Lean Healthcare Exchange

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Today we continue further into our “How to Create an A3” blog series.  Step 4 is Target Condition and Countermeasures.  In previous posts we covered defining the Problem Statement, Understanding the Current Condition, and Root Cause Analysis.

Target Condition is not the result you will achieve; it is an IDEAL state to strive for.  We do not just want to uncover solutions to problems; we want to design the work to create a new and better reality.  Bad systems beat good people, and our job is to change the system. Countermeasures, covered next week, are how you will change the work in order to get to the IDEAL state.  Toyota calls improvements countermeasures (rather than the ubiquitous “solutions”) because it implies:

a) We are countering a specific problem
b) It is what we will use now until we discover an even better countermeasure

When developing a Target Condition, you should strive to eliminate the work-arounds and re-work involved in the Current Condition.  Create a graphic of the IDEAL state (remember why we use graphics rather than text from our Current Condition explanation).  Rather than problematic storm clouds, we now have highlighted good features with fluffy clouds.  Remember, the IDEAL state should be defect free, no waste, and safe for all.

Applying this to our continued phlebotomy example, we can develop a target condition that might look like this:

Dan has 30 years of healthcare experience in many clinical and leadership roles. He leads Lean and process improvement consulting engagements for HPP.  His experience includes deploying Lean across numerous healthcare disciplines including Imaging, Laboratory, Nursing, Pharmacy, and Physician Offices.  Dan began his healthcare career as a nuclear pharmacist and has also severed as Director of Operations, responsible for 13 facilities.  He has been a featured speaker at a variety of healthcare industry events.

Dan holds a Master’s Degree in Business Administration from the University of Pittsburgh, Bachelor’s Degree in Pharmacy from Purdue University and a Specialty Certification in Nuclear Pharmacy from Butler University.

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Accountability is one of those words many people in healthcare throw around.

We all want it for ourselves and we especially want our employees to have it.  Few leaders know how to get it or how to give it.  Timothy Porter-O’Grady defines accountability as “A willingness to invest in decision-making and express ownership in those decisions.”  As such, accountability is a core component of Shared Governance.

You may be asking yourself, “Who cares, isn’t this site about Lean Healthcare?”

Exactly!  A mature lean healthcare organization is based on respect for people.  This concept includes moving decision-making to the highest level of expertise, which often is the lowest level of authority or title.  Systems and structures are necessary to support good decision making.  Following is a simple example that demonstrates these principles:

Vail Valley Medical Center is a 50-bed private community-based hospital which began implementing lean healthcare principles two-and-a-half years ago.  As part of their journey they have placed a heavy emphasis on A3 Problem Solving and have trained approximately 25 percent of their staff in this Lean Healthcare tool.  Recent training on lean management systems allowed charge nurses on a med-surg unit to apply their knowledge of Visual Management and A3 Problem Solving.

In developing their unit’s Visual Management, charge nurses Alissa Saari and Tania Boyd were coached by their CNO to align key areas of focus for the unit with overall organizational goals.  As with every patient care unit, expenses were of course among the top three focus areas.  Data for labor and non-labor expenses was provided to the charge nurses from the Director and was displayed on a bulletin board in the staff lounge.

This prompted conversations with staff on how the non-labor expenses could be decreased.  One observed issue was the disposal of non-used patient hygiene items at discharge.  By analyzing this issue, they realized nursing staff routinely brought these items to a room when a patient was admitted, whether or not a patient wanted or needed them.  The staff also knew that a second area of focus was patient satisfaction, especially improving scores around involving patients and families in decisions regarding their care.

After discussing the issue with Unit Healthcare Assistants a plan was developed to start the morning shift by rounding on patients, introducing themselves, and providing the patient with a list of hygiene items they might want.  Patients checked the items needed and those items were brought to the room.  Initial tests of this process included feedback from patients and staff which was overwhelmingly positive.  Unit Healthcare Assistants were thrilled that someone finally asked them what they could do to decrease expenses.

While the final data is being counted in terms of the impact this made on unit expenses and patient satisfaction, the charge nurses used a simple method of measurement by collecting the wash basins that were disposed of at discharge.  The before and after pictures of the wash basins were posted on the same unit bulletin board.  The sense of accountability and pride in the results is clearly evident in these pictures.

Imagine if 25 percent of your staff were accountable to implement small solutions to decrease expenses–what could happen in your organization?

