Day 2 of #HCSummit17 – Live Blogging the #Lean Healthcare Transformation Summit


For one last day, I'm at the 8th annual Lean Healthcare Transformation Summit in Palm Springs, California. See my notes from Day 1 in yesterday's blog post.

Follow on Twitter using the hashtag #HCSummit2017.

If you're here at the event, please say hello! I love meeting blog readers and podcast listeners.

I'll be adding updates and notes here again throughout the day. Talks will include some healthcare leaders and LEI's John Shook.

Kathy Krusie – CEO, Community Health Systems

About Kathy's new role, as of late 2015

“Lessons Learned from Three Lean Transformations”

Kathy has led Lean transformation efforts at Mercy Medical Center (Cedar Rapids, IA), St. Joseph Health System as CEO (Bryan, TX), and now at Community Health Network in Indianapolis.

Capitalize on strengths

  • At Mercy, it was a CEO-initiated transformation, starting with the ED value stream (she was VP of Ops)
  • Business community in Iowa wanted the hospitals to explore and adopt Lean
  • It was great opportunity in that the CEO wanted this to be a priority
  • They established “pull” from different parts of the organization that wanted help, with some prioritization based on strategic priorities and goals
  • Launched a “Managing for Daily Improvement” effort, not just Rapid Improvement Events
  • The impact on her own personal leadership philosophy:
    • I had probably advanced in my career because I was a control freak… but for most problems, I was the least-qualified person to solve it. We had to engage the people who were actually doing the work… with a skilled facilitator and that led to amazing results.
    • Giving up control created a much better solution
  • Goal at CHS – 14,000 engaged caregivers

Turn barriers into opportunities

  • Turning disaster into opportunity — after Mercy flooded in 2008, they were going to re-design, improve the hospital (had to rebuild the first two floors)

  • Even with the hospital shut down, they gave employees and option of taking time off, or come to work and we'll pay you to do something
  • Developing a Managing for Daily Improvement system… front-line employees are capable of solving many problems with a little bit of coaching
  • Also integrating Lean and HRO concepts (new CEO at Mercy was more into HRO than Lean)
    • How to integrate this without confusing the organization after a few years of Lean
    • It's entirely consistent, if not identical

  • They do daily patient safety huddles that Kathy's engaged in
    • Leads to coaching and development opportunities

Take Advantage of Serendipity

  • Kathy walked in to find “The Community Way” system, which starts with “Patients First,” just like Cleveland Clinic
    • Great foundation for a Lean transformation

  • Needed to remove waste from leaders' days

Experiment in a Safe Environment

  • Pilots are an effective way to move transformation ahead
  • Cites the Kotter change model
  • There wasn't enough trust in senior leaders… they couldn't trust us if they didn't know us
  • Needed to solve problems at much lower levels of the organization if we were going to hit our goals
  • Everyone is responsible for engaging in problem solving
  • KPIs aligned with goals are collected and displayed by ALL caregivers
  • Leadership goes on Gemba Walks and conducts huddles
  • Humble Inquiry and root cause analysis
  • Good to start these efforts in a few units, not just one
    • The units can use each other as sounding boards
    • Having just one pilot site puts a lot of pressure on them
  • When I thought I was coaching, I really looked more like an attorney doing cross examination
  • Power differentials can be scary, even if we think we aren't scary people
    • Mark's Note: Kathy is very approachable and not scary… but she's not my CEO and I've gotten to know her a bit… she makes a good point about the POSITION being intimidating

  • I continue to be impressed with the power of MDI
  • I remain absolutely convinced that Lean is the value proposition that allows us to serve our communities in the best possible way…
  • Questions in her mind:
    • How can I bet help my organization develop the leadership skills needed to support a lean journey?
    • How can I create sufficient focus for our improvement efforts?
    • What is the appropriate pace of change for my organization?
  • I'm not sure I'd still be in healthcare leadership if not for Lean… would have been totally worn out by the challenges and pressures of healthcare.
  • What would you differently? I would have tried to do more faster…

Timothy Pehrson – VP North Region, Intermountain Healthcare

About Tim

“The Tipping Point”

