related to the inputs and outputs of each step in the process.  The below example was developed to select team members for an event which was intended to reduce discharge delays on a specific nursing unit..  Team members were chosen from the functions circled in red.

Lean Healthcare SIPOC

Many representatives should be front-line staff of the process targeted for improvement since they best understand segments of the process and have experienced the problems first-hand.

Call on ad hoc team members as needed. These are staff that have limited interaction or responsibility with a process but may be able to provide information about a part of the problem.  Don’t make them sit through an entire event.

Avoid having team members who just need to understand the solutions being implemented.  They can be updated and provide input during the week with scheduled informal report outs.

Projects with right sized teams chosen using the SIPOC method with a good sponsor and leader will be the most effective at achieving sustainable improvements.


This week’s blog was written by Linda Duvall, Director with HPP.

Linda leads Lean Healthcare transformation engagements for HPP. She has nearly 30 years of experience in business leadership, program management and lean transformation.  Prior to joining HPP, she worked for Vanguard Health Systems as a process improvement specialist providing leadership and support for regional and hospital level process improvement teams.  Linda holds a Bachelor’s degree in Industrial Engineering from the University of Evansville.

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I had the great pleasure to hear Dr. Deming speak at a packed Cobo Hall in Detroit in the late 1980’s.  Then in his late 80’s, he was a fascinating speaker that enthralled the audience with his philosophy of the changing role from manager to leader to transform a culture.

Lean Healthcare Management Systems Quote by William Edwards Deming

In Lean Healthcare, as your organization matures from a “lean tools application” organization to a “transforming culture with lean” organization, the processes and systems that support the workforce become critical for success.

These processes and systems are defined as the Lean Management System.  Dr. Deming had the knowledge that management’s role had to change in order for the culture to change.  He defined this changing role in his writings and teachings and it is exemplified in his overall philosophy.

Dr. Deming believed that you did not have to pick between quality and cost savings.  He taught that both could be achieved through practicing continual improvement and through systems thinking.

In his book, Out of the Crisis, Deming offered fourteen key principles (which later became Deming’s famous 14 points) for managers to utilize in transforming business effectiveness.  The book essentially launched the Total Quality Management movement; ironically, Deming never used the term “Total Quality Management” in the book.

I would like to examine three of the 14 principles as pre-cursors to Lean management system fundamentals.

Principle 1:  Create constancy of purpose toward improvement of product and service, with the aim to become competitive, stay in business and to provide jobs.

In a Lean Healthcare organization utilizing Lean management system thinking, this is exemplified by the Hoshin Kanri strategy: the deployment of the strategic business plan throughout the organization to ensure everyone is focused on the correct initiatives.  For example, from a service perspective, the senior staff will have key objectives and goals around customer feedback as measured by tools such as HCAHPS or Press-Ganey. For the senior staff, these are very high-level, but when these goals reach the unit level of the organization, they become very specific and focused on problem solving around detailed questions and statements.  This is the strength of Hoshin planning: that strategic alignment drives the organization.

I am currently helping a hospital through the process of a lean culture transformation and it is so empowering to see focus in areas as wide ranging as the emergency department to food services.  The transformation is consistently managed visually in each area through visual management boards that provide the plan for the day, and very importantly, the problem solving that defines the history of a problem.  The structured problem solving and the leading indicators to drive improvement show change within strategically aligned initiatives.  (I believe Deming would be proud to attend a team huddle and hear the passion and focus as the food services team drives “late trays” toward zero.)

Principle 2:  Adopt the new philosophy. We are in a new economic age. Western management must awaken to the challenge, must learn their responsibilities, and take on leadership for change.

Leadership for change is perhaps the most important aspect of a Lean management system.  This principle calls for leaders to lead the change, not manage it.  This is driven by behaviors like coaching, modeling, mentoring and empowering.  This is the leadership taking the responsibility for the transformation and actively leading the transformation.  This is going to the gemba.  This is leadership standard work driving accountability.  This is leaders leading.

Principle 14:  Put everybody in the company to work to accomplish the transformation. The transformation is everybody’s job.

An army of problem solvers includes everyone in the organization pulling the rope in the same direction.  Everyone in the organization must first understand the need for change and then embrace their role in that change model.  The model must be driven by the empowerment to solve staff’s own problems and be recognized for those efforts.

I once had an employee in a Toyota assembly plant who was installing tail-lights on Corollas tell me his job was to “solve problems.” He explained that installing the tail-lights was only the result of his efforts to perform the highest quality and most efficient job he could and to continually improve that process.

In any healthcare organization, the focus is the patient.  But the quality of care for that patient needs to be the result of staff empowered to improve their processes to take the quality of care to the next level.

Dr. Deming was certainly ahead of his time in his thinking of how to analyze and improve processes.  But, as vital as those statistical methods and process improvement applications were, they never could have sustained without his leadership philosophy of ownership and leading the transformational change.

I would like to offer one more Deming quote that parallels his philosophy with a Lean management system being critical to cultural transformation:

“The greatest waste in America is failure to use the abilities of people.”

