Presented at the Virtual Lean Summit 2020 - Thanks to Dubai Quality Group and the Lean Gulf Institute for the invitation to speak and share.

1. A Vision for
Lean Healthcare
Mark Graban
President
Constancy, Inc.
Slides & Resources: https://www.markgraban.com/virtual2020/

2. Thanks to:

3. Slides & Resources: https://www.markgraban.com/virtual2020/

4. What problem(s) are we trying to solve?

5. The Goals That Matter in Any Organization
• Safety
• Quality
• Delivery / Access
• Cost
• Morale

6. Leanness is measured
by outcomes, not by
the number of tools
that are implemented

7. Lean Benefits Many Stakeholders
• Patients

8. Lean Benefits Many Stakeholders
• Patients
• Providers
• Payors
• Facility Owners

9. Value is Defined by the Customer (Patient)
• Not just “safe treatment”
• Health
• Longevity
• Quality of Life

10. The Best Patient Experience is a Safe One
Dr. Eric Dickson
CEO of UMass Memorial Health Care
“First, don't kill me if I
come to your hospital.
Second don't hurt me.”

11. “Lean” ala The Machine That Changed the World
HALF

12. “Lean” ala The Machine That Changed the World
“Lean production… uses less of
everything compared with mass production
—
half the human effort in the factory, half
the manufacturing space, half the
investment in tools, half the engineering
hours to develop a new product in half the
time. Also, it requires keeping far less than
half the needed inventory on site, results in
many fewer defects, and produces a greater
and ever growing variety of products.”

13. “Lean” ala The Machine That Changed the World
• Half the errors
• Half the infections
• Half the patient harm
• Half the waiting time
• Half the length of stay
• Half the head count (or more likely,
half the employee turnover)
• Half the cost
• Half the space
• Half the complaints from patients and
physicians

14. Aim for Perfection – The Ideal State
“Lean producers, on the other hand,
set their sights explicitly on
perfection: continually declining
costs, zero defects, zero inventories,
and endless product variety. |
Of course, no lean producer has ever
reached this promised land —
and perhaps none ever will…”

15. Aim for Perfection – The Ideal State
• ZERO harm to patients or staff
• ZERO delays
• ZERO angry customers
• ZERO voluntary staff turnover

16. Paul O’Neill (1935 – 2020)
• CEO of Alcoa
• Pittsburgh Regional Health Initiative
• U.S. Treasury Secretary
Goal: ZERO lost work time injuries
“People should not be hurt who
work for Alcoa. It’s not a priority.
It’s a precondition.”

17. “Theoretical Limits” – Paul O’Neill
• Leaders set goals at the theoretical limit of performance
• Leaders eliminate excuses in the organization

18. What’s Possible – Dr. Richard Shannon

19. “Where care
comes to you.”
Park Nicollet Frauenshuh Cancer Center

20. Right Care,
Right Place,
Right Time

21. Lean Hospitals for Patients
• Passionately and meticulously focused on
the patients, families, and guests, aiming
for perfect, harm-free care, while
respecting patients and their time

22. Lean Hospitals for Patients
• The patient comes first in all activities,
decisions, and priorities
• Leadership helps create that expectation
with all stakeholders
• Clinical care
• Excellent service
• Caring environment
• Address physical and emotional needs
Cleveland Clinic

24. What would the Patient Experience in a
Lean Outpatient Surgery Center?
• Everything is communicated properly in advance
• Arrival and parking is hassle free
• Registration without repetition
• Safe, high quality care (“perfect care”)
• Excellence service
• Family / parents get great service while waiting
• Perfect communication on discharge
• Accurate and understandable billing statement

25. Lean Hospitals for Staff
• A Lean hospital recognizes that employees
are the true source of value for patients and
the hospital, rather than being viewed strictly
as a cost to be reduced
• Top leadership makes a consistent
commitment to all employees that Lean
improvements will not lead to layoffs

