Management Journal Article about Children’s Medical Center Dallas

I am happy to share, with permission, a new journal article that I co-authored with Jim Adams (“The Synthesizer“), the senior director of laboratory operations at Children’s Medical Center Dallas. It is now published in the Wiley journal “Global Business and Organizational Excellence” under the title “CMCD’s lab draws on academics, automakers, and therapists to realize its own vision of excellence.” (free PDF)

It’s a long article, but hopefully an interesting story of one lab’s journal to create their own culture and management system, based on influences ranging from Lean and Toyota, Peter Senge and Systems Thinking, and  Dr. Murray Bowen’s “Family Systems Theory.” We hope the combination of these three approaches breaks new ground and spurs additional synthesis of improvement theories and practices.

The abstract of the article reads:

Focused on transforming the laboratory at Children’s Medical Center Dallas into a learning organization, the lab’s leaders looked beyond benchmarking to develop a customized approach – measured against their own ideal state – to achieve operational excellence. By applying lean principles, systems thinking, and family system theory; improving the facility’s physical layout; and, most important, redefining the role between supervisors and staff workers, the lab has cut its turnaround times, improved service to patients and physicians, and evolved into a work environment that fosters personal and professional development.

An excerpt from the start of the article that talks about the three approaches:

Taking a Three-Pronged Approach to Becoming a Learning Organization Children’s Medical Center is a private, not-for-profit pediatric health-care provider in North Texas that sees more than 300,000 patients each year and includes a hospital in Dallas that is licensed for 559 beds. One of the ten largest children’s hospital systems in the United States, it has been recognized as one of the top pediatric providers by U.S. News & World Report. Children’s also holds the prestigious “Magnet” status, the highest national recognition granted for nursing excellence.

Since 2006, the medical laboratory at Children’s has aspired to become a learning organization – that is, one that continuously transforms itself to provide the best possible patient care while being a preeminent workplace. Under the leadership of Jim Adams, senior director for lab operations and the lead author of this article, and Dr. Beverly Rogers, the lab’s medical director, the lab embarked on a learning journey that synthesized three distinct approaches:

  • systems thinking, as taught by Peter Senge;
  • Toyota’s lean management approach; and
  • family systems theory, a theory of human behavior developed by Murray Bowen, MD.

Essentially, those involved in the improvement effort innovatively applied lean principles to transform the lab into a learning organization, which Senge (1994, p. 3) defines as one “where people continually expand their capacity to create the results they truly desire, where new and expansive patterns of thinking  are nurtured, where collective aspiration is set free, and where people are continually learning how to learn together.”

Although the various lean tools and techniques that the lab team employed were helpful, the adoption of a new way of thinking ultimately led to higher levels of sustained performance. Lean was a means to an end: becoming a learning organization in order to provide the best patient care. To establish the culture necessary to effect change, the staff at the Children’s lab:

  • Implemented lean principles and methods into operational processes,
  • Reconfigured the physical layout to promote the application of lean principles, and
  • Trained leaders and staff about lean principles so that they would understand how the relation- ship between leadership and staff had to fundamentally change.
  • Activities supporting all these areas have occurred simultaneously over the past four years, each taking center stage at different times.

Anyway, it’s a long piece. I hope you think it’s a good piece. Maybe it’s something to read over the weekend. Please let us know your thoughts and reactions to the article.


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Mark Graban's passion is creating a better, safer, more cost effective healthcare system for patients and better workplaces for all. Mark is a consultant, author, and speaker in the "Lean healthcare" methodology. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. His most recent project is an eBook titled Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also the VP of Improvement & Innovation Services for the technology company KaiNexus.

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