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Evidence That Continuous Improvement is Practiced at US News & World Report Best Hospitals

Posted by Mark Graban

May 10, 2017 6:59:00 AM

Doctor with a clipboardEarlier this year, the magazine U.S. News & World Report announced their “best hospitals” list for 2016-2017. It’s a regular feature, which is intended to “help patients make more informed health care decisions.” That’s very important, of course.

The magazine’s website says that “The Best Hospitals methodologies include objective measures such as patient survival, number of patients, infection, adequacy of nurse staffing and more.”

We’d expect that the best organizations are continuously improving. We’d hope they are using Lean, Six Sigma, Kaizen, and other methodologies to engage everybody in continually reinventing and improving what they do and how they do it.

Looking at the top hospitals on the list, we don’t have inside, first-hand experience with all of them. Some of our customers are on this list: UCSF Medical Center, BJC Healthcare, and the University of Michigan Health System. We offer our warmest congratulations to them and we hope we’ve played even a small part in their success and progress.

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Let’s look at the hospitals and what can be found online about them and their improvement approaches. Searching for job postings and the terminology that’s used can be a good indicator of whether these approaches are still active in the organizations and what those job posts imply – Lean as a bunch of projects or a deeper part of the culture?

 

Mayo Clinic, Rochester, Minn.

What evidence do we have that Mayo uses these methods? A 2009 presentation from ASQ says that the Mayo Clinic uses Lean and Six Sigma methods. An undated paper from the Lean Enterprise Institute talks about their use of Lean to improve cardiovascular care. Mayo’s Medical Laboratories posted an article about their “Lean and Six Sigma” approach in 2013.

Cleveland Clinic

Their improvement is structured using what they call the Cleveland Clinic Improvement Model (see this PDF). I wrote two blog posts about the model (here and here) and also wrote about my visit there to see their Lean and continuous improvement approaches. Here is another article, posted by the Lean Enterprise Institute (LEI), about the Cleveland Clinic approach. They have current job openings for continuous improvement specialists and managers in Ohio and their Abu Dhabi campus. They don’t have any jobs posted with the terms “Lean” or “Six Sigma” which tells me, along with the CCIM terminology, that they are focusing on making this approach their own.

Massachusetts General Hospital, Boston

When I lived in Boston and worked for the Lean Enterprise Institute (LEI) in 2009 and 2010, I don’t remember any interaction with MGH about Lean. At the time, there were active Lean efforts at some other Boston hospitals, including Beth Israel Deaconess and Brigham and Women’s. LEI did publish a 2005 article, however, about MGH using Lean to increase capacity in their Proton therapy center. I can also find a 2011 presentation online about the “culture of Lean” and their “journey” at MGH that includes references to “doing your job” and “improving your job” as we hear about from Toyota and one of our other customers, Mary Greeley Medical Center

Johns Hopkins Hospital, Baltimore

Over the past ten years, I’ve met people from Johns Hopkins at various Lean events around the country. Their “Armstrong Institute for Patient Safety and Quality” does a lot of education about Lean and also trains and certifies “Lean Sigma” green belts. This page spells out some of the results and success stories from their work, including reducing readmissions, improving MRI safety, and boosting the bottom line through better charge capture. They have some current job postings, including “quality improvement team leaders” that call for Lean Sigma experience. I also found a presentation that describes their approach to Lean Six Sigma.

UCLA Medical Center

I had a chance to visit UCLA in 2010 or 2011 when I was working for LEI, as UCLA Medical Center was part of the Healthcare Value Network initiative. It looks like that is no longer the case. At the time, their COO was really into Lean, but he left and went to another health system. Harbor-UCLA Hospital and their eye clinic got help from Toyota a few years ago, as you can see in this amazing video. That’s certainly a powerful proof of concept that Lean works. UCLA hosted a “quality forum” that included a presentation about Lean in orthopedics surgery. A job search shows a current opening for a “Lean Specialist” at their flagship hospital.

 

New York-Presbyterian University Hospital of Columbia and Cornell

I don’t know this system or any of their Lean work. An online search brings up a person who is a “Hospital Clinical Systems Engineer” there, being certified in Lean and Six Sigma. A search of their current job openings says there are four jobs with the keyword “Lean,” different manager positions that say, for example, “Experience with LEAN Process Improvement” is required. Another position requires “Experience with Lean Six Sigma.” That’s an interesting inconsistency in terminology. If they are using Lean or continuous improvement strategies, it’s hard to find any evidence online.

UCSF Medical Center, San Francisco

In the past few years, I’ve met leaders and physicians from UCSF who are very enthusiastically embracing and practicing Lean in different ways. They are starting to offer training on “Lean Management and Process Improvement” to medical residents, which is very exciting. They have a “Lean Process Improvement” web page about efforts “designed to improve the new study submission and review process and reduce time to CHR (Committee for Human Research) approval.” That’s a great example of using Lean to improve your work, regardless of what that work is. They also have a “Lean IT” page that describes the methods and benefits in that realm. A job search shows postings calling for Lean include improvement specialist roles and management positions, which is great because Lean is something the entire organization should embrace, as they are calling for leaders with “Background in leading within a Lean Management System.”

Northwestern Memorial Hospital, Chicago

Over the years, I’ve corresponded with a few leaders and specialists from NMH who are working on Lean. I co-authored a journal article about Lean and hospital medicine with one of them. A web search shows a reference to the use of Lean methods in the refurbishment of a facility. The hospital’s Magnet “redesignation document” has mentions of “Northwestern Memorial’s DMAIC and LEAN process improvement methodologies.” I also found a case study about “Streamlining Diagnostic Testing at Northwestern Memorial.” A job search currently only shows one job that calls for Lean, a manager position, as they are to identify “opportunities for and leads/participates in Lean, Six/Sigma, and process improvement activities.”

NYU Langone Medical Center

A web search returns a blog post about their “embrace” of Lean and Six Sigma practices. This article says “NYU Langone Hospital Senior Administration established lean management as a fundamental approach to workflow improvement across NYU Langone Medical Center, dating back to 2008. The benefits of lean include simplified and efficient processes, improved quality and safety, reduction of worker overburden, improved finances, and patient and staff satisfaction, to name a few.” This video describes their “High Reliability Organization” approach, which is very complementary to Lean.

 

Barnes-Jewish Hospital/Washington University, St. Louis

BJC Health has been pursuing Lean as an improvement strategy for many years now. I’ve met some of their people at conferences and interviewed a surgeon, Dr. David Jaques, about some of their innovative improvement methods back in 2009. You can read about their transformation in this PDF document. They realize that Lean is not about cutting staff, it’s actually a great alternative to mass layoffs. They say that avoiding layoffs "has been adopted as a leadership practice given the negative consequences associated with linking Lean and layoffs.” You can read about their “focus on process improvement” and also watch a webinar about their use of Lean design practices

 

At KaiNexus, we want to see every healthcare organization perform to its full potential, for the sake of patients, staff, and the long-term financial health of the system. We believe strongly that it requires nearly full participation in different improvement methodologies. Lean isn’t just a set of tools or a few projects – it’s a way of thinking, a management system, and a culture. It's an integrated system.

It’s encouraging (and hopefully inspiring to others) that most of our leading hospitals are using Lean, Six Sigma, HRO, and other improvement strategies. And we’re especially thankful that a few of them are customers of ours here at KaiNexus.

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