$500k in Stimulus Money for Lean Healthcare Training – Then What?


This headline jumped out at me: Local hospital receives $500,000 to train workers.”

What also jumped out at me, in the article, is that the money comes from the federal American Recovery and Reinvestment Act (commonly referred to as the “stimulus” act).

That's a lot of money for training. What value and improvement will lots of training lead to?

It's a short article without too much detail. It reads, in part:

Rockford Health System gets a big boost to train employees on a system that aims to improve the patient experience.

The Illinois Department of Commerce and Economic Opportunity announced $788,000 in federal workforce investment funds for five health systems in the Stateline region.

Most of that money  goes to Rockford Health System.   It received $500,000 to train 834 employees on the Lean Six Sigma System, which is a program that improves quality and efficiency for patients.

Using Lean for improving the patient experience is certainly a great motivation – this can include improvements that reduce errors (improving quality and patient safety), reducing waiting times, and creating more patient-focused value streams.

But $500,000 for 834 people is $600 per person. We don't know if that buys a one-hour workshop or a two-day course.

Regardless, I have to question the value of training that many people all at once. Why? Because training alone tends to not accomplish much.

If (and I say “if” because we don't know) this is ONLY a training effort, I'd be afraid that it could be wasted money. Why? If we train people and then the organization doesn't have the capability to help all of those employees and leaders DO anything with the training, we might end up with a lot of frustrated people who have learned a few Lean concepts that sound good, but haven't translated into actually.

Again, I don't know if this is the case in Rockford, but it gives me pause because other organizations have gone down a failed “let's just train everybody and expect them to do great things” route.

Since 2005, I have done a lot of training and coaching of healthcare employees and managers in their first days or earliest days with Lean. Typically, when exposed to the core mindsets of Lean, people get really excited because they are getting a chance to examine their work and patient needs. They are learning new ways of looking at things and they're being told that Lean is about ‘kaizen' and employee engagement.

But what if people are trained and leaders aren't really on board with the idea of people making improvements? What if leaders are threatened by people taking initiative? What if managers don't help create time for people to study their process and to make improvements?

The training would go nowhere if the culture isn't ready for Lean and if there aren't resources available to help and mentor people with Lean.

I've always advocated, including in my book Lean Hospitals: Improving Quality, Patient Safety, and Employee Satisfaction, that Lean shouldn't start as a “hospital wide” initiative. I've advocated starting small – with a scope of one value stream, such as emergency department flow (including upstream and downstream) or the laboratory flow (including specimen collection and results reporting). You can more easily create a “model line” area by training a smaller number of people and then, more importantly, get to DOING something with that training.

Once you've demonstrated success with Lean, then you can go train others and continue working on the management system in culture in those areas you're spreading Lean too – and continue working on it on a hospital-wide culture basis.

I hope Rockford is able to make effective use of those training dollars — those are partly MY tax dollars, so I hope they're used wisely.

What would you expect might happen, keeping in mind that we're speculating based on a short news story? What have you done with training in your hospital?

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. Politically loaded? Surely you jest, sir.

    Let me approach this from another angle. As a resident and tax payer of the great State of Illinois, I say, who cares if the money that will be spent on training will be a waste?

    Our state is broke. Not only is it broke, it is deeply indebted. And not only deepled indebted. The unfunded (and largely unaccounted for) state union pension obligations, which may or may not be accurately reflected under government account principles, are staggering.

    So, what’s another $788,000? It will probably bubble up to over a million before we’re done. Accountability? Metrics? Actual results? No matter. It’s not “Lean” to spend money this way, but, hey, whatever. Let’s party!

    And that’s the way I see it. Adam Zak

  2. While I have no experience with Lean training in a hospital, I do have experience in manufacturing. Hopefully this money will be used over several years and they start with the managers and supervisors so they understand an implement Lean. Without the people at the top using Lean… it’s not going to go very far.

  3. Like you Mark, I was rolling out Lean within Healthcare in 2005-2006. What I observed was the entire range of curiousity and excitement. Curiousity from the management teams to excitement at the RN, Nurses Aide level, all focused on the patient experience.

    I agree with you, the criteria for such a grant should have proven success from an initial from an initial foray into this world. It sickens me the Stimulus Act has turned into a giant money grab with no controls on how it will be enacted or even sustained.

    A thought I have had is you can only gain so much of an efficiency within the Hospitals without changing the behaviors…the behaviors in my experience go all the way back to the Learning Hospital the Dr’s/RN’s learned their trade at…another point where the behaviors come from are the Healthcare companies. Perhaps the money is better spent on training programs at the learning hospitals and how to influence the Healthcare companies to actually comp the hospitals on what is best for the patient not what is best for the Hospital system?
    Great post!

  4. For six hundred dollars, the best expectations for the trainee are: a day away from work; receiving a decent buffet lunch; some four color takeaways and a Kinkos-printed diploma stating that the attendee was “Successfully Exposed to the Material”.

    Like you, I would prefer to the money invested in ten people receiving ‘train the trainer’ certification and a mandate to spread it around.


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