Back in September 2015, I wrote a post (“Learning to be Lean” – An Inside Look at a Rapid Improvement Event“) that linked to a Modern Healthcare article about a Rapid Improvement Event at Presence Health in Illinois.
The piece was written by journalist Sabriya Rice, who had been allowed to participate in the event. The event was claimed to have reduced operating room turnaround time, which “has the potential to add $600,000 of added revenue over the course of a year.”
Of course, “potential revenue” is not the same as “actual revenue,” but, still, it sounded like a reasonably well run RIE that showed promise. But, we didn't know if Presence was just running some random projects or if they were on more of a ThedaCare path. ThedaCare, of course, started out primarily using RIEs to engage people in the first few years of their Lean approach before waking up to the fact that they also needed to change the management system and engage everybody in daily continuous improvement.
ThedaCare has been on their “Lean journey” for about 14 years now. The program has become, pretty much, “the way they do things” and it survived the transition from one CEO (Dr. John Toussaint) to another (Dr. Dean Gruner). Gruner was promoted internally from CMO because the ThedaCare board wanted Lean to continue.
Apparently, the Lean journey at Presence, regardless of what form it was taking in late 2015, has not survived a CEO transition at Presence Health. A new CEO, Michael Englehart, took over about six months ago (just after that Modern Healthcare story was published).
Here is the latest Modern Healthcare piece by Sabriya Rice:
“Rethinks” is an understated headline, given what seems to have happened.
“Former CEO Sandra Bruce brought the concept in 2012. Bruce retired last fall.
A Presence Health spokesperson said in an e-mail that it “is in an ongoing process to position all system hospitals for long-term growth and viability.” Upon evaluation of the Lean program, “we saw ways to enhance it and align it in a more focused way to serve our patient and business needs.”
I have no idea what the corporate speak of the second paragraph means.
Evaluate? Enhance…. align it?
An unnamed source was more blunt:
“Sources close to the situation tell Modern Healthcare that new leadership was “not a fan of Lean” and that the program has been disbanded.”
I had one Presence Health employee connect with me on LinkedIn and, when I asked them about what happened with Lean, they wrote:
“Yes, the rumor is true the Breakthrough Improvement department at Presence was disassembled as of 4/15.”
This person had already accepted a new Lean role at a different health system, so they probably saw the writing on the wall.
Again, from Modern Healthcare:
“A Presence Health spokesperson did not say whether the system's new direction would still include those weeklong breakthrough events.”
It sounds like they won't be.
Why Would a CEO Not “Be a Fan” of Lean?
Sabriya Rice called me on Thursday to get my perspective, as she had quoted me in her article from September.
We had a relatively long chat where all I could do was speculate about why these sorts of things happen. Let's try to brainstorm them here (and post a comment, below, if you like).
I haven't needed Lean before. This is one I've heard back in 2011 when I was writing the second edition of Lean Hospitals. One hospital had been featured pretty prominently in the first edition — they were doing Lean projects, using Lean design to build a new Emergency Department with better patient flow (pretty innovative for ten years ago) and their main Lean champion was a VP who was trying to influence culture change. In my research for the second edition, we quickly all agreed to not include that hospital in the book anymore. I was told, second hand, that the new CEO had been successful at their previous stops (they were an outside hire) and that Lean wasn't needed there. The Lean champions and change agents basically all left and went to other health systems.
That's sort of what I was thinking of when I was quoted in the new piece as being opposed to arrogance:
Leadership arrogance, [Graban] said, is often another factor.
“People think that through the force of their personality or financial wizardry that they are going to be able to fix a hospital without engaging employees in the improvement,” he said.
I knew I was being provocative. Not all healthcare leaders are arrogant, of course… but there are too many who are. Compare that to the humility that's a key aspect of Toyota or a Lean culture.
I don't understand Lean. It could be that a new CEO comes in and is pretty ignorant about Lean. They don't have any experience with it. Maybe they've somehow gotten the idea that Lean is all about cost cutting and they're already good at cost cutting (which probably means layoffs, which is NOT the Lean approach).
Ten years ago, when I started, it was a challenge that healthcare leaders hadn't even heard of Lean or the Toyota Production System. Now, they've heard of it, but many haven't taken the time to really learn what it is.
Lean wasn't making a difference. It could be that a hospital wasn't really getting good results or sustainable results with their Lean approach. Maybe the retired CEO had paper-thin support for Lean and basically just approved some spending on projects or a consultant. Maybe the RIEs weren't really engaging people. It could be they were just running some random projects in the same, old, broken healthcare culture. A Lean approach is supposed to simultaneously improve quality and reduce cost (again, cost reduction isn't the primary goal). If Lean wasn't accomplishing any of that… should they have been more patient or should they have ended this attempt?
Either way, it's sad to see a hospital give up on Lean… or to have killed an initiative before it really could have made a difference?
What do you think? There's been some good discussion about this on Twitter:
— Brad Miller (@LeanKaizen) April 29, 2016
— New England Lean (@NELeanguy) April 30, 2016
— Vance B (@vansmac2) April 30, 2016
— Simon Kelly (@eye_kelly) April 30, 2016
What do you think, either from your own experience with the demise of a Lean program? Or would you recklessly brainstorm and speculate with me?