Early in my Lean healthcare journey, I was excited to learn the tools of Lean.  My first experience in a kaizen event had me hooked. I could see a team come up with, test, and implement a solution to a problem within one week.  My experience with process improvement teams prior to that included work that often took months to come to fruition and may or may not have delivered the sought-after outcomes.  However, I quickly learned that even the best ideas, testing and implementation plans could be undone with the lack of support by a well-intended management team.

One of the first publications I was exposed to that discussed Lean management systems was Creating a Lean Culture: Tools to Sustain Lean Conversions by David Mann.  Mann describes culture as an idea arising from an experience; as such it cannot be measured.  He further suggests that a management system drives the culture by sustaining and extending the gains from implementing Lean improvements.  As I have gained further experience in Lean healthcare, I find that a Lean management system is indeed the key to achieving high quality clinical outcomes, meeting our patients’ expectations, controlling the high cost of healthcare and providing an environment that is satisfying for those who provide the value in healthcare.

In working with many healthcare organizations to implement Lean management systems, I have found several key components make a difference:

  • Alignment of goals:  Whether you use traditional hoshin planning or another form of strategic planning, the critical element is alignment of all improvement activities to the organization’s strategic goals.
  • Disciplined adherence to process:  Managers who keep their eye on the process, knowing how well the process is meeting patient and customer expectations and how well staff are adhering to standard work of the process are essential in real time.  Retrospective reports from the last quarter or last month or even from last week’s performance are all too late.  Measurement of performance must move to the daily or hourly level of review to identify problems and make improvements as close to the work as possible.
  • Standard Work:  In order to ensure disciplined adherence to process, standard work must be defined both for the front line staff meeting the patient’s needs as well as leaders at every level of the organization who are monitoring and improving standard work.
  • Visual Management:  Getting everyone on the same page is much easier when the goals are displayed in a manner that is accessible and understandable to all.  In order to be understandable to all, process and outcome indicators need to be connected to the work done in each area.  As a staff member, if I cannot see how I can contribute, it is unlikely that the metrics posted will have much meaning to me, and I will not change my behavior to help move the metrics.
  • Coaching for Continuous Improvement:  Lean tools are often described as easy to understand, but not necessarily easy to apply.  Managers and leaders at all levels of a Lean healthcare  organization should move improvement activities out of a conference room and coach others in applying the tools to problems surfaced in real time.

Today, I still get jazzed by the ideas that front line staff come up with to test and implement in a kaizen event.  It is even more exciting when I see a manager coaching staff to make and sustain improvements through the use of Lean management skills.  A few examples I have been witness to at a current client include:


  • Increased new users in Pediatric and Internal medicine clinics
  • Diversifying insurance payer populations

Patient Safety & Quality

  • Increased vaccination rates for flu and pneumococcal immunization by 14% and 9% respectively
  • Increased colorectal screening

Patient Satisfaction

  • Improved inpatient OB patient satisfaction scores in understanding the purpose for taking medications by 45% and courtesy of staff by 75%


  • Improved clinic productivity from 74% to 91%
  • Reductions in med-surg monthly overtime from $21,000 to $2,343 per month an annual expense reduction of more than $220,000

Workplace Engagement

  • Reducing staff assaults from combative patients by 50%

These are just a few of the improvements that came from managers who led improvement at the front line, without kaizen events, which were aligned to the goals of the organization and came as a result of disciplined adherence to process.

Lean Management Systems workshop at Denver Health Lean AcademyNeed more information on implementing a Lean Management System?  The Denver Health Lean Academy is hosting a Lean Management Systems workshop January 29, 30 and 31, 2014, and a complementary Coaching for Optimal Lean Performance workshop on January 27 and 28. Attendees will leave with a personal action plan for their organization.  For more information and registration visit www.denverhealth.org/LeanAcademy.

This week’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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