As leaders in a transformation to a Lean Management System, this is truly is a guiding statement for success.


Today’s blog was written by Steve Taninecz, Director at HPP.

Steve has nearly 40 years of experience in manufacturing and healthcare organizations.  Steve’s work in the healthcare field began as an Educator/Trainer/Coach for the Pittsburgh Regional Health Initiative, then as part of a New England for-profit health system overseeing, counseling and coaching culture change to the hospital system’s leadership for the successful implementation of lean.  Steve holds a Bachelors Degree from Youngstown State University in Industrial Management and a Masters Degree in Organization Leadership from Geneva College.

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So how long does it take for a healthcare organization to truly practice Lean Healthcare on a daily basis?  I mean, really have it happening in front-line patient care?  You know, a point where leadership goes to Gemba each day and discusses visual management boards with staff, coaching and supporting the continuing improvement effort, cheerleading those who do the work, and leading the teams as they all work towards the ideal state of patient care?  Does it take one year?  Does it take five years, or maybe ten?  Most hospitals find themselves in an inescapable whirlwind of change, both internally and externally.  They do not have the luxury of time before they start thinking about a “plan B.”  A pivotal time for healthcare is here.

So what can I do as a leader to increase the likelihood that my hospital will successfully transition from the current state of doing business to a future state?  A future where everyone is hungry to solve the smallest of problems with the same tenacity as they would the most complicated of problems?  The answer is to acquire an appetite for Lean.

When you have an appetite for Lean, it means you live it every day in the work you do.  Everywhere you go, every meeting you attend or lead; your eyes, your ears, your thinking; the decisions and actions are all geared toward taking the organization a little closer to that future state where everyone is thinking about the customer and how they can make the right work easier to do.  When everyone in the organization stops thinking of Lean as one more chore on the pile, and decides that Lean Healthcare is the only thing we need to do in all the work of our hospital, that organization has acquired an appetite for Lean.

Leadership in any organization has a great advantage when it comes to leading a transformation to a Lean Healthcare way of viewing work, doing work, and solving problems.  The healthcare staff already follows leadership’s cues on what is important, what they are looking for from the troops, and what is rewarded.  All that is needed is for leadership to acquire an appetite for Lean and see it as the one way to do work.  The trickle-down effect goes into play.  Add to that advantage some staff training in Lean methodologies and tools, show them how it’s done, and the transformation begins!  When the appetite for Lean has been acquired by leadership, the transformation train picks up speed quickly.

A few suggestions on how leaders can begin to develop an appetite for Lean:

  1. Attend Lean leadership training sessions hosted by healthcare organizations that have been doing Lean successfully for years – I can personally recommend the Denver Health Executive Site Visit for a jump start.
  2. There are a variety of books written by healthcare leaders who have had a successful Lean transformation journey.  “On the Mend” by John Toussaint is a good one.
  3. Visit an organization that offers onsite Gemba training and observation.
  4. Pick a patient care service line at your own hospital or clinic and go see how it works first-hand.  There is nothing like observation to open the eyes of those who lead.

Because Lean Healthcare is done incrementally, any organization can make the journey.  One step at a time; leadership first, if you please.


This week’s blog was written by Matt Hanrion, Senior Manager with HPP.

Matt has more than 30 years experience with Lean and provides consulting services in a variety of areas within healthcare.  He is a lead trainer with HPP and has coordinated TQM teams within every area of a hospital system, developing and rolling out TQM education to staff.  Matt has a B.A. from Westminster University with a double major in Computer Science and Biblical Studies, and a M. Ed. in Education from Columbia International University.  In addition, Matt served in the US Pacific Naval Submarine Fleet as a Missile Launch Systems Petty Officer and is a Vietnam Veteran. 

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Lean Healthcare Team HuddleAs I was at my daughter’s hockey game this past weekend, I was watching the coach (my husband) make changes with the team between periods. The role of a coach is to motivate, hold players accountable, and make adjustments during the game to achieve a goal.  It was then that I realized how similar a sports coach and a supervisor or coach of a Lean Healthcare team are, and how both work to attain common goals.

Whether it be reaching the 90th percentile on your patient satisfaction scores or winning a state championship, every coach must be able to make adjustments leading up to and during the game. The scoreboard at a sporting event and your scorecard on a department’s visual Lean Healthcare Team Huddlemanagement board are instrumental tools designed to help achieve common goals. Both are indicators of your performance at that moment in time.   At the start of a game, the coach may tell players the position he or she will be playing, who will be playing, what to expect from the opposing team, and take a moment to see if there are any questions.  In between periods, the coach brings the team together to review what happened during that period, discuss what the players need to do to adjust to what they learned from that period, and again confirm that all players know what is expected of them.  After the game, the coach meets the team in the locker room to discuss what worked well, what they need to work on at practice to improve their game, and give positive feedback to keep the team motivated.

