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A Vision for Lean Healthcare

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Presented at the Virtual Lean Summit 2020 - Thanks to Dubai Quality Group and the Lean Gulf Institute for the invitation to speak and share.

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A Vision for Lean Healthcare

  1. A Vision for Lean Healthcare Mark Graban President Constancy, Inc. Slides & Resources: https://www.markgraban.com/virtual2020/
  2. Thanks to:
  3. Slides & Resources: https://www.markgraban.com/virtual2020/
  4. What problem(s) are we trying to solve?
  5. The Goals That Matter in Any Organization • Safety • Quality • Delivery / Access • Cost • Morale
  6. Leanness is measured by outcomes, not by the number of tools that are implemented
  7. Lean Benefits Many Stakeholders • Patients
  8. Lean Benefits Many Stakeholders • Patients • Providers • Payors • Facility Owners
  9. Value is Defined by the Customer (Patient) • Not just “safe treatment” • Health • Longevity • Quality of Life
  10. The Best Patient Experience is a Safe One Dr. Eric Dickson CEO of UMass Memorial Health Care “First, don't kill me if I come to your hospital. Second don't hurt me.”
  11. “Lean” ala The Machine That Changed the World HALF
  12. “Lean” ala The Machine That Changed the World “Lean production… uses less of everything compared with mass production — half the human effort in the factory, half the manufacturing space, half the investment in tools, half the engineering hours to develop a new product in half the time. Also, it requires keeping far less than half the needed inventory on site, results in many fewer defects, and produces a greater and ever growing variety of products.”
  13. “Lean” ala The Machine That Changed the World • Half the errors • Half the infections • Half the patient harm • Half the waiting time • Half the length of stay • Half the head count (or more likely, half the employee turnover) • Half the cost • Half the space • Half the complaints from patients and physicians
  14. Aim for Perfection – The Ideal State “Lean producers, on the other hand, set their sights explicitly on perfection: continually declining costs, zero defects, zero inventories, and endless product variety. | Of course, no lean producer has ever reached this promised land — and perhaps none ever will…”
  15. Aim for Perfection – The Ideal State • ZERO harm to patients or staff • ZERO delays • ZERO angry customers • ZERO voluntary staff turnover
  16. Paul O’Neill (1935 – 2020) • CEO of Alcoa • Pittsburgh Regional Health Initiative • U.S. Treasury Secretary Goal: ZERO lost work time injuries “People should not be hurt who work for Alcoa. It’s not a priority. It’s a precondition.”
  17. “Theoretical Limits” – Paul O’Neill • Leaders set goals at the theoretical limit of performance • Leaders eliminate excuses in the organization
  18. What’s Possible – Dr. Richard Shannon
  19. “Where care comes to you.” Park Nicollet Frauenshuh Cancer Center
  20. Right Care, Right Place, Right Time
  21. Lean Hospitals for Patients • Passionately and meticulously focused on the patients, families, and guests, aiming for perfect, harm-free care, while respecting patients and their time
  22. Lean Hospitals for Patients • The patient comes first in all activities, decisions, and priorities • Leadership helps create that expectation with all stakeholders • Clinical care • Excellent service • Caring environment • Address physical and emotional needs Cleveland Clinic
  23. What would the Patient Experience in a Lean Outpatient Surgery Center? • Everything is communicated properly in advance • Arrival and parking is hassle free • Registration without repetition • Safe, high quality care (“perfect care”) • Excellence service • Family / parents get great service while waiting • Perfect communication on discharge • Accurate and understandable billing statement
  24. Lean Hospitals for Staff • A Lean hospital recognizes that employees are the true source of value for patients and the hospital, rather than being viewed strictly as a cost to be reduced • Top leadership makes a consistent commitment to all employees that Lean improvements will not lead to layoffs
  25. Lean Hospitals for Staff • Does not overburden employees with more work than can be done in a high-quality manner, • Nor does it pressure people to work harder or be more careful as a means to quality, safety, or efficiency • Employees are not sent home every time census drops, as that is seen as an opportunity for kaizen
  26. Lean Hospitals for Staff • To be challenged to grow, personally and professionally, always striving to learn and improve his or her technical, leadership, and problem-solving skills • To feel a sense of pride for contributing to a high-performance organization, for understanding his or her role and how his or her work impacts patients, coworkers, the hospital’s bottom line, and the community
  27. Lean Hospital Mindsets • Efforts and goals are tightly integrated with hospital strategy and vision, moving beyond the isolated use of tools to the engagement of all employees and leaders in the building of a Lean culture • Realize that success comes not only from technology and clinical excellence, but also through employee engagement and operational excellence • Has a leadership method and model that is taught to supervisors and managers and is practiced by all leaders, used as criteria for selection and advancement
  28. Lean Hospital Mindsets (2) • Creates collaborative relationships for all partners and stakeholders, including physicians, vendors, and payers • Patient safety practices and quality data are shared openly with other hospitals and the community • Has specific leaders who are responsible for the overall flow, management, and improvement of key patient care value streams • Determines proper staffing levels based on patient volumes, actual workloads, and the time required to do work in a safe, high-quality way • Best attempts are made to match staffing to volume in different time periods
  29. Lean Hospital Mindsets (3) • Proactively fixes problems and reduces waste, rather than being strictly reactive • Employees are encouraged to expose waste and make improvements to the system, instead of hiding problems and making things look good • Breaks down departmental silos to focus on improving care and preventing delays for patients, allowing employees to feel pride in their work • Never satisfied with being better than average, being in a top percentile, or with winning awards; it always strives to get better
  30. Lean Hospital Mindsets (4) • Designed to minimize waste for patients and for all who work inside its walls • It is designed with direct input from staff to support efficient workflows and value streams, rather than forcing departments and employees to adjust their work to the space. • Has process technology, automation, and information systems that make work easier or less error-prone • The hospital does not install automation or new systems for the sake of having new systems
  31. Lean Hospital Mindsets (5) • A Lean hospital recognizes that there is waste in every process, focusing on continuous improvement and root cause problem solving instead of workarounds and fire fighting • Individuals (employees or leaders) are not blamed for the waste or problems
  32. Top leadership makes a consistent commitment to all employees that Lean improvements will not lead to layoffs
  33. The CEO as Chief Lean Leader Dr. Eric Dickson CEO of UMass Memorial Health Care “It was a tough decision… extensive conversation… what is the culture we are trying to build here?”
  34. The CEO as Chief Lean Leader Dr. Eric Dickson CEO of UMass Memorial Health Care “We didn’t know how bad this was going to be, how long the recovery was going to be.”
  35. The CEO as Chief Lean Leader Dr. Eric Dickson CEO of UMass Memorial Health Care “We saw revenue drop by 40% in March and we could have saved maybe $5 to $10 million of furloughs and layoffs. At that point, we said, will it be worth it if in three or four months down the line…”
  36. The CEO as Chief Lean Leader Dr. Eric Dickson CEO of UMass Memorial Health Care “We looked at our particular cash situation and said, you know what, we're going to stand by our people, respect for people. We're not going to furlough. We're not going to lay off, but we are going to ask every one of them to be an ambassador for the organization. We are going to ask every one of them to look at the way they're doing their job and spend time that may be downtime to kind of think about ways you can improve.”
  37. Listen to the entire conversation https://www.valuecapturellc.com/HE11
  38. Leanness is measured by outcomes, not by the number of tools that are implemented
  39. An Integrated System
  40. Q&A Discussion Mark Graban • Email: • mark@markgraban.com • Web: • www.LeanBlog.org • www.MarkGraban.com Resources: https://www.markgraban.com/virtual2020