Day 2 Notes: Lean Healthcare Transformation Summit 2014

photoToday is the second and final day of the 5th annualLean Healthcare Transformation Summit. Follow along on Twitter with hashtag#HCSummit14 to see my tweets and thoughts from others. I will be adding updates to this post during the day, as well. These are not meant to be complete notes or a transcript… but quotable and interesting thoughts or comments from each talk.

See yesterday’s post about Day One.

James Hereford Keynote

COO of Stanford Health and Clinics – Bio

The fundamental difference between Lean and TQM (or other improvement methods from the past) is not how improvement is done… what’s fundamentally different is the management system.

“We don’t have the luxury of saying ‘this is a journey’ and taking 10 years to get there.”

Healthcare is the most complex operating environment there is. No other industry can claim that title. We are capital intensive, labor intensive, in the service business (with our customer being highly involved in the process), and we’re in the knowledge management business. It’s a highly regulated and litigious environment. When we make mistakes, it can cost lives. See pic.

Why wasn’t Lean management invented here? Nobody was really being that demanding of us on cost, quality, service, etc. These days are changing. We have to be able to change faster.

“Lean is not a program, it is a total strategy” — Taiichi Ohno

We’re going to hold the pretense that the people at the top of the pyramid are smartest and are going to make all the decisions in a highly complex environment? That’s not going to happen. We have to flip the pyramid upside down.

Three major components of the Lean management system that addresses three key problems we all have

1) How do we align vertically?  (Strategy Deployment)

2) How do we develop our skill and knowledge to know exactly what we need to be paying attention to?   (Active Daily Management)

3) How do we optimize things horizontally?  (Value Stream Management)

“We need to create an environment where we have creative problem solvers throughout our organizations.”

The power of strategy deployment:

Executives MUST participate in a meaningful way

Engages people who are doing the work, identifying ways they can contribute to goals

Creates ownership throughout the organization through “catch ball”

Challenges: Iterations are slow. Catch ball is a sophisticated conversation

A value stream map needs to look at the end-to-end patient experience. Must maintain focus on the patient. Provides context for improvement, so we’re not doing random things.

It’s easy to be enthralled by RPIWs (kaizen events). “The danger is that we believe that this is the Lean transformation” — also need daily Lean management.

Active Daily Management – five foundational concepts

1) Setting standards

2) Having standard work to achieve that standard

3) Have leader standard work… check and help and problem solve

4) Visual systems to detect abnormal conditions… so everybody can see the problems, near real time

5) Active problem solving to fix abnormal conditions and improve standard work… everybody owns the problem and works on them in a huddle or huddles. The role of the manager is to coach the problem solving (not to solve it themselves)

Why does the Lean management system work? We’re building a learning organization. Cites Chris Argyris and Carol Dweck’s MindsetMove away from control and extrinsic awards (see Dan Pink’s Drive). Lean creates “bounded autonomy” which increases engagement.

We can’t just improve incrementally, we have to TRANSFORM our healthcare organizations quickly.

You don’t learn how to play golf by going to watch Tiger Woods.

The Lean community needs to stop complaining about technology and work. as Toyota does, to integrate its power in right way.

CEO Panel

  • Maura Davies, President and CEO of the Saskatoon Health Region
  • Laura Easton, President and CEO of Caldwell UNC Healthcare
  • Kathryn Correia, President and CEO of HealthEast Care System

(notes soon via @MikeLombard)

Laura Easton:  50% of employees engaged in improvement events, 15 MDs out of 100 engaged/year. Smaller system = more nimble. Started with kaizen events, now working on value streams and policy deployment.

Kathryn Correia: not planning to copycat the work done at Thedacare, like collaborative care. Her challenge:  get an organization of 7000 people move toward creating more benefit and reducing burden on staff. How does lean become a way to free up capacity so we can do more good?

Maura Davies: Many members of public proud of health system but frustrated w/ issues. Wait times for elective surgery major issue:  15000 pts on wait list for 3 months. Adopted hoshin kanri at provincial level, strategic plan for whole system. Staff complain that supplies are sometimes unavailable after Kanban system was put in. “Did we have supply shortages before Lean? Of course. Now, we are tweaking and adjusting the system so that we’ll eliminate that problem.

Some tweets from the CEO panel:

CEO panel 2014

 John Shook Keynote

“Healthcare needs to be fixed from the inside.”

The state of Lean healthcare per John: picture.  “Kamikaze Kaizen” is a term that’s critical of random “drive by” Kaizen events that aren’t really connected to strategy and/or aren’t sustained.

Don’t just copy the artifacts and solutions we see elsewhere… maybe we are wired this way. But we need to understand the question that led to the answer or method.

When people say things like “oh just use Lean or whatever different tools you want,” they’re not thinking of Lean the same way we do (it’s really about a management system and philosophy, not just tools).

Five Lean transformation questions — see post and videopicture

“A roadmap will only take you where somebody else has gone before. But every transformation is different.”  A compass (a true north) can be more helpful than a map for your own journey.

How we design the work really influences people’s attitudes, morale, etc.

How do we improve the work AND develop capabilities?

The process of doing the work is INTEGRATED within the process of improving the work.

“Lean is eminently practical.”

“In a Lean system, team members must think. Through thinking, team members grow and become better team members and people.”

“No problem is a problem” — how to see problems, how to stop hiding them, how to get them out? “Hiding problems is the worst illness for any organization.”

Are we “implementing” or “experimenting?” Focused on an outcome or on learning?

We need to teach people to find problems, give them permission to fail, but the ability to succeed in solving them.

Change the leader’s role from “How can you get others to do something” (the only one you can change is yourself).

All Lean change requires: 1) Intention (a decision) 2) Process  (a means, a routine, a kata) 3) Practice (deliberate practice with a coach).

Thanks for reading! I hope to see you at the Summit next year in 2015.


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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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