In a Lean Healthcare setting, a visual management board with daily huddles can do the same thing.  It may not be possible to bring your team together several times throughout your shift, but it should be possible to achieve a daily huddle to proactively discuss:

  • Patient schedule for the day
  • Do we anticipate any potential obstacles?
  • Is anything out of the ordinary happening at the facility?
  • Staffing for the day
  • Improvement opportunities – what are we tracking and what is our goal?
  • Staff time to share future improvement ideas

As a leader of a Lean Healthcare team, taking the time to huddle around your visual management board helps to ensure your team knows the plan for the day, what is expected of them and that they have support for critical decisions needed during the day.


Today’s blog was written by Nicole Einbeck,  Lean Design Consultant with HPP.

For nearly two decades, Nicole has worked in the healthcare field; from Human Resources and Risk Management, to Occupational & Employee Health, Safety/Wellness, and Process Improvement.  Most recently, Nicole spent the last five years assisting in the Lean Transformation process at Monroe Clinic, in Monroe, WI. 

Today, Nicole works primarily in healthcare lean led design revolving around new construction and move-in services, focusing her effort towards improving work flow and documenting new standards for clients. Her recent experience as the Move Project Manager and Process Improvement Specialist allows her to see the effectiveness of Lean tools furthering her development, understanding and expertise in coaching others to think and see differently. Nicole has a Bachelor’s degree in Health Promotion/Wellness and Psychology from the University of Wisconsin Stevens Point.

***Thanks to the Women’s Health Department at Monroe Clinic in Monroe WI for a shot of their team huddle***

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Most things cannot run themselves.  Even computers and robotics are not completely autonomous.  They need maintenance and improvement.  Let’s look at another example, the human body.  It too requires care and feeding.  If not properly cared for, it deteriorates prematurely.  In order to maintain good health and well-being, you must eat properly, get adequate sleep, exercise regularly, and so on.  These are processes which can deliver better outcomes.

Lean Healthcare Sustainability - The Missing LinkBut how do you know how you are doing?  There are feedback mechanisms that can help you.  You should check your weight daily, check your pulse while working out, check your physical measurements weekly and get an annual checkup from your physician.  These are measures.

You can also see what you look like in the mirror.  This is visual feedback.

These are components of a daily management system. I describe it simply as keeping a process “between the lines.”  It’s like driving a car:  Constantly looking at the road for potential hazards, adjusting steering and speed, obeying laws, and being safe.

What if you wanted to run a marathon?  Daily management alone is not going to get you there, since it’s about more than “keeping it between the lines;” you would have to improve your body in order to perform at a higher level. You would need a strategy and plan for executing that strategy. It would include gradually increasing the distance you could run over a number of months before the actual event.  You would have to change your diet and sleep, and measure your progress in order to perform at this higher level.  You would know daily whether you are ahead or behind your plan.  This is an example of strategic planning and deployment connected to your daily management system. I describe it as taking a process to a whole new performance level.

Healthcare leaders are struggling to understand why the Lean improvements they make are not sustaining.  They wonder why Lean is not self-sustaining, or autonomous.  The laws of nature and human behavior apply.  A body at rest will stay at rest unless some force is applied.  Work is required: a different kind of work, which will result in different behaviors and outcomes.

The Adult Behavioral Health department at a large safety net hospital had a goal to increase its number of patients with commercial health insurance.  They asked a local commercial payer how they could achieve this goal while providing better service.  They set up a process where the unit sends a text message containing their bed availability two times per day to patient evaluators for this insurance company.  The number of commercial health patients then increased significantly.  All was working well until management noticed that the number of commercial health patients dropped off dramatically in a particular month.  They contacted the commercial payer and found that they had stopped receiving texts.  The problem was corrected immediately and the nurse manager created a visual daily management system to ensure the texts were going out daily as planned.  The number of commercial health patients has not dropped since (keeping it between the lines).  No magic was used here, just discipline.

What are the benefits of a Daily Management System?  More stable processes and outcomes, comfort in knowing real-time what your problems are, a foundation for continuous improvement and engaged people, to name a few.

So what is the missing link?  The most overlooked part of Lean is the management system required.  Managing, maintaining, and improving your processes is the work of the leader.  No matter what management and improvement system you choose, it will require daily, weekly, monthly, and annual structured care and feeding.


Today’s blog was written by Dwayne Keller,  Senior Vice President with HPP.

Dwayne has more than 20 years’ experience in executive leadership positions. He has led a variety of projects to include Lean transformation, strategy deployment, and Lean-led facilities design, connected to each organization’s business case.  His breadth of experience combined with a deep understanding of Lean allows Dwayne to effectively mentor client leadership teams through the Lean transformation process.  Prior to HPP, Dwayne served as Executive Vice President of Operations with Medical Reimbursements of America (MRA). Healthcare executive teams visit MRA to learn from the Lean Revenue Cycle Management System Dwayne implemented.

He is an executive faculty member and instructor for Belmont University’s Lean Healthcare Certificate Course. Dwayne holds Master’s and Bachelor’s degrees in Mechanical Engineering from Bucknell University, and a MBA from Clemson University.

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