Today’s blog was written by Maureen Sullivan, a senior associate at HPP.

Maureen has over 28 years of healthcare experience in clinical nursing, management and quality leadership to Healthcare Performance Partners.  As a registered nurse, Maureen’s clinical experience is in medical surgical nursing with progressive responsibilities in nursing management at the front line, middle management, and administrative levels.

Maureen has an associate degree in Nursing from Joliet Junior College and a bachelor of science in nursing with an emphasis in healthcare management from Metropolitan State College in Denver, Colorado. Maureen achieved certification from the National Association for Healthcare Quality, certified professional in healthcare quality (CPHQ), Colorado State University in process mapping, and University of Michigan in Lean Healthcare.

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There are many Lean tools available to use to improve a process.  But often times it is difficult to select the appropriate one because the issue is not clearly defined.  This leaves managers asking “What tool is the most appropriate? How do I communicate the need for this process change?  Is the issue worthy of a full Lean event such as Kaizen or can I solve the problem in a different way?”

The A3 approach might be the way to go.  What is A3?  By most people’s definition it is an international standard paper size similar to an 11 X 17 sheet of paper.  But in Lean terminology, it is more than that.  It can be waste-free report writing, a continuous improvement activity, a form of visual management, or a method of communication.  However you decide to use the tool, there are 6 steps to the process:

Step 1: Identify a Problem or Need

Step 2: Define the Current Condition

Step 3: Root Cause Analysis

Step 4: Target Condition and Countermeasures

Step 5: Implementation Plan

Step 6: Follow-Up Plan

Today’s blog will cover Step 1, Identifying a Problem or Need, or, the Problem Statement, with the other steps discussed in future posts.

There are few things both more fundamental and more frequently fouled than the problem statement. How you structure the problem statement determines your focus. Make sure your problem statement is actually about the current observable condition, not about a perceived solution, cause, or what you want.  Be descriptive, focus on the problem—not solutions. Do not combine multiple problems into one and provide background information that is essential to understanding the extent and importance of the problem—such as, how the problem was discovered, why the problem is important to the organization’s goals, the various parties involved, and the problem symptoms.  The problem statement could also be referred to as the issue and the background.

A problem statement in healthcare might look like this:

Phlebotomy draws by nursing staff often result in the wrong tube being used.  The problem started about 12 months ago when the laboratory issued 4 different reference guides and did not include photos.  This has resulted in re-draws of 25% and an increase in TAT of 50%.

Or this:

Denial correspondence from insurance companies is received by mail.  Processing this correspondence requires manual transportation of the paper information across 4 buildings.  This consumes the resources of 9 FTE’s resulting in TAT of 9-11 days, which is 125% greater than the dept. goal of 4 days.

Seems simple enough right?  The goal is to ensure that your problem does not suffer an identity crisis because it was not accurately defined.  Staying true to this one concept will keep your problem solving efforts on track and ensure success.

Stay tuned as we walk through each step in A3 problem solving? How do you structure your problem statements? How do you prevent jumping to conclusions?

Dan has 30 years of healthcare experience in many clinical and leadership roles. He leads Lean and process improvement consulting engagements for HPP.  His experience includes deploying Lean across numerous healthcare disciplines including Imaging, Laboratory, Nursing, Pharmacy, and Physician Offices.  Dan began his healthcare career as a nuclear pharmacist and has also severed as Director of Operations, responsible for 13 facilities.  He has been a featured speaker at a variety of healthcare industry events.

Dan holds a Master’s Degree in Business Administration from the University of Pittsburgh, Bachelor’s Degree in Pharmacy from Purdue University and a Specialty Certification in Nuclear Pharmacy from Butler University.

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Many healthcare organizations are embracing Lean Healthcare as a methodology for improved flow and efficiency.  However, many of these organizations are overlooking Reliability and Safety when it comes to patient care.  The elimination of defects, in regards to patient safety, in Lean Healthcare is called Reliability and Safety.

2012’s goals and objectives are in full swing.  Many have set targets for Ventilator Associated Pneumonia, Central Line Infections, Wrong Site Surgery, and other core measures and many of these targets will sound like, “Reduce by 25%” or “Lower percentage than 2011.”  These goals cause me to reflect back to when I was a young executive leader of an operation. 

