1st Edition

Sustaining Lean in Healthcare
Developing and Engaging Physician Leadership





ISBN 9781439840276
Published May 20, 2011 by CRC Press
148 Pages - 67 B/W Illustrations

USD $77.95

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Book Description

Among the first books to focus on physician engagement during a Lean effort, Sustaining Lean in Healthcare: Developing and Engaging Physician Leadership explains how to ensure ongoing physician participation long after the consultant leaves. Dr. Michael Nelson, an early adopter of Lean in healthcare, explains how to use these synergic tools to achieve consistently high levels of quality and clinical care outcomes.

The book begins with a Lean primer that provides a firm foundation in essential Lean concepts—including value stream maps, 6S, Kanban, Heijunka, and Gemba Walks. Next, it examines how to create a physician engagement plan and covers the specific responsibilities of physician leadership through the Lean transformation. Explaining what to look for when judging success, it provides numerous examples that demonstrate how to sustain success over the long term.

Complete with tips for spotting the danger signs that might indicate your plan is off course, this book details time-tested techniques and strategies for reducing waste in healthcare. It supplies a methodology for establishing shared expectations of success with your medical team early on in the process, as well as a proven framework for simultaneous Lean deployment across multiple locations.

Praise for the book:

In this book , Dr. Nelson draws on his forty years of medical practice and his experience as an early adopter of Lean for healthcare, to identify a crucial piece to aligning healthcare organizations for success; Physician Engagement. … Healthcare executives and clinicians will appreciate and learn from Dr. Nelson’s insight.
—Robert Iversen, Director, Accenture Management Consulting

…Instead of writing another how-to book, Mike has taken the opportunity to provide insights that are sure to help any healthcare organization sustain the impact of its Lean engagement.
—Rick Malik, Worldwide Director, ValuMetrix® Services, Ortho Clinical Diagnostics

… provides realistic estimates of timelines for projects, expected satisfaction, quality, and financial paybacks, as well as the time commitments required for Lean healthcare initiatives to become durable successes.
—David Mann, PhD, Principal, David Mann Lean Consulting

… simplifies and organizes the steps needed to effectively and successfully take advantage of the significant contributions Lean management can make … .
—Edward D. Martin, MD, Co-Founder and Chairman Emeritus, Martin Blanck & Associates, Inc.

Lean has become a critical predictor of successful systems going forward. Sustaining Lean in Healthcare is the book to get this done.
—Stephen C. Beeson MD, Author of Engaging Physicians, A Manual to Physician Partnership

Table of Contents

The Basics of Lean
Implementation Phase
     Lean Tools for Product and Process Approaches
          Value Stream Maps (VSM)
6S
Kanban
Single Piece Flow
A Simple Exercise
Level Loading (Heijunka)
Product Process Flow
     Lean Tools for Operator-Focused Approaches
          Full Work Analysis
          Standard Work
Sustainment Phase
          Visual Controls
Huddles
Assessment (Audits)
Gemba Walks
Culture Change
Improvement Model
     What Are We Trying to Accomplish?
     How Will We Know That a Change Is an Improvement?
     What Changes Can We Make That Will Result in an Improvement?
Plan
Do
Study
Act
Kaizen

Lean and Physician Culture
Clinical Decision Making and the PDSA Cycle

Creating a Physician Engagement Plan
A Bit of History
Elements of a Physician Engagement Plan
     Vision and Goals
     Selection and Development of Physician Champions
     Reward and Recognition Plan
     Approach to and Engagement with Frontline Physicians 
     The Physicians’ Role in Sustaining Improvements and Maintaining the Lean Culture

The Senior Leader’s Role
Success Starts at the Top
Leadership Is More Important Than Tools
The Senior Leader’s Role
     Important Duties of a Leader
          Create the Vision—Determine the Right Destination before You Start the Journey
          Selecting the Right People
          Provide Resources and Invest in Infrastructure
          Executive and Champion Role Definition and Training
          Frequent and Clear Communication
          Strategic Alignment
          Deployment Plan
          Establish Measures for Success
          Project Spread and Sustainability
Summary—Active Leadership Is Essential to Effective Deployment

Analysis and Preparation
Business Needs Assessment and Operational Impact
     Lean Resources
     Likelihood of Financial, Quality, or Satisfaction Improvements
     Resources
          Leadership
          Desire to Improve
          Architecture
          Readiness
Preparation Phase
Stakeholder Analysis

