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.

The Lean approach to business management has its roots in manufacturing, but today it is widely used in hospitals and other healthcare organizations. The ideas of waste reduction and process controls are attractive, but some leaders implementing Lean healthcare run into some pretty serious challenges.

Here are a few of the most common mistakes.

When people ask me about my job and I explain that my company offers Lean software, people who know anything about the Lean business management methodology usually assume that all of our customers are manufacturers. That’s not an unreasonable assumption given Lean’s origins in the Japanese automobile industry, but it’s also not true. We have customers in all sort of industries from banking to non-profit. We have clients in industries ranging from logistics and financial services companies to construction companies and hospitals.

Identify, Specify and Create Value for the Users

Kristin Bentz, RN, BSN, CPHQ
Lean Transformation Specialist, LeeHealth

I am a registered nurse by trade. I spent the first 18 years of my career career caring for critically ill and injured patients in large healthcare institutions nationwide. Before the turn of the century, the words ‘quality’ and ‘performance improvement’ were not commonly used in the clinical environment. Policies and procedures were typically drafted by senior leaders who were far removed from current state front line. This operational disconnect resulted in functional barriers to performance, and these barriers were often addressed by the creation of process workarounds.  These workarounds then evolved into practices of normalized deviance and unfortunately surfaced as root causes for many medical errors.

When the Institute of Medicine released To Err is Human in 1999, the US health care system had a rude awakening. We were a human services industry who contributed to more fatalities per year than car crashes and firearms. We were informed that as many as 98,000 Americans die every year at the hands of health care professionals. After 16 years of quality and safety initiatives from the Institute of Healthcare Improvement, The Joint Commission, and a trillion dollars in federal health care legislation, the British Journal of Medicine now cites that the third leading cause of death in the United States is attributed to medical negligence.  It is estimated that over 250,000 patients per year enter our health care facilities and die because of errors in care delivery.  The initial root cause analysis blamed system failures in health care communication and collaboration for the accidental death of patients, and these systemic failures continue to plague our health care institutions today.