Is Your CI Team Too Good at Solving Problems?

At the AME 2026 International Conference in Milwaukee, I went to a session from OhioHealth whose title is a bit of a math problem: "Scaling Lean: Empowering 35,000 Problem Solvers with a Small Lean Team." The presenters were Emily Swaney, Vice President of Operational Excellence, and Todd Schneider, Senior Advisor in OhioHealth's Lean Promotion Office.

The small team is 11 people. The health system has 35,000 associates, 16 hospitals, more than 200 ambulatory sites, and 19 corporate functions.

If 11 people tried to do the improvement work for 35,000, the math would break down on the first Monday. So they don't try. Their final slide summed up the role in four words: "teachers, not doers."

That sounds obvious on a slide. It's harder in practice, and Emily and Todd were candid that OhioHealth learned it the hard way.

The old model worked, which was the problem

OhioHealth created a Process Excellence department in 2005. According to the presentation, the team's main job was to act as project managers for large cost-saving initiatives, using improvement tools as needed.

That's a common starting point, and not a foolish one. A capable central team can deliver visible savings quickly, and visible savings keep a program funded.

Emily described the downside plainly. The team got very good at solving problems, which meant other people didn't get the chance to. One slide traced the chain. Solving problems on behalf of teams stunted people's growth. Improvement capacity bottlenecked at the central team. Ownership and accountability were limited, sustainment was weaker, and the improvement culture suffered.

I've seen this pattern in a lot of organizations. A CI team gets credit for the savings it "delivers," so it keeps delivering. Leaders learn that improvement is something the CI team does to their area. When the project ends and the team moves on, the gains often slip, because nobody local owned the change.

In 2016, the department became the Lean Promotion Office, with the Shingo Guiding Principles as its True North. Its primary responsibility changed from running projects to one goal: develop 35,000 problem solvers.

How a continuous improvement team of 11 covers 35,000 people

Changing the mission is the easy part. What I found more useful was how OhioHealth structured the continuous improvement team so the new role would hold.

Each team member is a relationship manager for one to four business units. A business unit might be one large hospital or a group of smaller sites. The relationship manager has two main responsibilities: develop local Lean leaders, and work with those leaders to mature their management system.

Other work is shared across the whole team: kaizen facilitation, A3 facilitation, and system-wide training. That lets them level-load. If one person's business units are in a heavy stretch, someone with capacity picks up the facilitation.

A few other design choices are worth copying:

• The team reports through the VP of Operational Excellence to the system COO, not up through any one hospital. The presenters cited visibility to organizational priorities, being seen as a partner on operational performance, and speed of change as the benefits.
• Each team member's written accountabilities are specific and shared across the team. 25% of the weighting goes to developing the team and advancing system standards.
• The team works from its own internal standards: tools and templates, training modules, a coaching approach, and a kaizen facilitation script.

If 11 people each coach differently, the organization gets 11 versions of Lean. Standardizing how the team teaches is how leaders across 16 hospitals hear a consistent message.

When I interviewed Emily on Lean Blog Interviews earlier this year, she explained how this works for kaizen events. The Lean Promotion Office facilitates five-day events, and then the process owners own the follow-up. The team doesn't lead projects.

Teaching leaders to teach

The arithmetic only works if leaders do the developing. Eleven people can't be close to 35,000 associates every day. Those associates' own leaders are.

So the Lean Promotion Office puts its effort into the system's roughly 1,500 leaders, starting with executive teams. The presentation laid out a sequence. The Lean Promotion Office describes clearly what good looks like. The executive team self-assesses against an 11-element management system assessment, identifies the gaps it wants to close by year-end, and builds a Lean Roadmap with the Lean Promotion Office. The team then provides coaching, training, and routine accountability along that roadmap.

In our podcast conversation, Emily described how executive behavior at the gemba has changed. Early on, leaders tended to offer solutions on the spot. Now they're more likely to ask what people learned and what they'll try next. OhioHealth also uses "second coaches," people who coach the coaches, including managers coaching hospital presidents.

There's one explicit exception to "teachers, not doers." When an issue is an immediate patient safety risk, leaders step in directly. Developing problem solvers doesn't mean waiting for a coaching moment while a patient is at risk.

What the numbers look like

OhioHealth shared the current scale of its management system: more than 750 standardized KPI boards, 65 daily gemba walks, 30 strategy deployment X-matrices, more than 60 kaizen events a year, and tiered huddles in 16 business units. They've also hosted 34 organizations from four countries that came to learn from them.

None of that is work the Lean Promotion Office could do itself. Those numbers count what leaders and frontline teams are doing.

The session opened with a quote from Dr. Steve Markovich, OhioHealth's President and CEO: "Lean is not just a thing we do - it is who we are, and it is embedded in our DNA."

Questions for your own CI team

If you lead a CI or OpEx function, this session raises a few questions worth answering honestly:

• How much of your team's time goes to doing improvement work, and how much to developing others to do it?
• When a project ends, who owns the result?
• If your team disappeared for six months, which improvements would keep going?
• Does each person on your team know which leaders they're responsible for developing?

Your answers don't have to match OhioHealth's. Their model has been more than a decade in the making, and they described it as still evolving. But if your honest answer to the third question is "not much," that's worth knowing now.

You can hear more from Emily in our full conversation: OhioHealth's Lean Management System with Emily Swaney.

The visibility problem that comes next

A note from KaiNexus, since this is our blog: OhioHealth's session wasn't about our software, and nothing here should suggest it was.

Organizations that make this shift often hit a practical problem, though. When the central team stops doing the improvement work, it loses the visibility that came from being in the middle of every project. Improvement now happens on hundreds of boards, in dozens of units, run by leaders the CI team coaches but doesn't manage. A spreadsheet can't tell a small team which units are moving, which are stalled, and where coaching would help most.

That's the problem KaiNexus was built to solve. We've written more about why you can't scale operational excellence without a centralized system. If you're moving your CI team from doing to teaching, see KaiNexus in action.