Through our annual goal setting process targeting the corporate breakthrough objectives, we set a target of a 50% reduction in lost time accidents.  Ed Novonty, one of my early mentors, rejected this target through our ‘catch ball’ process.  I still recall his words, “Joe, I cannot accept that you are targeting to hurt 5 people next year.”  By saying this, Ed challenged me to look at the goal as though I were responsible for hurting these people, as opposed to generically reducing injuries.  My leadership team’s incentive was tied to meeting these goals.  Ed inquired about our process for accident investigation and about our leading indicators for such an objective.  After much discussion our target became zero.

This dialogue played out again when Cindy McDonald, Vice President for FirstHealth of the Carolinas, pitched to the board that we were embracing a strategy of ‘Achieving Zero.’  She explained that FirstHealth had made great strides.  Achieving linear improvement was not going to deliver patient expectations.  It required a new way of thinking and approach.  One event that could be prevented was one too many.  Who would volunteer their family member to be one of the patients that acquired Ventilator Associated Pneumonia or develop a Surgical Site Infection while still meeting target?  I observed physicians stepping up to become team leaders.  Each event was investigated in detail, leading indicators were developed, response teams were established, and Six Sigma was applied to the potential patient population.

According to Weick and Sutcliffe in their breakthrough book “Managing the Unexpected:  Assuring High Performance in an Age of Complexity,” FirstHealth was taking the next step in their three year journey of Just Culture to a deeper Mindfulness.   Reliability and Safety is an integral part of Lean Healthcare.

So, the question remains: “What is your healthcare organization’s target for hurting patients this year?”

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Meetings are a necessary evil.  Really.  There is no other way to rapidly and effectively make decisions.  As a matter of fact, that is my rule of thumb.  When I evaluate whether a meeting is effective, or whether I am going to attend one, I look to see if there is clearly defined decision to be made.  I use this rule of thumb to cancel or redirect the agenda for meetings.

Hypothesis:  IF meetings were used to only make decisions, THEN thousands of hours of employees time could be saved and used for activities that Add Value to the Customer.

In many cases meetings are used in place of following PDCA: Plan Do Check Act.  I call these “get-togethers.” There is not a clear meeting purpose (problem) or agenda communicated before the meeting.  Not all of the right people are invited that are needed to make decisions.  People show up without data or facts based on Observation. They show up late and end late.  Actually you should finish 5 minutes early in order to have time to get to the next task on your calendar.  The Scientific Method is not followed when problem-solving. There is not any action items assigned nor is there any follow up.  The Waste is abundant when PDCA is not employed in meetings.

Our time is too precious and our resources are too thin to not critically evaluate the value of every meeting we call or attend. Meetings can be a huge source of Waste without discipline.  I encourage you to Observe every meeting you are in over the next week and evaluate whether at least one decision was made in each one.  I think you will be both surprised and excited about the amount of time that can be freed up for your organization and you!

This week’s article was written by guest author, Dwayne Keller. Dwayne is the Executive VP of Operations and Process Improvement for Medical Reimbursements of America. He has over 25 years of leadership experience in the implementation of Lean Healthcare in various hospital systems and healthcare settings, He coaches at all levels of Healthcare organizations, from CEO to front line staff to deliver improved outcomes via Lean. His deep understanding of Lean as a holistic process improvement “system,” and leadership guidance in connecting Lean implementation to each organization’s specific business case needs in a visual way, sets him apart in the industry. Dwayne has also been a speaker and lecturer at various Lean Enterprise conferences as well as a presenter at the Shingo Prize Conference. Dwayne received an MBA from Clemson University and hold both a Master’s and Bachelor’s degree in Mechanical Engineering from Bucknell University.

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We have come full circle on the role of a manager in engaging others in healthcare  improvement with Lean Healthcare Exchange’s last blog sharing coaching’s importance. This week’s blog puts it all together for the manager in their work to make quality healthcare more reliable.

We improve healthcare to make it more reliable. Reliability may be defined as meeting expectations over an intended time. Readmissions is an example where reliability has not been met and we all know the increasing cost of readmissions as we enter this new phase of reimbursement. I thank a physician friend of mine at Massachusetts General Hospital for bringing this focus even clearer to me as I help organizations choose work for their teams. My company’s motto is, “Making Quality Healthcare More Affordable.” Improving reliability, in turn, improves affordability.

