Occasionally, I have transcripts made from podcasts – and here is the transcript from Podcast #164 with Rachelle Schultz, CEO of Winona Health.
Last year, Rachelle was also part of the CEO panel at the Lean Healthcare Transformation Summit. I'll be at this year's Summit, June 5-6 in Orlando, and I hope to see you there. I'll be moderating a panel with three CEOs: Henry Hawthorne from Columbus Regional Healthcare System (Whiteville, NC), Alan Aviles from New York City Health and Hospitals Corporation, and Don Shilton from St. Mary's General Hospital (Ontario, Canada).
Mark Graban: My guest today for this episode is Rachelle Schultz. She is the CEO of Winona Health in Minnesota. Rachelle was part of the CEO panel that I moderated at last year's Lean Healthcare Transformation Summit, and her comments on leading a health system's Lean transformation were very well received, so happy to have her on the podcast today. In this discussion, she says, in part, “Everything I do has to drive Lean.” We're going to talk about how her system is using Lean in these difficult and challenging times and what the impact has been on quality, patient satisfaction, financial measures, and other things.
We're going to talk a little bit about the current health-care environment, with health reform and the pressures that health care is under. Curious to hear how you're using Lean to help improve your operations, improve carrier providing, coping with that challenging environment. Are there other particular opportunities being integrated at the hospital, primary care? How does that all work together?
Rachelle: From my perspective, we started our Lean journey really formally about four years ago, and we dabbled in a few things a couple of years before that. We really started this work intensely four years ago. From my perspective, it was really around the key strategy that goes to our long-term survival. I felt as though, as we really learned more about this, if we operated using these principles, if we really understood this, we could really weather many of the things coming our direction. Today I still believe that. I actually probably believe that more strongly even now as opposed to then. I think that there are so many things coming down the pike that are yet to be defined. Our imperative is really around making sure we're very efficient around our systems and practices and doing it, actually, going forward, from a patient perspective as opposed to the regulatory environment, or are often designed around providers, for example.
It flipped a lot of that for us. We really have to look at the true continuum on how a patient moves through a clinic to a hospital stage to going home and how then they're managed in the home. Actually, I think a lot of the dialog nationally is around that kind of a model. I think that's the direction we're working in. Lean is the context, I guess, in which we are defining how that work needs to happen, how those systems or processes need to be redesigned. I think it lends itself pretty critically to our long-term viability and sustainability as an organization.
Mark: For a lot of organizations out there – you used the word “survival” – do you think it may really come down to that for community hospitals in other parts of the country that aren't being as aggressive with process improvement and other methodologies like Lean?
Rachelle: I do. I think that many organizations, smaller institutions, like ours, for example, you see a lot of mergers and acquisitions, lots of them coming together thinking bigger is better, and if we do that, somehow we're buffering ourselves from what might be coming down the pike. I think, fundamentally, what we're missing as an industry is the need to go back and really do this redesign work and really understand what the principles are around that and really tackle what have been very difficult issues. Whether they're internal political issues or medical-staff issues or whatever they are, I think, if we stay focused on what we need to do to help patients be well and be healthy and solve disease problems and things like that, if we really design our systems along that, I think we can make a lot of progress. I think there still remains a lot of reticence to do that. I see that in our organization on any given day. It's a resistance to change. This has worked for us. At a time, it did work for us, but it doesn't work for us anymore. I think we're needing to embrace the need to make those kinds of changes, which really impact everything we do and how we think about just about everything we do.
I don't think we've gotten over that hump. I think it's more, a lot of the advocacy, if you will, that's out there is really more about protecting what we have than changing to meet what the future demands are.
Mark: You bring up a good point. You're right, there's a lot of consolidation and merger and acquisition. A lot of times people think bigger is better. Sometimes bigger just leads to bigger. If we can focus on the better, through process improvement, improved care, it'll be interesting to see how that plays out. Sounds like you plan on staying independent and going the “better is better” route, not the “bigger is better” route.
Rachelle: Exactly. I think that's a fallacy that so many have. I do think that for smaller institutions, there's a sense of “We don't have the resources, and so we can't do this,” and so then they join up. I mean, it's just the logical steps. We join up then with a larger organization, and they'll make the changes or they'll help us or they'll give us the resources. I go back to ground zero, which is, they don't have those same capabilities to make these changes. Nothing changed, other than you became part of a bigger system, but the problems still remain, and you still have to make those changes. I guess I fundamentally feel that it's like the principles of empowering your staff and getting things to the lowest level of where the work is done. By trying to delegate it up, it's moving it the wrong direction, and I think we still have to solve our own problems. That's the beauty of – I think what I like about our independence and our community health system is our Lean work has made everything so transparent. We see the brokenness of the system every day. There are thousands of problems to work on. Our challenge is to pick the right ones that move us in the right direction.
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