Central is a 588-bed tertiary care hospital in a Midwestern city that is part of a national organized delivery system, which is owned by a not-for-profit health care system (HAU Care). The chief operating officer of the hospital selected Lean as the preferred methodology to address quality improvement problems and to change the hospital culture.
To examine Lean implementation at the hospital, we interviewed 51 staff members from multiple job categories at all levels of the organization between February and December 2010. Data were collected from in-person interviews conducted during two site visits, telephone interviews, and digital diaries recorded by members of Lean project teams. We studied two projects prospectively: Improvement of the "Door-to-Balloon" Process and Management of Surgical Procedure Cards. By prospective, we mean that we began data collection at the start of the project and continued to collect data until shortly after the project was completed.
The hospital hired an external consulting firm to guide its Lean journey, which included an aggressive rollout of Lean projects in four value streams. As a result of the rollout, the hospital reports that it has seen improvements in efficiency in multiple processes and a cost savings of $1.5 million over the initial projects from early 2008 through 2010.
Potential Lean adopters can learn lessons in several areas from the hospital's experience:
- Alignment: Align Lean with what matters to clinicians and their patients. Carefully map out and effectively communicate how Lean will support fulfillment of the organization's mission in a meaningful way.
- Leadership: Senior leaders must respond quickly when Lean implementation challenges arise. Senior executives should closely monitor the execution of Lean in the early phases by being involved in Rapid Improvement Event (RIE) teams and talking with staff, managers, and staff supporting Lean implementation.
- Staff engagement: Middle management support is critical for frontline staff buy-in. Particularly in the early phases of Lean implementation, the extent of middle management support should be considered as a deciding factor in selecting Lean projects. Projects that improve staff's work directly encourage engagement. Sharing past successes and linking Lean processes to improved patient outcomes can increase engagement. Compensate physicians for their time. Physician engagement has been shown to be critical for success and a true challenge under the previous structure where physicians were not employed by the hospital.
- Scope and pace of Lean activities: There is a learning curve to Lean implementation. Organizations require time to collectively develop the expertise to show consistent success with RIEs. Start simple, with visible gains to staff.