Let’s look back to a November blog with the story of Dr. Semmelweis and how his leadership failed in its role of coaching, supporting and leveraging unquestionable safety improvement – washing hands saves mothers’ lives. Finally, in a blog posted recently, “Leadership Advantage,”  Brad Schultz shared the importance of coaching for continuous improvement and sustaining the gains – reliability. Let’s apply the key point of coaching and reliability to the story about Dr. Semmelweis. Dr. Semmelweis’ improvements met expectations in saving mothers’ lives, but his leadership failed to coach others in the techniques and also failed in its role of leveraging standard work. Thus, Dr. Semmelweis’ improvemenets failed to sustain and thus caused a lack of reliability.

In between these two blogs is “Closer To The Problem.” This is a very important point for managers at every level. Tom Stoffel writes, “Data and reports may be reviewed regularly by top leaders at a facility, however, when we move the data closer to the problems – day-to-day problems – we are closer to making lasting and necessary improvements possible.” The OR turnaround time improved – reliability improved – when measured close to the problem, and staff and management used the measurement system to control the process. Dr. Semmelweis had the data close to the problem by sharing it with his colleagues, we think, but what failed is the manager in his role to coach continuous improvement.

Key point: Managers who measure new ideas to improve reliability get new ideas from staff. What’s the saying; “If you want it, measure it?” If we want managers to coach others to improve healthcare, maybe the first data an organization should consider are the number of implemented ideas. Roll this up by manager and maybe we will find those managers who are better at coaching for continuous improvement and higher reliability.

Here’s a tip if you want to try these suggestions. Make measuring ideas easy. Simply count the number of legitimate A3s implemented.  Place a bin in the work area and a chart above it showing the number of A3s implemented. Visual Management applied! Sometimes, just measuring will create the improvements. Good luck and let me know if you try it.

This week’s blog was written by Rick Morrow, a Director at HPP. Rick has 25 years of leadership experience in healthcare, aviation, automotive, supply chain and technology. Prior to HPP, Rick held the position of Director, Business Excellence with The Joint Commission and led the Center for Transforming Healthcare. Prior to the Joint Commission, Rick held senior level Continuous Improvement positions with United Airlines, Motorola, SKF and Eaton. As Vice President at SKF, a firm known as a leader in reliability, his LSS was credited with achieving Zero Defect processes which he then rolled out internationally. At Motorola, he directed the quality turnaround of its safety product, OnStar. He wrote Motorola’s corporate-wide Lean courses and led the strategic and tactical planning using TPS globally. Certifications include Motorola Master Black Belt and a MBA from the University of Illinois’ Executive Program. He is an international speaker on Lean and Six Sigma at conferences including NPSF, ASC and ASQ. Rick is a contributing editor on safety publications.

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I was working in an operating room last week with a team of OR staff.  We were improving operating room turnaround times using Lean Healthcare principles.  Part of the process was to identify how long it should take to set up the next case.  As you may guess, the overwhelming answer was, “it depends.”  In fact, the team observed and identified that the amount of time it takes to turn over a room depends on many factors. 

However, you could have knocked me over with a feather when the OR charge nurse commented, “If we had access to this room turnaround data, we could review it weekly.  We could look at it and recall what happened in particular cases to cause the turnaround time to be longer than expected.  Then we could address those issues in the moment.”

Here is the back story to explain why I was so pleasantly surprised:

First of all, for those that have studied Lean Healthcare you recognize that Lean is a problem-solving methodology.  We like to remind the staff with whom we work that Lean Healthcare is about “making the right work easier to do.”  Of course, a prerequisite for effective problem solving is that we know why something is a problem.  Previous to our Lean efforts, operating room statistics, including turnaround time, were published monthly.  The data was posted on the wall near the break room and was promptly ignored by staff (I refer to this as autopsy data.  The patient is already dead and we are just finding out the cause of death).  Nobody cared about the data because it seemed irrelevant.  There was no connection between the data and the daily pulse of the OR.

Secondly, we had been working at this particular facility for months trying to pull together data in order to provide clean statistics for room turnaround.  We had progressed from the monthly posting of data to weekly.  We had the ability to break down the turnover times by operating room and by staff.  In fact, the OR had even included the data in their weekly newsletter.  And yet, turnover times had only improved marginally.  Front line staff members were still waiting for the Lean team to solve their problems.  It wasn’t until the charge nurse brought the data closer to the problem — a weekly review with key staff and anesthesia — that they made the connection between the data and the day-to-day. 

