Across the globe, healthcare leaders are working hard to implement the principles of continuous improvement in their organizations. Continuous improvement is a systematic, repeatable approach to enhancing the quality of care and patients' health outcomes. Building a culture of continuous improvement is not a short-term project or a quick fix but a journey that never ends. It requires commitment, investment, and persistence.

The goal of continuous improvement is operational excellence, which represents a way of working that delivers improvements in care quality and safety through the use of continuous improvement techniques. Improvement is owned and delivered by frontline staff and reinforced by ongoing training, technology, and supported by the entire organization.

If you are striving to become a Lean organization, waste elimination is probably near the top of your list. In fact, Lean practitioners have identified very specific types of waste, known collectively as the 8 Wastes of Lean. Certain types of waste are really easy to spot and fix, while others can remain unnoticed. We thought it might be helpful to share some practical examples of how each type of waste occurs in business and in the larger world.

The Leapfrog Group is a nonprofit organization founded in 2000 by large employers and other purchasers of healthcare concerned with quality and safety. The cornerstone Leapfrog Hospital Survey collects and reports hospital performance, giving consumers and other purchasers the ability to make informed decisions and find the highest-value care. The Leapfrog Hospital Safety Grade assigns letter grades to hospitals based on their patient safety record, providing transparency around critical issues such as errors, injuries, accidents, and infections.

The best performing hospitals on the Leapfrog Hospital Survey are recognized each year with the prestigious Leapfrog Top Hospital award. These hospitals have better systems in place to prevent infection, reduce medication errors, deliver the highest quality maternity care, among other qualities. To be eligible to receive the award, hospitals must have received a Leapfrog Hospital Safety Grade of A in the most recent scoring round. The award is not limited to a particular number of hospitals; instead, all teaching, rural, general, and teaching hospitals, that meet the high standards for each year can receive the award.

Recently, our very own Senior Advisor, Mark Graban had the opportunity to chat with Mike McGowan, Director of Process Excellence at Marietta Memorial Hospital. Mike has worked as a Medical Technologist, Chemistry Supervisor, Laboratory Director, and Senior Director in healthcare for the last 35 years spending most of that time at Marietta Memorial Hospital. He is a Lean Six Sigma black belt and is a 2014 graduate of The Ohio State University with a Master’s Degree in Business Operational Excellence.

Their conversation centered on how Marietta Memorial Hospital System uses training and five specific roles to build and spread a culture of continuous improvement. Mike shared what their organization does well and where there are still opportunities for improvement. He also reflected on the leadership behaviors necessary to achieve cultural change. This post is a recap of their conversation.

View the Webinar:

How One Community Hospital is Creating a Culture of Continuous Improvement

Presented by Mike McGowan, Director of Process Excellence at 
Marietta Memorial Hospital

• Learn how Memorial Health System uses training and five specific roles to build and spread a culture of continuous improvement
• Hear what MHS has done well and where we could improve
• Discuss the leadership behaviors necessary to accomplish a culture change

One of the exciting things about the Lean management approach is that it is applied differently in every industry and organization. While it got its start in manufacturing, healthcare organizations have significantly benefited by using the same principles and practices with modifications. The exact tools and methods may vary from one organization to another, but there are a few core doctrines that Lean healthcare organizations all have in common. Together, they form a way of thinking that transforms organizations and changes the behavior of employees at every level of the org chart.

Lean healthcare is simply the use of the Lean business management philosophy in healthcare facilities. The goal of Lean is to reduce or eliminate waste in every procedure, process, and activity by applying the principals of continuous improvement. When an organization becomes Lean, there is an impact on every team member from operations and administrative staff and even clinicians. Everyone is tasked with identifying ways to eliminate any task or expense that does not add value for patients.

Why are members of the healthcare industry applying a business approach that got its start in manufacturing? According to the Centers for Medicare and Medicaid Services, national health spending is projected to grow at an average rate of 5.5 percent per year for 2017-26 and to reach $5.7 trillion by 2026. That rate of growth is simply unsustainable under existing conditions. A widespread shift in thinking and a sharp focus on customer value is necessary to keep the already overtaxed system from collapsing under increasing weight.
One change in thinking that is already becoming evident is the focus on growing more customer-centric and developing solutions that increase customer satisfaction while maintaining profitability. That’s where Lean’s focus on eliminating waste comes in. The central question, “Does this provide value for the customer,” is asked by every member of the organization, ensuring organizational alignment and consistent decision making.

The Lean business management approach is used widely in healthcare organizations because cutting waste from health care delivery is not just a nice idea; it is an urgent imperative. Healthcare organizations are under tremendous pressure to provide the highest quality care for the lowest cost possible.

When resources are strained, Lean is a powerful solution.

Here are the functions that Lean software serves in a healthcare organization.

Even after about 20 years of Lean adoption in some healthcare organizations, there are still others that are just getting started. There are many paths for starting Lean healthcare in your hospital, health system, or clinic and there’s an opportunity to learn from the lessons of those who went before you.

Here are some of the different ways to start, stated with some of the pros and cons.

Rapid Improvement Events

Some hospitals take the approach of starting with many Rapid Improvement Events (RIEs), sometimes known as Kaizen Events or Rapid Process Improvement Workshops (RPIWs). These events generally range from two to five days and give staff and leaders dedicated time to work on significant problems that need to be solved.

One pro is that RIEs can be used to solve problems that can make a significant impact on measures that matter, including safety, quality, patient flow, cost, and staff morale - that is if projects are selected carefully. One downside to starting with RIEs is it can take a long time to get everybody in the organization exposed to Lean through the RIE learning-by-doing approach. Some organizations, like ThedaCare, have learned that RIEs need to be supplemented by other methods, like Daily Kaizen, Lean management system practices, and strategy deployment.

We spend a lot of time and effort on this blog digging into the details of how to start, spread, and sustain a Lean culture. We think it is important to get very specific about the Lean tools and techniques that produce measurable results for healthcare organizations. So of course, we care a lot about technology solutions that bring it all together. However, sometimes it is a good idea to pull back and move away from the details. Once in a while, it pays to get the 30,000-foot view and remember why we are doing this at all.