HealthLeaders Article: Systemwide Process Improvement


It's great to see Lean mentioned in mainstream healthcare management publications, such as the article in HealthLeaders (print and online) called “Systemwide Process Improvement.” The article highlights one hospital you might know really well, Seattle's Virginia Mason Medical Center (featured in the book Transforming Health Care: Virginia Mason Medical Center's Pursuit of the Perfect Patient Experience) and one you might not know as well,  Mercy St. Vincent Medical Center in Toledo, Ohio. The home towns of the Space Needle and the Glass Bowl, each pursuing Lean in a very systemic way.

The piece features two organizations that aim to embrace Lean in a very systemic organization-wide way, as opposed to looking at a collection of tactical tools.

Dr. Gary Kaplan, CEO of VMMC highlights this as he says:

… it's important to differentiate that [Lean] is a way to manage and lead—it's a management system, not a program.”

Kaplan talks about changing mindsets:

“In the early years, we said, ‘We can't be successful unless we change the mind of senior leadership,' so they were the first people we trained. So often we find people come to learn the VMPS, but we learn that their C-suite isn't engaged—it's really a critical piece of the process,” he says. “Healthcare is known for following the fad of the month or year to save money … but we look at this as a comprehensive management system that's also about quality, safety, and patient and staff satisfaction.”

He's right to point out that Lean is more of an ongoing way of thinking, that successful Lean organizations think of this as less of a fad and more of a long-term approach to impacting a wide range of measures, not just cost.

The article highlights many results, but focusing on the good news side of patient safety, their impact includes:

Nursing teams cut the incidence of pressure ulcers to 2% from 8%, preventing a projected 838 patients per year from  acquiring bedsores.

Mercy St. Vincent Medical Center is a 500+ bed teaching hospital in Toledo, Ohio. They have combined Lean and Six Sigma into a program of their own, started in 2006, they call THE or Total Hospital Efficiency. Some would say that “Effectiveness” would be a better term, but they seem to have an approach that works.

Their balanced results:

Mercy St. Vincent's process improvement effort reaps annual financial rewards now that it has linked disparate operating systems: The hospital has reduced average length of stay by 23%, lowered direct costs by $8.6 million, increased operating margin to 5.3% from 2.7%, and has seen improvement in other quality metrics, such as preventable harm and hospital-acquired conditions.

Lowering length of stay correlates well with cost AND quality, as the less time you spend in a hospital, the less opportunity for error, infection, and preventable harm. Reducing L.O.S. led to freeing up the capacity of 100 beds, a far less expensive way to increase capacity than new construction (at the cost of $1 million a bed).

Again, to highlight this, the CEO emphasizes:

By improving flow we were able to create this additional capacity and bring in more patients without spending a single dollar,”

This is way better than traditional cost-cutting. By focusing on patient flow, they not only reduce cost by shortening L.O.S., but they avoid a huge capital expense. We need more of this in healthcare.

Imran Andrabi, MD, president and CEO at Mercy St. Vincent Medical Center knows that Lean is about improving the interconnected system of healthcare and it's more than just cost reduction and  Joseph Sober, vice president for service excellence and workflow process, says:

“Lean has helped us generate savings from projects and reduce the length of stay by 1.3 days; it has helped us bear these tough economic conditions. But if someone is going to put one of these into place just for the purpose of cost savings, they would be disappointed because this is also about the patient experience and satisfaction. This goes well beyond enhancing margin,” says Sober.

VMMC talks about having senior leadership on board from the start, while that was a challenge at Mercy St. Vincent's:

Getting to this stage required Mercy St. Vincent to leave the path it was on and transform its culture. The journey started out the way most providers do, with Lean to target key areas. But, Sober says, one thing that could've been done differently would be to have better engaged senior leadership at the outset of the process.

I wish them continued success in their culture change efforts and systemic improvement.

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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. Mark, Thanks for thoughts and sharing the findings of the conference.

    Flow is what is the nature of things. Only when someone/something is interfering the processes gets messed up.

    So putting the stones out of the way is improving the processes (as long as the stone owners can be “brought on board”.

    Cheers, Ralf

  2. “He’s right to point out that Lean is more of an ongoing way of thinking, that successful Lean organizations think of this as less of a fad and more of a long-term approach to impacting a wide range of measures, not just cost.”

    This is so critical. I know my experience with plants implementing Lean Manufacturing, the ones that recognize it’s a journey are more successful. I always advocate rapid implementation to drive performance, but with the caveat that this journey doesn’t simply end once you make some improvement.


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