There is much evidence that the current healthcare system is in crisis. There are countless problems plaguing a system which spends too much and delivers too slowly.  A key component to transforming healthcare will be tapping into the natural problem-solving skills of the frontline workers.  Data and reports may be reviewed regularly by top leaders at a facility, however, when we move the data closer to the problems – day-to-day problems – we are closer to making lasting and necessary improvements possible.

This week’s article was written by Tom Stoffel, a director & consultant for HPP. Before joining HPP, Tom served as President of Transformation Group, Inc,. Tom developed TGI Healing Healthcare – a brand of Lean Healthcare training tools designed to share lean principles through hands-on learning. Tom has led healthcare organizations in both the development of high-level Lean Strategies down to hands-on implementation of Lean in a clinical setting. Tom has achieved the levels of Certified Lean Specialist from the Business Improvement Group and the National Institute of Standards and Technology (NIST), along with being an ASQ Certified Quality Engineer. These certifications build on an Engineering Degree from the University of Michigan. Training experience includes Lean, Quality, and Leadership Training, as well as serving as an Adjunct Faculty Member at Waubonsee Community College.

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How many times have you heard, or said, these exact words? In my experience, this phrase begins to echo during brainstorming or when solutions are being created by a team during a rapid improvement activity.

Another common statement is, “We met, talked about some of these same issues and discussed potential solutions…”

However, nothing happened next.

I myself can recall saying the same things.  So, if solutions have been known or pointed out in the past, why hasn’t anyone solved them? Why is it taking us so long to solve them, and why does it seem that the same issues keep coming back?  A key question to ask is, “Who will start solving these issues or breakdowns that have been hanging around and are chipping away from our productivity and goals?”  Well, these are all great questions and often the solutions are not that easy.

I can remember a wonderful and talented director I coached a few years ago. Sherri was handpicked by an executive member to change things around in the department.  She was in one of my A3 classes and she was definitely a star student.  At the end of one of the sessions she invited me to tour the department.  She gave me a quick history and tour of the department and clearly pointed out processes, procedures and areas where she had led and implemented changes.

“Things are a little more stable now, however, on a daily basis it seems that I get intertwined with all sorts of fire fighting from light bulbs needing changing, to billing process with errors, all the way up to patients and physicians being dissatisfied.  It just seems that the minute I walk in those doors, I put a fire hat on, and boy, I start running.”

Sherri was a well respected leader and everyone in her department was excited to have her as their leader.  So, I looked at her and asked her with a smile, “How can I help you Sherri?”

“Well Alex, I will be honest with you, today in the A3 class I was a little embarrassed when one of my staff members brought out an issue that she has never shared with me before, but she felt very comfortable sharing it to the class.  She also added that she has been telling leadership about this particular issue for years.  She’s a great employee with great ideas and a great attitude.   I want my staff to feel comfortable to come up to me and tell me things.   I don’t want them to think or feel that I’m the same old run of the mill leader.”  I was very impressed with Sherri’s desire to win, and not being afraid to try new things. 

“Well Sherri, A3 is a great tool to use in solving issues and eliminating them, but let’s start with you.  In a way, you have become the one with all the answers, the one to go to when any issues arise no matter the size of the issues.  Everyone expects for you to fix everything every time.  For you, this will only frustrate you and eventually burn you out.  For them, they will receive very little coaching and development structure from you and both the staff and the department will never achieve and operate at their full potential.”

While there are many ways to start correcting and changing these behaviors, I got Sherri started with the following:

• Change and challenge your daily actions and activities often.  Ask yourself, ‘does what I’m doing really focus on improving patient care? Am I creating a proactive team that takes steps to solve problems as they emerge?’ Become the compass.
• You must share and communicate clearly both what the right work should be and its purpose.
• Create a simple, realistic, and manageable platform that you can review on a daily basis.
• Establish responsibility and ownership. Provide them with the right tools and training to win, but first start with one tool.  This means that some staff members will challenge your actions and decisions.
• Celebrate your wins and successes. Reward your team for their accomplishments.  Make it big and known to all.  In healthcare this is often a missed action item.

“Please remember Sherri, this is just a start.  As your team starts to function as potential championship contenders, your role will then be to create a climate where your staff’s worth is determined by their willingness to learn new skills and grab new responsibilities, thus perpetually reinventing their jobs.  The question then becomes not what they have known or what they have been saying for years, but rather how much they have improved their work for years.”

