When Better Care Leads to Lower Costs: A Pharmacist-Driven Kaizen Story
In healthcare, improvement initiatives often get derailed when they start with one primary question: “How can we cut costs?” That doesn't engage people.
But what if we turned that question on its head?
What if better care, smarter systems, and more thoughtful clinical practice naturally led to cost savings–not as the goal, but as a meaningful side effect?
That's exactly what happened at Franciscan St. Francis Health (as Joe Swarz and I documented in our Healthcare Kaizen books).
The Opportunity: Rethinking Albumin Use in Cardiac Surgery
The story begins with a routine practice: using albumin to expand blood volume in patients undergoing open-heart surgery. This was the established norm, embedded in post-op protocols.
But when staff started asking questions–looking closely at both clinical value and cost–it became clear that this might be an area for improvement.
Over a 10-month period, across 323 open-heart surgeries, average albumin use was 6.9 units per case. It wasn't a bad number on its own–but it prompted curiosity. Was all of it necessary? Could outcomes be maintained or improved with less?
The Kaizen: Clinicians Collaborating to Improve Practice
This wasn't a top-down mandate. It wasn't a Lean event led by outside consultants. It was a Kaizen in the truest sense–driven by those closest to the work.
Clinical Pharmacist Christopher W. Gregory and Pharmacy Manager Ronda Freije partnered directly with the cardiac surgeons. Together, they re-evaluated the clinical philosophy behind volume replacement.
Instead of reacting to a cost target, they reflected on purpose: What's best for the patient? What's supported by evidence? Where can variation be reduced?
Their Kaizen led to a change in post-op order sets–not just tweaking the protocol, but reframing the thinking behind it.
The Results: Measurable Improvement
The outcomes were both clinical and financial:
| Metric | Before Kaizen (10 months / 323 surgeries) | After Kaizen (10 months / 387 surgeries) | Improvement |
|---|---|---|---|
| Albumin Units per Case | 6.9 units | 2.4 units | 4.5 unit reduction |
| Estimated Savings per Case | — | $250-$300 | — |
| Annual Cost Savings | — | $90,843 | — |
And while the hard-dollar savings were significant–over $90,000 per year–the real success was in the process: engaging pharmacists and physicians in a conversation about improving care, not just reducing costs.
Why This Matters
This case is one of many from Healthcare Kaizen, but it stands out for a few reasons:
- It challenged long-standing clinical habits through respectful, evidence-based dialogue.
- It empowered frontline professionals to lead change in an area typically governed by hierarchy and tradition.
- It illustrates a key Lean principle: when we improve processes and reduce unnecessary variation, we often improve both quality and cost.
It's also worth noting that only a small percentage (about 10%) of Kaizens at Franciscan St. Francis Health were formally quantified for financial savings. But this one, rigorously measured and validated, had one of the highest bottom-line impacts–without cutting corners or sacrificing care.
Final Thought: The Right Starting Point
Too often, healthcare organizations approach improvement from a reactive, budget-driven mindset: “We need to cut costs–fast.” That path often leads to burnout, short-term thinking, and negative impacts on patient care.
But when we start with the question, “How can we improve care?”–and when we engage those closest to the work–we open the door to improvements that are sustainable, meaningful, and often surprisingly economical.
Respect for people. Clinical excellence. Better systems. That's the real Lean equation for long-term success.
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If you’re working to build a culture where people feel safe to speak up, solve problems, and improve every day, I’d be glad to help. Let’s talk about how to strengthen Psychological Safety and Continuous Improvement in your organization.
Hi Mark,
You write so well. I think you captured the essence of the improvement concisely. It reminds me of the amazing people I’ve had the opportunity to work with over the years. Christopher and Ronda are big believers in continuous improvement and they have lead the way in the Franciscan pharmacy. It also reminds me of the amazing things that can be done when it’s psychologically safe to question the work we do, seeking ways to make it better.
Thank you!
Joe