Podcast #289 – Lean & A Mobile Paramedic Pilot at Geisinger Health


My guests for Episode #289 are Kathleen Sharp, MBOE, LSS MBB, now the Director of Optimization at McLeod Health, and David Schoenwetter, D.O., FACEP, a Medical Director at Geisinger Health System.

They are joining me to talk about the innovative Geisinger Mobile Health Paramedic program that they developed and piloted with Lean thinking throughout. Kathleen and David will discuss why it was important to engage stakeholders in innovation, how they viewed and addressed resistance to change, why it was important to test the idea in practice, and why it was important to measure results. They also discuss their lessons learned and their challenges along the way.

This WSJ article has a nice summary of the program: “Paramedics Aren't Just for Emergencies.”

“In the Geisinger pilot program, mobile health visits can be requested by a patient's primary-care doctor, a cardiology clinic, or after an emergency room or hospital discharge. Patients who frequently visit the ER are offered the option of being seen at home by a paramedic as an alternative to an ER visit and potential hospital admission, especially for conditions that can be treated at home if caught early.”

I hope you enjoy the episode. It's long, but it's an interesting case study, I believe.

Streaming Player:

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For a link to use for this episode, refer people to www.leanblog.org/289.

For earlier episodes of my podcast, visit the main Podcast page, which includes information on how to subscribe via RSS, through Android apps, or via Apple Podcasts.  You can also subscribe and listen via Stitcher.

Episode Summary:

Download a 6-page episode summary:

Other topics discussed include:

  • Past blog posts about ProvenCare and ProvenExperience
  • How Kathleen and David got introduced to Lean
  • What's the reimbursement model for this?
  • Why do they “have a foot in two canoes?”
  • How the pilot was structured
  • Was this approach spread? Is it expandable?
  • How this approach provides “much better care”

Here is a presentation from AME 2016 shared by Kathleen (PDF):

The local news station WNEP Channel 16 did a two-part story on the Mobile Health Paramedic Program.

Part 1 video is an overview of the mobile health paramedic heart failure program:

Part 2 video includes an interview with a heart failure patient (video is no longer available?)

Citizens Voice Article

HFMA Article 9/20/2016

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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. I’ve received a number of messages about my comments around how I think of resistance. It’s been difficult to keep up with all of them, so I’m posting here.

    In my view, resistance not something to be “overcome”, rather, I consider resistance as additional information (albeit in an unpleasant form). Resistance can signal lack of clarity in messaging, a need for focus, and/or gaps that need to be considered.

    It took years for me to learn to view resistance that way, and it has helped me become better at change management, providing focus/clarity, and driving improvement.

    It’s often quoted that 70% of major change initiatives fail, and often there are unheeded signs early on. Allow me to suggest that the “signs” include passive and active resistance. I consider resistance as part of the voice of the process . “Overcoming” resistance muffles that voice. IMHO it’s worthwhile to take the time to listen to the information it’s providing.

    Kathleen Sharp, MBOE, LSS MBB

    • Kathleen,

      Great work and wonderful podcast!

      I appreciate your insightful perspective on “resistance” . Another cut into this is a the statement (paraphrased, I’m sure) that I’ve heard attributed to Shigeo Shingo: “90% of resistance is cautionary.” In other words, when the surgery scheduler or the nurse (or whoever!) says “That won’t work!” we shouldn’t take it as them trying to prevent improvement. We should honor their concern, actually try to understand why they think that, and be mindful of their concern as we proceed. As you say, it’s another source of information. They don’t want to fail, they don’t want to let their patients down. It’s a good thing!

    • Thanks again for sharing these reflections, Kathleen.

      I think you (and others) would really enjoy the book “Motivational Interviewing for Leadership.” I just recorded a podcast with the authors that I’ll be sharing soon.

      The MI approach emphasizes that this so-called “resistance” is a NORMAL step in the change process. Too many people write someone off when they are being “resistant.” But that should be the START of the conversion with that person, not the end of it.

      We need to honor and respect the person and their view. As change agents, we should listen to them and not just continue telling them why they should want to change.

      It takes patience, but it’s a more effective path to change and helping others.

    • On the “70% failure rate” the exact phrase and study isn’t about “failure.” It’s more about not meeting stated goals, which could mean the goals are unrealistic :-)


      In 1993, Michael Hammer and James Champy stated in Reengineering the Corporation:

      “Sadly, we must report that despite the success stories described in previous chapters, many companies that begin reengineering don’t succeed at it…Our unscientific estimate is that as many as 50 percent to 70 percent of the organizations that undertake a reengineering effort do not achieve the dramatic results they intended.”

  2. Here are Kathleen’s comments on “resistance” from the summary of the podcast:

    Stakeholder Pushback

    I asked about the discussion with stakeholders and the paramedics themselves, wondering if Kathleen and David received much pushback.

    David first explained that the program only used paramedics, and not EMTs, and that Kathleen’s mantra was that she was there to help with the process, but that she was not there to give clinical advice, often saying that she didn’t even know how to take blood pressure.

    “Now in the end the paramedics got tired of hearing that and they actually taught her how to take a blood pressure so then she could no longer say that,” He said.

    Aside from the clinical advice issue, David said he thought that commonly, at least in healthcare, pushback is just a lack of understanding and that the truth of the matter is they don’t completely understand what they’re being asked to do.

    “Nobody likes to fail, so when you’re not really sure about what you’re being asked to do, or how you’re being asked to do it, or what even the end game is, I think it is very common to say, ‘Well, that’s not really my job, this person should do it, or that person should do it,’” he said.

    “And Dr. Schoenwetter and I would have conversations about pushback, and he gave a lot of room and latitude and acceptance to make it safe for them to surface problems. For Lean practitioners, one of the things we can often get caught up in, a pet peeve of mine, is when I hear people refer to resistance as something to be overcome, because resistance is just more information in an unpleasant form,” Kathleen said. “if you take it in that way, you can learn.”

    “And for the Lean practitioners, I would challenge them, that when they are getting that resistance from physicians, take it in as information in its most unpleasant form. Are you being clear enough? Is there another way that you can approach it? And are you really responding to the values that the physicians are trying to get out of whatever that initiative is around? That resistance I think made me a better Lean facilitator,” Kathleen said.


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