UMass Memorial Health rolled out KaiNexus to 16,000 caregivers across multiple hospitals and clinics in six months -- and within a year, they'd crossed 100,000 improvement ideas in the system. In this presentation from KaiNexicon, Cliona Archambeault, Senior Director of Process Improvement, walks through exactly how they did it: the advisory group that shaped configuration, the phased deployment, the coaching model, and the leadership behaviors that drove adoption at scale.

Watch the video of Cliona’s presentation for more, or read the recap below:

UPDATE: Since this presentation, UMass Memorial Health has surpassed 200,000 frontline improvement ideas. Their CMS star rating improved from one star to four stars. Patient safety composite scores (PSI-90) dropped from 1.47 to 0.69. And the system achieved its highest bond rating in 35 years. Read the full story of where this journey has led.

Read the full story of where this journey has led.

About UMass Memorial Health

UMass Memorial Health has hospitals and physician clinics throughout Central Massachusetts, with over 16,000 caregivers and 1,100 physicians. When Dr. Eric Dickson, also a practicing emergency room physician, became the CEO in 2013, he noted that with their True North goal, being to ‘be the best place to get care and give care,’ they needed everybody, every day, to identify problems and think about how to solve those problems. 

They needed to create an army of problem solvers. As Cliona explains in the presentation, the idea system became their "principal countermeasure against the lean waste of not utilizing human talent." Ideas aren't a side project at UMMH -- they're part of the management system. Every caregiver is expected to attend Lean White Belt training and participate in the idea system. Shortly afterward, they launched their first one.

Pre-KaiNexus Idea System

The UMMH idea system started in 2013 as a paper and whiteboard-based solution. The board included sections for new, active, parking lot, needs help, and completed ideas. The idea card included the problem, why, and idea, and later iterations also included the strategic alignment to true north. A few teams experimented with digital solutions using SharePoint and other technologies. Throughout, the CI team continually focused on coaching and managing the system. The number of ideas implemented each year was counted, and new caregivers learned about the idea system in White Belt during the New Caregiver Welcome.

Reimaging the Idea System

When the Pandemic hit in March 2020, they needed a new way to gather ideas and support their CI work while many teams transitioned to working from home. This is when Dr. Dickson asked the CI team to reimagine how the Idea System could work. 

Soon, UMMH began its partnership with KaiNexus, an enterprise platform purpose-built for managing continuous improvement -- from idea capture and tracking through impact measurement and reporting across the organization.

Before configuration, they assembled an Idea System Advisory Group to gather insight into how they would successfully build this electronic idea system. They learned three key insights from this team that they kept in mind during configuration: keep it simple, keep it familiar, and allow teams to customize.

Rolling out KaiNexus & Building Adoption

Once KaiNexus was configured, which they refer to internally as Innovation Station, it was time to roll it out it to the organization - all 16,000 caregivers. So over the next 6 months, they launched phased rollouts until each and every caregiver was in the system. With the help of their CI coaches, internal marketing team, and KaiNexus Training and Support, the UMMH team successfully rolled out KaiNexus.  

With their first adoption milestones hit -- teams onboarded, first ideas entered, top blocks customized -- the team turned to defining what sustained adoption would look like. They'd always measured the number of ideas implemented, going back to fiscal year 2013 when the paper-based system launched. With KaiNexus, that count was automatic. The question became: what else should we measure? They chose participation rate -- the percentage of caregivers actively contributing -- and set a goal of 50%, up from a 20% baseline.

With a group as large as 16,000, there are many important things to focus on - not only to introduce the platform but also to build adoption. These things included: 

Involving Leadership: To foster Leadership engagement, the UMMH Team measures and reports on each team's participation using data from KaiNexus and shares these results with Leadership. These monthly scorecards provide status reports on the True North goal. 

Additionally, Leaders are encouraged to ‘Like, Follow, and Comment’ on items in the system to encourage caregivers to continue interacting with KaiNexus and to ensure Leaders are familiar with ideas coming into the system. They use frequent communication, such as email campaigns and including KaiNexus agenda items at leadership meetings, to nudge these behaviors.

