Monday, September 14, 2009

Becoming a Lean Enterprise: New Insights from Along the Journey

I have worked with Lean in the hospital/health care environment for the past several years, and recently decided to take a step back and attempt to focus on the most critical factors which have determined success or failure in our various initiatives and strategies.

As part of my professional experience, I have both served as the COO of a major university teaching hospital, as well as the CEO of an organization that operated 139 hospitals across the U.S.

Because of this background, I have tended to focus on the more strategic aspects of Lean, and the role that it can play in the redesign of our delivery systems, and have reached several conclusions which may be of interest.

First, while many health care providers indicate that they have engaged in the use of Lean Thinking in one or several areas of operations, few have made the strategic commitment to become a Lean Enterprise.

While the first is relatively easy and painless, the second is substantially more complex, and requires a comprehensive assessment of the entire organization and it’s “current state”. That assessment includes its’ beliefs and values, it’s current management practices, and the structure of its’ key management jobs across the entire enterprise.

It also involves the important insight that the traditional hospital hierarchy was never designed to effectively manage productivity, cost or quality, and was certainly never designed to function as a Lean enterprise. Work and tasks in our hospitals tend to be organized around the health care professions (Nursing, Pharmacy, Clinical Laboratories, etc.) and do not lend themselves to effectively managing flow and value streams.
Even though, over the years, we have seen significant measurable improvements in the four critical areas around which our strategic plan is designed much is left to be done. (These four areas are Patient Safety, Customer Service, Clinical Quality, and Profitability.)

As a result of our Lean initiatives, we have seen substantial gains in these strategically important areas, including a 55% reduction in patient falls, a 41% reduction in urinary tract infections, a 7% reduction in labor costs on our inpatient units, and elimination of over 15,000 miles of nurse walking through flow redesign .

However, as we continue to assess our progress to date, it has become clear that to sustain these and many other gains, we must now focus our attention on policy deployment. . This step is critical in assuring that we have clear alignment from the “board to the bedside” in our strategic priorities.

Second, to that end, we are now redesigning the jobs of all key managers to assure that we have a new system of accountability which reflects our commitment to Lean. From top to bottom, we are formally realigning manager responsibilities around the “four pillars” of our Lean “house,” Patient Safety, Clinical Quality, Customer Service and Profitability

We are also creating new performance metrics and Key Performance Measures (“KPI’S”), which are closely linked with annual individual
performance evaluations and individual financial incentives.

Finally, we have realized that new skills are required of our managers, in order to successfully execute and sustain our gains. To that end, we have created a new entity called “Signature University” which provides certification training in critical areas of Lean and Leadership. All managers must become certified in eight critical skill areas to remain in their newly defined jobs, and financially progress within the organization.

All of these new insights are helping us more quickly transform our delivery systems, and move toward becoming a Lean enterprise.

David Spencer
Senior Vice President
Signature Hospital Corporation

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