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)
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.
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:
- What's the target?
- How are you doing versus the goal?
- What are your ideas or action plan?
- 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”:
- Front-line staff
- Supervisors, managers directors (ideas that Level 1 can't address get escalated)
- Directors / VP / Chief Nurse Executive
- 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.