When they reached 100,000 ideas in their system in January 2022, CEO Dr. Dickson filmed a congratulatory video for the team that submitted the 100,000th idea. (Please read this article if you want to learn more about UMMH reaching 100k Ideas!). This kind of involvement from top executives and leadership is extremely important for driving participation.   

Strong Coaching Support:  While rolling out the platform, they designated 15 coaches to support different areas across the organization. But beyond just having a designated resource, they host Idea Generation coaching sessions that teams can sign up for online, which has been an extremely successful way of engaging people in the platform. 

Jami Yi, one of the CI Coaches, leads these 60-minute sessions and helps the teams generate & input their ideas and follows up on them. For example, the Family Practice division of their organization participated in a 60-minute brainstorming session and generated 36 ideas!

Encouragement from within KaiNexus: It was important for the UMMH team to make the platform as accessible as possible. For example, they moved their Grant program workflow, which provides funds for Improvement work, into KaiNexus. This is meant for teams that have an idea but need funding to turn their vision into reality. Before KaiNexus, this process was done from a SharePoint site, and if you didn’t know where to go, it was confusing. Putting this Grant Program into KaiNexus cleared up a lot of confusion. (They are on track to exceed their allotment for funds this year, which they have never done before!) 

Additionally, they have integrated the following into KaiNexus:

• Union Teams PDSA Template

• Green/Black Belt Training A3 Templates

• DMAIC Templates 

Having these workflows in KaiNexus gives people an incentive to use the platform more. 

They also use the Honor Roll feature to engage caregivers by recognizing outstanding ideas. Each month, CI coaches have the opportunity to recognize impactful ideas from caregivers all over the organization by awarding them ‘Honor Roll’ status. They then highlight those Honor Roll Ideas in a news article posted on their Intranet. This Honor Roll recognition is an extremely important part of their adoption strategy. 

The KaiNexus Vision

With 16,000 caregivers, configuring a system to meet each and every one of their needs was a daunting task. But by establishing a clear vision, that being ‘KaiNexus is where UMMH gets improvement work done,’ they are able to take a step back and evaluate what is best before making any decisions.

What helps them stay close to this vision is by having clear priorities they ask themselves before  changing something in the system: 

• Will it help more users get into the system/improve accessibility? 

• Is it an improvement workflow we’re adding? 

• Will it help advance the capability/culture of improvement? 

• Will it cause a burden to administration? 

To manage platform changes, the team runs a formal change control process. Some requests are straightforward and get implemented quickly. Others -- particularly anything that affects the idea system boards used by all 16,000 caregivers -- go through the Idea System Advisory Group for feedback first. The group still meets monthly, maintaining the same collaborative approach that shaped the original configuration.

Where the Story Has Gone Since

When Cliona gave this presentation, UMass Memorial Health had just crossed 100,000 ideas. The story didn't stop there.

The system has now surpassed 200,000 frontline-driven improvement ideas. Active idea teams -- teams implementing at least one idea per month -- grew from 261 to 417 after the team shifted its focus from raw idea count to team-level engagement. An Innovation Fund established in fiscal year 2015 has provided $11.1 million in grants to support the implementation of ideas.

The clinical and financial outcomes improved. CMS star ratings rose from 1 to 4 stars. Patient satisfaction moved from the 10th percentile to the top quartile. The patient safety composite (PSI-90) dropped from 1.47 to 0.69. Emergency department length of stay was cut nearly in half. And the system achieved its highest bond rating in 35 years.

UMass Memorial Health Team has worked hard to make KaiNexus a place where not only improvement work gets done, but a place to inspire their caregivers to take the power into their own hands to improve their jobs, patient care, and their organization. 

UMass Memorial Health didn't get these results from methodology alone -- they built the infrastructure to capture, track, measure, and spread improvement across 583 teams. See KaiNexus in action -->