  • Tim runs 5 hospitals in the region
  • Goals including extraordinary care, superior service, affordable cost
  • They've demonstrated better quality and lower cost — quote from Elliot Fisher saying that if everybody could practice medicine like Intermountain, we could reduce healthcare costs by 30 to 50%
  • Continuous Improvement story started in 2006 with a visit to Autoliv

  • Did a pilot in a non-clinical area, then clinical… saw nice success, which led to full scale implementation in 2009 across the region
    • 60,000 implemented employee ideas (not suggestions)

  • If we don't solve these issues of safety, cost, our system will collapse
  • Lots of uncertainty and instability now
  • Is there a cure?
  • Healthcare reform has to happen from within. There won't be a political solution to our mess. It won't come. Continuous improvement has the ability to correct problems in healthcare, but it has to happen on a large scale. The industry needs us.

  • What does the C-suite think when they hear us talk about journeys and model cells?
    • “This might take a while” (sloth)
    • Science projects (cute but thrown into the garbage). So much energy for so little gain?
    • “Show me the money”

    • How do we reach a tipping point where Lean can be adopted at large scale?
      • Four main points to follow 

  •  The points:
    • 1) We need to change our messaging — to better sell this to the C-suite. Use the power of context to get senior leaders' attention
      • Journeys –> Enterprise Operation or Management System
      • Model Cells –> Everyone is involved in engagement
    • 2) Create a continuous improvement method or model or system
      • You need to create frameworks and common language around improvement
      • Great book recommendation Own the Gap
        • If we have gaps, what are we doing about them?

  • It's simple, elegant, yet complex
    • 3) Strategy Deployment
      • Why is strategy important?? If we don't know what winning looks like, how can we improve?
      • Don't just know what you're doing, understand what it means to be successful
      • SD teaches us what to focus on

  • “At Autoliv, you see run charts everywhere” (come learn about them in my workshop)
    • 4) Implement huddles, huddle boards, and idea systems
      • At every level of the organization – you need a huddle board in your C-suite even
      • Huddle boards are very important. Idea systems are very important
      • People like to collaborate. They like to see how they're performing.
      • Why do huddles? It allows you to layer on other key Lean methods… like scientific problem solving, 5 whys…


  • This is being rolled out across the entire system over the past 6 months

  • This is all fractal and scaleable

John Shook Keynote

  • John's thoughts on “Understanding Leader Engagement in the Lean Transformation” (John Toussaint's theme from yesterday)
  • “All successful companies are alike; each failed company fails in its own way.” (apologies to Tolstoy)
  • “No single diet will work for everyone” (Time Magazine) — applications to organizations and ourselves?

  • “Things are always progressing or declining”

  • Balance between social and technical approaches in Lean
  • Which is more important? People or process?  (“it's a false dichotomy”)
    • About 90% of the room raised hands for people
    • USA Summit, 81% said “people” in online poll
  • It's BOTH
    • “The people are the same everywhere”
    • So process comes into play
  • If things get too far out of balance, it needs some correction. It's never perfectly in balance.
  • “Aligning people and process is the role of management”

  • “Lean — the team at MIT, the six of them in the room, could have called it something else. Had I been there, I would have argued for something else. But the word is fine.”

What's your challenge?

  1. Purpose – alignment around the problem to solve
  2. Designing, doing, improving the work
  3. Developing capability and people
  4. Management system / leader behavior
  5. Basic thinking

  • What IS the role of the CEO or senior leader in a Lean initiative?
  • What if the leader does NOT lead the initiative?
  • What if the leader isn't even interested in changing or learning new skills?


My blog post on this:

Learning Jazz (and Lean?): Imitate, Integrate, Innovate

  • Terell Stafford
    • Maintenance
    • Growth
    • Exploration (“now you can really innovate”)
  • Alice Lee talking about a community health center in Lynn, MA

  • Grasping the situation – lack of stability at the management level
    • Prioritization
    • Decision making
    • Communication
    • Clear roles & responsibilities
    • ID development gaps
    • “One Lynn Health Center”
  • “You're torturing the front line, the way you're currently behaving.”
    • Management reflection “We cause the problems.”

  • Start solving problems at the appropriate level

Thanks to everyone at Catalysis!!!

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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.



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