A Lean Guy Visits Scott & White Hospital – Leader Standard Work, Huddles, and Lean Culture

Hosted by Steve Hoeft, author of the book Stories from My Sensei: Two Decades of Lessons Learned Implementing Toyota-Style Systems, I had a chance to visit Scott & White Hospital in Temple, Texas. With his permission (but without editorial review), I am sharing some stories from my visit to their excellent health system (which is in the process of merging with the larger Baylor Health system in the Dallas / Fort Worth area).

Baylor is one of the largest health care providers in North Texas with about $4 billion in annual revenue. Scott & White, with a national reputation for quality care and efficiency, is dominant in Central Texas. (link)

Huddle Room

The visit started with a stop in their “huddle room” where the senior leadership team, including the hospital CEO and the system CEO, Dr. Bob Pryor, have their daily stand up meeting. It’s a room similar to the “visual room” at ThedaCare that’s full of strategy deployment objectives and actions. Dr. Pryor is expected to be the system COO at the merged Baylor/S&W system. 15 senior leaders packed themselves int he room, as part of a cascading series of huddles that go all the way down to the front line staff for rapid communication up and down the chain in both directions.

One wall of the room has “leader standard work” posted for many executives, including the CEO. Each posted document lists items that are done daily, weekly, monthly, or quarterly. This is a new initiative, so not every leader had their SW document posted yet.

leader standard work

The second wall is their Hoshin Planning board (another term for strategy deployment)… the “Scott & White Alignment Tool” (or SWAT), to gain alignment in the organization around their goals (in five categories) and HOW the goals will be accomplished. The system CEO was personally reviewing progress against these goals.

The third wall was their “SQDCM” metrics board, showing performance in the typical Lean areas of Safety, Quality, Delivery, Cost, and Morale. These goals are aligned at each level of the organization (as we also see at ThedaCare, see their DVD on this process: Thinking Lean at ThedaCare: Strategy Deployment).

The fourth wall is a white board that has in-progress “A3s” and other working initiatives.

Walls 2 and 4 (I just realized I didn’t describe them in order):


The leadership team models a problem solving behavior of four questions:

  1. What’s the target?
  2. How are you doing versus the goal?
  3. What are your ideas or action plan?
  4. How can I help?

As the leadership team review metrics, common questions were “are we working that action plan?” and “do we understand why?” As one bit of progress was discussed, Dr. Pryor said “I’d like to go see that” (and I’m betting that he did). As another issue was discussed, Dr. Pryor emphasized the classic “no problems is a problem” mindset of Lean.

Dr. Pryor ended the huddle by asking, and it seemed very sincere, “Any suggestions for me? How can I do things better?”

Lean Management Systems

Lean is by no means new to Scott & White, but their Lean Management System effort started about a year ago after visiting the Toyota Georgetown plant in Kentucky.

The LMS includes four levels of “accountability meetings”:

  1. Front-line staff
  2. Supervisors, managers directors (ideas that Level 1 can’t address get escalated)
  3. Directors / VP / Chief Nurse Executive
  4. Senior leadership team

It also includes leader standard work (as seen in the executive meeting), visual controls, and daily accountability – combining for a process focus for the organization.


Team huddles are used to work issues that can be worked on quickly, measuring the impact of changes. For example, a team might work on:

  • Reducing the number of call lights per day (by more effective hourly rounding on patients)
  • Noise at night
  • Pain management for patients

A team worked on an issue related to labor and delivery, measuring patient wait times DAILY and huddling to talk about reasons for delay and capturing suggestions for improvement.

The CNE said this whole management process was a “life changing experience for me as a leader” and “I wouldn’t go back to the old ways.”

They emphasized that the improvement process “has to be easy” and they had been “making it too hard” before. The teams charted data by hand now, for example. The process was “challenging for the first few months, but one success happened” it took off. I have seen this with the Kaizen process in other organizations. Once people see that it works, you no longer have to push. The improvement process and the things being measured “has to be meaningful to them” (the staff).

Dr. Pryor said, “For 115 years, we didn’t do this… we didn’t ask what’s meaningful and we didn’t ask for their ideas.”


I saw many great Lean management practices at Scott & White. The years of Lean leadership provided by Marji Henry have been supplemented with the addition of Steve Hoeft (formerly of the University of Michigan and Altarum Institute). They have hired people away from Toyota and have a lot of internal coaches and talent.

Many teams presented projects and huddle board work that they had done. It’s great to see educated and passionate healthcare professionals have a methodology for reaching their goals for improving patient care.

More impressively, the senior leaders, from Dr. Pryor on down, are VERY committed to the Lean management system, including modeling these behaviors themselves. It’s easy to find a place to see Lean tools and tactics — it’s much harder to find a place where you can wee Lean management being practiced every day.

About LeanBlog.org: 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. Mark is also the
VP of Customer Success for the technology company KaiNexus.

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11 Comments on "A Lean Guy Visits Scott & White Hospital – Leader Standard Work, Huddles, and Lean Culture"

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  1. Tom Herrick says:


    Thanks for sharing this. Very nice to see visual management at work. Similar to meeting rooms I have put in place when running continuous improvement efforts at production sites and warehouses. Great to see these tools in use in health care and the involvement of everyone is nice to hear about. The culture is definitely one of continuous improvement.

    Best regards,

  2. Dean Bliss says:

    Scott & White is an organization that gets it, with leadership that understands. I worked there for a few months, and I enjoyed every minute (well, except for the 100 degree heat).

  3. Bart Sellers says:

    Scott & White presented at the 2012 Healthcare Systems Process Improvement Conference. Their presentation on Strategy Deployment demonstrated the thoroughness of their approach. Their presentation is available through the SHS newsletter (no sign-up needed).


  4. Edward Blackman says:

    Sensei Hoeft – It is great to hear and see how you are transforming the thinking at S&W. You are missed up in Michigan.

  5. Robert Yokl says:

    Mark, what a great example for Lean strategies working on a daily basis! This is not only a great Lean example it is a good example of how we can attack all of our major day to day issues in healthcare.

    Great article!

    Bob Yokl
    Robert Yokl recently posted..How to Win Arguments with Value AnalysisMy Profile

  6. Bob Emiliani

    Leader standard work is the “what to do.” They are not done. They need to move to the next step: the “how to do” the work They need to create standard work combination sheets for leader standardized work.
    Bob Emiliani recently posted..Winning Over Business TraditionalistsMy Profile

  7. Bob Emiliani

    Standard work combination sheets are beneficial for leaders’ work as well. Why? Same reasons as for operators. Quality in each leadership process will vary greatly from one leader to another without SWCS.

    Leaders will not understand their work (their process) if they do not break it down. Doing so will identify where the waste is, and all the benefits that ensue from that (for employee as well leader).

    They will learn more by creating standard work combination sheets. And, they should be consistent in what they ask of workers and what they should so themselves. Examples of SW and SWCS are here in my book: http://wp.me/P3kI3Y-2oE
    Bob Emiliani recently posted..What’s Not To Like About Lean?My Profile

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