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Lean & the “Work-Out” Process in Healthcare – Success, My Questions, and Your Experiences

by Mark Graban on September 17, 2013 · 4 comments

thailand details  aerobics mural at samitivej sriracha hospital  sriracha thailand 150x150 Lean & the Work Out Process in Healthcare   Success, My Questions, and Your Experiences leanIn the past few years, I’ve heard of the “Work-Out” process that has origins at GE. This consultant’s website gives a good overview and it squares up with what I’ve been reading in the book The GE Work-Out : How to Implement GE’s Revolutionary Method for Busting Bureaucracy & Attacking Organizational Problems.

I’ve never used this methodology, but I know of a few healthcare organizations that have used it. For example, a  KaiNexus customer recently used this approach to get some great results (see below).

I’m curious to learn if my readers have experience with this process and thoughts or experiences to share as a comment.

Vanderbilt University Medical Center recently did a “100-day workout” process, using our KaiNexus software to facilitate and track the improvement ideas that were implemented. The classic “work-out” formula says to do a 90-day process, but Vanderbilt modified it because they thought 100 days worked better to create consistent scheduling for the monthly meetings that took place. I like the idea of modifying a methodology as it makes sense, as I wrote about yesterday.

Here is a video that Vanderbilt produced, as part of a blog post they wrote (Vanderbilt has an ownership stake in KaiNexus, since the prototype for our platform was developed there and they helped commercial our technology). They generated over $800,000 in cost savings and revenue increases in those 100 days.

100-Day Workout, KaiNexus drive big savings at Vanderbilt

 

The results are certainly impressive and we thank Vanderbilt for sharing them.

While reading more about this “Work-Out” process, here’s what it seems to be (at a really high level):

  1. Form a team including a lot of front-line employees
  2. An executive kicks off the session and then leaves, as to not influence the discussion
  3. Conduct a facilitated one to four-day session where employees brainstorm what should be improved
  4. The executive comes back and has the best ideas presented to him or her
  5. The executive decides “yes” or “no” on ideas
  6. The ideas get implemented
  7. The team reports out after 30, 60, and 90 days

The book describes the process as:

Large groups of employees and managers—from different levels and functions of the organization—come together to address issues that they identify or that senior management has raised as concerns. In small teams, people challenge prevailing assumptions about “the way we’ve always done things” and come up with recommendations for dramatic improvements in organizational processes. The Work-Out teams present their recommendations to a senior manager in a “Town Meeting,” where the manager engages the entire group in a dialogue about the recommendations and then makes yes-or-no decisions on the spot. Recommendations for changing the organization are assigned to “owners” who have volunteered to carry them out and follow through to get results. That’s Work-Out in a nutshell.

I like the involvement of front-line staff and the Work-Out book says that the experts are the people who really do the work.

I’m not sure if I really like the idea of the executive leaving the initial meeting. The book I’m reading says:

In general, we strongly recommend that neither the champion nor the Sponsor remain at the Work-Out session after the teams begin their work…  even the most adroit senior people exert subtle influence on participants—either inhibiting certain ideas or channeling the thinking in a particular direction. Part of the power of Work-Out is that senior people get to hear relatively unadulterated, unfiltered ideas—and not just what they want to hear, or what people expect them to want to hear.

I guess that’s a good goal of wanting honest, unfiltered feedback. But, I’d rather see executives work toward a culture where employees can be honest and unadulterated with them in the room. I’d rather see a “Kaizen Event” approach, where we ask executives to participate but to “check their titles at the door.” This is perhaps easier said than done, to the Work-Out point.

I also don’t really like the idea that the executive gets to make all of the yes/no decisions. I guess if I were running a Work-Out process, I’d rather see these decisions be made by consensus, with input and recommendations from the team members AND the executive working together on that. The executive can help explain the organization’s strategy and objectives, while guiding the employees to make good decisions instead of doing it for them.

But, who am I to question the method if it brought great results at Vanderbilt?

Do you have any first-hand experience with Work-Out? I’m curious to hear about your experiences. Do you find this approach can be compatible with Lean thinking and Lean practice?


Mark Graban 2011 Smaller Lean & the Work Out Process in Healthcare   Success, My Questions, and Your Experiences leanAbout LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as the new Executive Guide to Healthcare Kaizen. Mark is also the VP of Innovation and Improvement Services for KaiNexus.


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{ 4 comments… read them below or add one }

1 Michael Lombard
Twitter:
September 17, 2013 at 1:02 pm

Yes, we had success with the GE Work-Out methodology at a large pediatric hospital. As you mentioned, there are several strong points of this approach: involving front-line staff, making visible the senior leader’s/champion’s support, creating an environment in which radical new ideas can emerge, and checking implementation results at periodic intervals. Good stuff. That’s why we often get good process improvement results using this approach.

However, there’s another objective beyond getting good process improvement results, and that’s the building of good improvement habits and skills. This is not a strong point for the GE Work-Out approach, or for that matter, any methodology that relies on projects or events (e.g. DMAIC, Kaizen Events). Some awareness-building does occur when a project or event facilitator models the right improvement habits and skills, but that’s not the same as habit/skill-building. Once the facilitator is removed and the project/event ends, we are left with mostly the same old habits and skills.

However, that doesn’t mean that we shouldn’t utilize Work-Out, DMAIC, etc. If we want to show significant process improvements quickly and do some awareness-building, they are excellent tools. But I don’t feel they should be an organization’s overarching improvement methodology. For that, we need something that is based on continuous, daily improvement principles that lead to habit and skill formation. Fortunately, building these habits and skills will only make us more effective as an organization when we do need to use GE Work-Out or DMAIC on a complex problem.
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2 Andy Wagner September 17, 2013 at 5:12 pm

After 9-years with GE Aircraft Engines, I was not aware that “GE Action Workout” was anything other than the same week long Lean workshop that everybody else is doing, until I saw the book on somebody’s desk at my current company. It’s true, our workshops didn’t include the top-level sponsor, but it did not occur to me that that was part of the technique–I just assumed that they didn’t want to get their hands dirty. ;-)

One disadvantage of this approach is the disproportionate focus on spending the last day and a half–of five, on preparing a pitch for the sponsor.

As for the 30, 60, 90 day follow-up, the multiple events that I was part of at GE didn’t have any better–or worse–follow up than I’ve seen at other companies. It depends entirely on the team and its leadership/sponsorship, whether they own the changes and follow through.
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3 Mark Graban
Twitter:
September 17, 2013 at 10:18 pm

Comment from LinkedIn:

Ashley Norris: Froedtert Hospital in Milwaukee also uses the work-out methodology to facilitate change management within the organization. We are also looking to hire someone to join our Six Sigma/Lean group. Check out the LinkedIn organizational page for more info. Come be my co-worker!

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4 Kelly September 18, 2013 at 2:14 pm

When I was in the EMS(electronic Manufacturing Service) sector that assembled PCB’s we used this method. It was called the Value added Study team. We used the same cross functional team the only difference was during the Kick-off session the Plant Manager would set goals and stretch goal around key KPI’s.

This worked extremely well

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