leanhealthcare_processgoalsA few weeks ago I was listening to sports talk radio and heard an interview with one of the top head coaches in college football – Nick Saban of the Alabama Crimson Tide.  At the time, Saban’s team was preparing for the semifinals of the college football playoffs – and we all know they won the game and went on to ultimately win the national championship title.

I am pretty sure Nick Saban doesn’t have a lot of experience with Lean principles, and even less experience with Lean Healthcare applications but, I was fascinated by his comments.  I later found many references when I googled Nick Saban’s process that he referred to in the interview – they go well beyond football to articles on leadership and management principles.

In the radio interview he was talking specifically about goals.  In 1998 when Saban was head coach at Michigan State, his team headed to Columbus to face No. 1 ranked Ohio State.  He instructed his team to simply focus on the next play like it was a game within itself and not worry about winning.  As soon as the whistle blew on each play, it was to be wiped from memory; all that mattered was the next play and zeroing in on what actions needed to be completed in order to “win” that play.

The result? Michigan State upset the Buckeyes 28-24 and that game became a critical part of Nick Saban’s path to be a premier coach.

For the Alabama football team, Saban described the process touting the attention to details:  ensuring that the team trained correctly every day, that they practiced correctly, and that the food they ate and the time they spent in repetitions was planned and orchestrated.  He explained that it is all about the details of the process that prepared the team to be ready to “win every play.”  And by focusing on every play as a game within the game, the outcome of “winning the game” becomes secondary, but in fact becomes reality.

What can we learn from Nick Saban’s process?  It’s paramount to have goals, but in order to reach those goals, one has to put ultimate focus on the small pieces it takes to achieve those goals.  This is the lean component of his process.

I was working with a hospital that, like many hospitals, was struggling with their HCAHPS scores.  This of course has multiple ramifications.  Most importantly, the customers were not satisfied with the quality of the service to the patients and their families.  Financially, that leads to a slippery slope when it comes to Medicare reimbursement rates.

The hospital staff felt like they lived and died with the weekly reports that would detail their success or failure.  Those outcomes drove constant adjustment and questioning.  Digging into comments and data trying to find a new root cause.  Reacting and then over-reacting again and again (to results that were sometimes good and sometimes bad but constant with inconsistency).

Sound familiar to anyone?

Their biggest issues concentrated around nurse communications and response.  They felt the path to success started with nursing hourly rounding, and that they had been focused on this – but the results were still inconsistent.

As the hospital began their journey to become a Lean Healthcare organization, they looked hard at the “process” and became less focused on the outcome.  Their process was redefined with standard work and behavior and staff were retrained with this standard work as the focus.  Instead of the quality organization acting as the auditor of the process, this duty became the fundamental task of their leadership standard work with detail on layered accountability though all levels of the organization.  This included clearly defined responsibilities and requirements for staff documentation for verification and validation that the standard work was occurring correctly and effectively.

This was reinforced with managers and directors leading role play and modeling sessions to further refine the staff skills.  The leadership utilized real time coaching and mentoring for staff feedback.

The result?  The process drove the outcome.  They were able to push over the reimbursement level for HCAHPS as an organization.  They have carried that forward and are now at levels they previously thought to be unreachable.  They still look at those outcomes and have at times had to refocus on the process.  But now they recognize that the process is what drives the outcome.  They know what they need to do to focus on the process and they are becoming better and better at understanding this concept and utilizing their leadership standard work to maintain that focus.

Like Nick Saban prepared his players to win every play, the hospital has prepared the staff to “win” every patient encounter.  Players or staff, focus on the process….let the outcomes be the result of that focus.


Steve Taninecz, Director for Lean Healthcare and Process Improvement at HPPToday’s blog was written by Steve Taninecz, director at HPP.

Steve has 40 years of experience in manufacturing and healthcare organizations.  Steve’s work in the healthcare field began as an educator, trainer and 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 Bachelor’s Degree from Youngstown State University in Industrial Management and a Master’s Degree in Organization Leadership from Geneva College.

Image by freepik

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