26. Lean Hospitals for Staff
• Does not overburden employees with more
work than can be done in a high-quality manner,
• Nor does it pressure people to work harder or be
more careful as a means to quality, safety, or
efficiency
• Employees are not sent home every time census
drops, as that is seen as an opportunity for
kaizen

27. Lean Hospitals for Staff
• To be challenged to grow, personally and
professionally, always striving to learn and
improve his or her technical, leadership, and
problem-solving skills
• To feel a sense of pride for contributing to a
high-performance organization, for
understanding his or her role and how his or her
work impacts patients, coworkers, the hospital’s
bottom line, and the community

28. Lean Hospital Mindsets
• Efforts and goals are tightly integrated with hospital
strategy and vision, moving beyond the isolated use
of tools to the engagement of all employees and
leaders in the building of a Lean culture
• Realize that success comes not only from technology
and clinical excellence, but also through employee
engagement and operational excellence
• Has a leadership method and model that is taught to
supervisors and managers and is practiced by all
leaders, used as criteria for selection and advancement

29. Lean Hospital Mindsets (2)
• Creates collaborative relationships for all partners and
stakeholders, including physicians, vendors, and payers
• Patient safety practices and quality data are shared openly
with other hospitals and the community
• Has specific leaders who are responsible for the overall
flow, management, and improvement of key patient care
value streams
• Determines proper staffing levels based on patient
volumes, actual workloads, and the time required to do
work in a safe, high-quality way
• Best attempts are made to match staffing to volume in
different time periods

30. Lean Hospital Mindsets (3)
• Proactively fixes problems and reduces waste, rather than being
strictly reactive
• Employees are encouraged to expose waste and make
improvements to the system, instead of hiding problems and
making things look good
• Breaks down departmental silos to focus on improving care and
preventing delays for patients, allowing employees to feel pride in
their work
• Never satisfied with being better than average, being in a top
percentile, or with winning awards; it always strives to get better

31. Lean Hospital Mindsets (4)
• Designed to minimize waste for patients and for all
who work inside its walls
• It is designed with direct input from staff to support
efficient workflows and value streams, rather than
forcing departments and employees to adjust their work
to the space.
• Has process technology, automation, and information
systems that make work easier or less error-prone
• The hospital does not install automation or new
systems for the sake of having new systems

32. Lean Hospital Mindsets (5)
• A Lean hospital recognizes that there is
waste in every process, focusing on
continuous improvement and root cause
problem solving instead of workarounds
and fire fighting
• Individuals (employees or leaders) are not
blamed for the waste or problems

33. Top leadership makes a consistent
commitment to all employees that Lean
improvements will not lead to layoffs

34. The CEO as Chief Lean Leader
Dr. Eric Dickson
CEO of UMass Memorial Health Care
“It was a tough decision…
extensive conversation…
what is the culture we are
trying to build here?”

35. The CEO as Chief Lean Leader
Dr. Eric Dickson
CEO of UMass Memorial Health Care
“We didn’t know how bad
this was going to be, how
long the recovery was going
to be.”

36. The CEO as Chief Lean Leader
Dr. Eric Dickson
CEO of UMass Memorial Health Care
“We saw revenue drop by 40%
in March and we could have
saved maybe $5 to $10 million
of furloughs and layoffs. At
that point, we said, will it be
worth it if in three or four
months down the line…”

37. The CEO as Chief Lean Leader
Dr. Eric Dickson
CEO of UMass Memorial Health Care
“We looked at our particular cash situation
and said, you know what, we're going to
stand by our people, respect for people.
We're not going to furlough.
We're not going to lay off, but we are going to
ask every one of them to be an ambassador
for the organization.
We are going to ask every one of them to
look at the way they're doing their job and
spend time that may be downtime to kind
of think about ways you can improve.”

38. Listen to the entire conversation
https://www.valuecapturellc.com/HE11

39. Leanness is measured
by outcomes, not by
the number of tools
that are implemented

41. An Integrated System

42. Q&A Discussion
Mark Graban
• Email:
• mark@markgraban.com
• Web:
• www.LeanBlog.org
• www.MarkGraban.com
Resources: https://www.markgraban.com/virtual2020