Implementing Lean: A Hospital Case Study
Lean was a serious initiative from the beginning. It was energetically championed by our CEO at that time, John Toussaint, MD, who began his own lean investigations in 2002. By this time, I was a vice president with operational responsibilities in the hospitals for obstetrics, cancer care, and surgery, in addition to the philanthropic foundations, so I was involved from the beginning of our ambitious lean initiative.
Like many organizations beginning a lean initiative, we started by putting together teams to map our value streams. First, though, we had to define “value stream.” In industry, value streams show how products and information flow through a company from raw material to fabrication and shipping. In health care, we decided, the patient was the product, and so the value stream would be the flow of a patient through a cycle of care. A cancer value stream, for instance, includes testing, diagnosis, treatment, and, some percentage of the time, hospice.
For women having babies, our obstetrics value stream began with prenatal checkups, continued through delivery, and ended with baby’s first visit with a pediatrician. In this way, we shifted our focus from organizing work around specialized departments (silos) such as pharmacy or surgery to organizing around the needs of the patient. We recognized that most patients flow through multiple value streams. Also, we learned that our first pass at any patient’s care was disease specific — not necessarily taking multiple health issues into account.
Next, we set end-to-end improvement goals in those value streams — cutting through departments and old barriers — and pushed ahead with three or four kaizen1 improvement teams operating every week across the organization. Our Friday report-out sessions were part information sharing, part tent revival. We trained more than two dozen people to become lean experts facilitating kaizen teams and then started rotating frontline leaders and executives through those facilitator positions for two-year terms.
Organizing all the work was our ThedaCare Improvement System Office, overseen by a senior vice president reporting to the CEO. We called our kaizen team weeks Rapid Improvement Events and made sure they were multidisciplinary, with nurses, patients, pharmacy technicians, family members, and doctors all joining together to solve problems. Wherever we applied lean thinking, quality was improving, costs were falling, and patient satisfaction was inching upward.