“The day soldiers stop bringing you their problems is the day you have stopped leading them.  They have either lost confidence that you can help them or concluded that you do not care. Either case is a failure of leadership.”

— Colin Powell, Ret. Gen. & Chairman of the Joint Chiefs of Staff

This week’s blog was written by Alex Maldonado, an associate with HPP. Alex’s professional experience includes process improvement, operational, and leadership positions in the medical delivery systems and appliance manufacturing industries with Baxter Healthcare and Whirlpool. Alex has had a successful track record in improving results-driven processes with an emphasis in personnel training, project leadership, and operating systems designed to improve customer service and sustainability. He has led the development and implementation of processes to support Lean initiatives that reduce critical path lead-time, reduce expediting costs, capital improvement projects, inventory reduction, and trained and educated staff/employees in Lean Methodology. Alex is well recognized in the following areas: Value Stream Mapping, Hoshin Strategic Planning, Office and Floor 5S, Total Productive Maintenance (TPM), Process Failure Modes and Effect Analysis (PFMEA), Quality Improvements and Mistake Proofing, Six Sigma, Cellular Design, Standardize Work, Pull Systems (kanb an), Equipment Design and Installation (DFLMA), and Safety Programs. He has a B.S. in Industrial Technology Engineering from Mississippi State University and has also completed the Six-Sigma black belt program.

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I was sitting at the stop light and just as the light changed, my wife said “There’s a blue light.”  So I hesitated before going, checking for a police car.

“Why didn’t you go?” she asked.
“Because you said there was a blue light.”
Confused, we both let the conversation fade away.

After several instances of this, I asked her why she kept telling me she saw a blue light and she asked why I didn’t go when the light turned blue.
“When the light turned blue?”  Hmmm.  Sounds like we have a failure to communicate.

My wife is from Japan and in Japan, the shade of green used on some traffic lights here in the United States (a bluish, aquamarine sort of green) would be called “blue”.  I think I would call the “go” light on a traffic light “green”, even if it was purple, because for me “green” and “go” are synonymous.  Unfortunately, I cannot convey in writing the big “ah-hah” feeling we both had when we finally figured this out.

So it must be because of the language difference, right?  Maybe not.  You would be amazed to see the number of times we see communication problems because of unclear definitions and using the same word to mean different things in healthcare.

A recent value stream mapping exercise brought out the fact that one root cause of patient flow problems in a surgery department was that “ready” did not mean the same thing to everyone. For a surgeon or circulating nurse, “ready” meant “the patient can roll to the OR”.  For an outpatient nurse, “ready” meant “I have done everything that I am supposed to do.” Patient prepped, IV started,  labs drawn and sent to lab.  But, the lab results may not be back and H&P needs to be signed.  Was she wrong?  Not really.  From her perspective, she was “ready” to move on to the next patient.

So you can imagine the communication problems that resulted from this.

But this is not an isolated incident.  I have seen this same “ready” problem at hospitals in two different states.  I have seen heated discussions over what was and was not happening in a process only to find out (after 3 days!) that the root of the miscommunication was using the same word to mean different things.

The doctor tells the patient that they have “discharged” them.  For the doctor this meant they wrote the order.  But the nurse may have to draw final labs and give discharge instructions before the patient can leave the building.  Transport will say they have discharged the patient when they take them to their car.  Bed Control may say the patient was NOT discharged even if the patient is gone because the discharge is not entered into the electronic tracking system.  You’ll get three or four different answers depending on who you ask.  And the patient feels like they have been kidnapped because they can’t leave even though the doctor already “discharged” them.

So the next time you are trying to understand a process, don’t assume you know what people mean. Listen to make sure that they are not using the same words to mean different things.  You may have a few ah-hah moments of your own.

This week’s blog was written by Richard Tucker. Richard is a Director with HPP and has served as a coach, facilitator, and project manager for healthcare clients in the training and implementation of Lean Healthcare Tools and Methodologies. In addition to his ongoing support of healthcare organizations in their lean journey, Richard is a faculty member of Belmont University’s Lean Healthcare Certificate Course. Richard’s educational background includes BS and MS degrees in Engineering from Tennessee Technological University in Cookeville, Tennessee. Richard has attended formal training courses in Lean Manufacturing, Leadership Development, and Shainin Statistical Problem Solving in Japan, where he spent a great deal of time learning Lean and Quality Methodologies.

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