Lean Healthcare Transformation Summit 2012, Day 2

Following up on my notes from Day 1, here are some notes and key points from Day 2 of the Lean Healthcare Transformation Summit. It was great to meet and get reacquainted with so many blog and book readers. It’s such a collaborative and helpful community that meets at the LEI Summits. As the days progressed, I realized that the focus had shifted from the 1st Summit in 2010 (a focus on LEAN HEALTHCARE) to the broader focus on the big picture in 2012 (focus on HEALTHCARE TRANSFORMATION – with Lean being a big piece of the puzzle).

CEO Panel

For the third straight year, I was honored to moderate the CEO Panel discussion (grainy pic here), with four healthcare CEOs: Dr. Michel Tetrault (St. Boniface, Winnipeg), Rachelle Shultz (Winona Health, Minnesota), Paul DeChant (Sutter Gould Medical Foundation, California), and Joan Magrude (Missouri Baptist). Since I was triaging and asking questions from the audience, I’m going to post notes taken from Twitter (giving credit as appropriate).

  • Dr. Tetreault explains that he (CEO) works for the 4,000 employees of his hospital. (@leandotorg)
  • The four “true north” principles at St. Boniface were shifted from concepts to action verbs: satisfy patients, engage staff, do no harm, manage resources. (@leandotorg & @steph2v)
  • Rachelle Schultz, CEO of Winona Health stopped using Jointt Commission and started Baldrige process.First big turn for engagement. (@steph2v)
  • Schultz: “goal is get everyone involved in lean journey” (@leandotorg)
  • DeChant: “current work flow + electronic medical record = disaster for providers” (@leandotorg)
  • DeChant: “Goal is to return joy to the practice of medicine.” (@IsaacMitchell)
  • Magruder: lean is the work, NOT instead of. Don’t be apologetic about that. (@LeanSaskHealth)
  • DeChant: “It’s not about the tools, it’s about the culure.” (@steph2v)
  • Schultz: “A lot of people come in with solutions looking for problems” (which isn’t effective improvement) (@KimHeade)
  • DeChant: Using A3 thinking process has really helped staff discover root causes and begin to experiment. A big culture change. (@steph2v)
  • Characteristics of lean cultural foundation? Joan Magruder: 1st is leadership humility, don’t have all answers (@leandotorg)
  • All CEOs on the panel participate in Kaizen and other Lean events at their facilities…humanizes them to staff! (@josh_berry)
  • Joan Magruder: engage CEOs by demystify vocabulary, encourage visit to mature organization like ThedaCare or Virginia mason (@leandotorg)

Thanks to the CEOs and the Twitter note takers!

Alice Lee, Beth Israel Deaconess Medical Center

Alice presented a plenary session on the Boston hospital’s Lean journey (“business transformation” is in her title, she fought for that) that started in 2005.

Their goal is to “promote skills to survive and thrive in an unknown future.” This reminds me of the talk from Day 1, where the team from St. Elisabeth Hospital in Holland learned from Toyota that goal one is learning and goal two is improvement. The “unknown future” part reminds me of Eric Ries and the “Lean Startup” methodology, where a startup exists in an environment of extreme uncertainty.

Early on, “solving things that seemed unsolvable” (such as increasing cyberknife capacity and reducing defective lab specimen rates) built enthusiasm, but this was a project/event-based approach and Alice was unsure if this would really transform the organization. They could have “kept doing Rapid Improvement Events forever” with all of the challenges they faced.

But, a “game changer” came in 2009 when they got physician leaders and administrative leaders to learn together (not as trivial as it seems). They designed training that would provoke people to question how things are done.

She invoked the classic Shingo priorities for improvement to make things “easier, better, faster, and cheaper” (in that order) and that “offended some people.”

BIDMC then got all three missions together on a single plan, a single sheet of paper, for the first time ever (clinical, education, and research).

Their 2011 focus became “end to end patient flow” with better visual management of each patient’s discharge readiness. They worked to have a SINGLE shared plan for patient care, instead of a separate plan for each specialty.

Patients asked “where’s my nurse?” as time studies showed that a nurse only got to spend 8% of a shift with each patient – there was too much waste interfering with patient care!

One thing they discovered was that previously standardized medical times (“I guess that made sense”) at 8 AM and 8 PM created big bottlenecks for the pharmacy and for nurses to get medications in the units. The uneven workflow caused a lot of problems… and they starting making improvements in that regard.

As BIDMC has focused more on “human development” instead of just events, they have learned that there’s not an easy roadmap for transformation.”

Starbucks Teaches TWI

When teaching Lean in hospital settings, it’s fun to talk about Starbucks as an example of a business outside of manufacturing that is using Lean (even though a Starbucks person referred to their “17,000 coffee drink factories” in the session they held at the Summit. I have run into nurses who used to work as Starbucks baristas during their college days. The parallels aren’t perfect, but each setting is heavy on service and customization – all the more reason that Lean works. As I told one of the Starbucks Lean trainers at the end of the session, some of the people they are training in the stores are future healthcare professionals. So the training is, in a way, laying the groundwork for more Lean thinkers in healthcare in the future.

As they said at the start of the session, Lean is “all about people” regardless of the industry.

The Starbucks team from Seattle, the “support center” otherwise known as headquarters, teamed with local Minneapolis/St. Paul-area Starbucks partners and managers to teach the “Training Within Industry” methods that Starbucks has adopted as the Starbucks Training Method.

They are not just teaching standardized work in the stores… they are, more importantly, teaching methods for Kaizen (continuous improvement). This is really important stuff and I’ll elaborate in a future post.

John Shook

Shook, the CEO of LEI, have the final keynote and had great insights, as usual. Some key points and quotes:

  • “If the Toyota problems of 2008-2011 had been 10 years earlier, the Lean movement might have died, since Lean was so tied only to Toyota’s success [at that time.”
  • “We can’t just copy a tool… we need to understand what problem it was trying to solve… need a clear understanding of our purpose” to be successful.
  • In Lean, “the process of doing the work is integrated with the process of improvement work… the improvement process IS the people development process.”
  • When he was at Toyota, “Kaizen events” were typically three days long, with they became five days in many places “because it was convenient for consultants to sell (no offense).”

Thanks to all who attended and participated!


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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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