“Learning to be Lean” – An Inside Look at a Rapid Improvement Event


There's a really good article that was published by Modern Healthcare as a special report, written by Sabriya Rice. Sabriya spent a week observing a rapid improvement event (RIE) at the Sts. Mary and Elizabeth Medical Center in Illinois, part of the Presence Health system.

It's an in-depth article that, I think, very accurately reflects the reality that Lean is helpful, but the process isn't easy for a number of reasons.

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The RIE involved reducing the turnaround time between procedures in the operating rooms. The baseline time was just over 30 minutes and their goal was to reduce it to 25.

“Freeing up 6.5 minutes per case has the potential to add $600,000 of added revenue over the course of a year.”

Improvements like this have benefits for all stakeholders:

  • Less waiting time for patients
  • Easier work for staff
  • Higher revenue for the hospital if they can do more cases per day

That's what Lean is all about — improving workflows to reduce waste, done so in a way where everybody wins.

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I've seen improvements like this also improve quality, as having a more repeatable process often means that the rooms are cleaned and disinfected more consistently, which can help prevent infections.

The article gets off to a good, accurate start:

“HOSPITAL MANAGEMENT HAS THE ULTIMATE RESPONSIBILITY of figuring out how to make facilities operate at greater efficiency and higher quality. But under the Lean method, staff members more accustomed to taking orders from their bosses must learn to overcome their trepidation about speaking up and accept responsibility and authority for driving changes in their workplace.”

As Dr. Deming would have said, quality starts in the board room. Senior management has the most responsibility for the overall system. That said, frontline staff and managers are the experts in how the work is done and they have to be involved in order for meaningful improvements to take place.

The article quotes Dr. John Toussaint, from the ThedaCare Center for Healthcare Value, as well as Steve Hoeft from Baylor Scott & White. Listen to my recent podcasts with John and Steve about their respective new books.

An interesting tidbit about the approach at Baylor Scott & White:

“Rather than routinely pulling staff away for weeklong rapid improvement events, Dallas-based Baylor Scott & White Health now limits such events to major initiatives. Instead, everyone from top leaders to cleaning staff participates in daily huddles to identify and implement improvements. “Every single day, every person has the ability to bring forward an idea that can close the gap, without having to participate in a big event,” says Steve Hoeft, Baylor Scott & White Health's senior vice president of operations excellence.”

They're shifting toward a focus on daily continuous improvement, the is focus of my Healthcare Kaizen books. Yes, there's a time and a place for RIEs, but ThedaCare is another organization that has learned that RIEs aren't the only approach that's necessary for improving healthcare. Use RIEs for relatively big problems AND engage everybody in daily improvement.

Hoeft also laments the common challenge in healthcare:

“We hire the smartest people in the world and then don't ask them what they think. That doesn't seem fair, or even wise.”

Yes, that's really silly. I'm glad some health systems are doing a better job of listening and engaging people and their ideas.

I was also quoted in the article, after talking to Sabriya after she observed the RIE.

“The beauty of Lean is that it engages the creativity and skill of the front-line staff doing the day-to-day work, says Mark Graban, a Dallas-based consultant and author of several books on Lean. “It's much more effective than someone saying, ‘I'm going to come fix it for you.'”

It's really hard, as always, to answer the question about “how many hospitals are using Lean?” because not all Lean efforts are equal.

“Some are just “dabbling here and there,” while others have committed to transforming their organizations through systemwide Lean process improvements, Graban says.”

The article and the embedded video both focus on the need to reduce the amount of heroic effort that's needed in healthcare. I'm happy to see more people embrace that theme. Check out my podcast with Kim Barnas talking about her excellent book Beyond Heroes for more on this.

If we have better processes, people can more reliably deliver consistent, excellent care and service without jumping through hoops, fighting the same fires every day, or being “heroes.”

There's another quote from me that I've modified a bit, below, to perhaps be more clear:

“There's enough opportunity in healthcare for necessary heroics without adding unnecessary ones. Step back and ask: ‘In this case, do they have to be a hero?'”

Check out the excellent article at the Modern Healthcare site. Feel free to leave a comment here if you'd like to discuss it.

Update: See this April 2016 post about the health system apparently killing its Lean program

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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. The great thing about these concepts is they’re transferable from industry to industry. We work primarily with manufacturing facilities. Lean tools are a part of our overall program with daily huddles helping to maintain sustainability and a continuous improvement culture. We find the huddles are sometimes the hardest part to maintain/run properly to be effective. There is a right and a wrong way to manage the daily huddle – don’t assume becuase you meet every day as a team that you are doing it right. Reach out to an expert to make sure.

  2. Well well well, look at this:

    Presence Health rethinks its Lean initiative

    “Sources close to the situation tell Modern Healthcare that new leadership was “not a fan of Lean” and that the program has been disbanded. “

    We don’t know what happened. I’m quoted in the article talking about why a CEO might not be “a fan of Lean” in general and I’ll blog more about this for Monday.


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