Setting Expectations
Criteria for Intervention
     Who
     How

Physician Case Studies
Discussion
     Scenario #1
     Scenario #2
     Scenario #3
     Scenario #4
     Scenario #5
     Scenario #6
     Scenario #7
     Scenario #8

Keys to Sustaining Lean—A Physician Guide

Judging Lean Success The Process
Financial Success
A Balanced Approach
Tollgates
In-Person Monitoring
Scorecards
A Case Study

Sustaining
Lean Work
Improvement Work
Monitoring
Communications
Standardization
Summary

Pre-Implementation Tools and Approaches
Site Lean Team Selection: Roles and Responsibilities
     The Site Team
     Purpose of Site Team
     Characteristics of Site Team Leaders and Members
     Identifying Site Team Leaders
Pre-Implementation Checklist

Implementation Tools and Approaches
Typical Implementation Timeline
Gemba Walks
Cross-Training Matrix

Glossary

Index

Each chapter includes References

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Author(s)

Biography

Michael Nelson, MD spent 28 years practicing pediatrics while building the practice from a solo physician office to seven pediatricians. He has served as a hospital medical staff president and in various medical director positions. For the last 13 years, he has devoted increasingly greater time to quality improvement in healthcare. For the last 5 years of employment with Presbyterian Healthcare Services, he worked full time in quality improvement and became a certified Lean Six Sigma Black Belt. He was a physician leader for Lean Systems implementation at Presbyterian.

He is credited with:

  • Creating a health and chronic disease management system resulting in national benchmark performance in diabetes care
  • Developing a curriculum and teaching more than 200 clinicians and senior leaders advanced tools and techniques in quality improvement
  • Implementing elements of the advanced medical home
  • Creating a patient-centered care environment through the creation of patient and family advisory councils in PMG clinics
  • Leading and supporting successful Lean implementations resulting in dramatic improvements in ambulatory clinics and inpatient settings

He currently owns a Lean consulting business, Blue Corn Professional Services, LLC, and is a physician coach for the Studer Group.

Reviews

A super overview of Lean process improvement for any healthcare leader. A focused approach to Lean that will engage the physician audience. The book will be an excellent one as preassignment reading for a Leadership Development Institute that focuses on Lean and for the organization getting ready to embark on a Lean journey, particularly if they want greater physician engagement. ... It could be particularly effective if used as a book club format for physician leaders in an organization as a way of energizing them. The book has good follow-up exercises that demonstrate key points. Dr. Nelson has researched the material thoroughly. The book has very specific medical practice and hospital examples. ... Outstanding... I highly recommend this book.
Lynne Cunningham, Senior Coach, The Studer Group

Over the past two decades Lean Operations has made several significant runs in healthcare. The first attempts, with a few notable exceptions, lost momentum and were not sustainable because the incentives always seem to be misaligned. In this book, Dr. Nelson draws on his forty years of medical practice and his experience as an early adopter of Lean for healthcare, to identify a crucial piece to aligning healthcare organizations for success; Physician Engagement. It’s my experience that Lean methods work on processes in all industries, but nowhere is the human element more critical to their success than healthcare, and no one role is more critical than the Physician. Healthcare executives and clinicians will appreciate and learn from Dr. Nelson’s insight.
—Robert Iversen, Director, Accenture Management Consulting

Of the many books written about Lean journeys, Mike Nelson’s book offers a unique perspective. A physician himself, Mike focuses on the role he and his colleagues can play in creating and sustaining a Lean environment. He speaks from first-hand experience, having taken his own Lean journey and playing a key role in the quality aspect of a highly successful ValuMetrix® Services Lean engagement. His book clearly illustrates a fact that is all-too-often often overlooked – physicians must be included in any Lean engagement, since they are true enablers of change and are critical to sustaining the transformation. Instead of writing another how-to book, Mike has taken the opportunity to provide insights that are sure to help any healthcare organization sustain the impact of its Lean engagement.
—Rick Malik, Worldwide Director, ValuMetrix® Services, Ortho Clinical Diagnostics

Nelson does Lean healthcare a service as a physician and Lean practitioner focusing on engaging the physician. In this valuable resource, Nelson stresses and supplies guidance regarding the role of physician champion, and senior management’s responsibilities to the Lean initiative. As importantly, he provides realistic estimates of timelines for projects, expected satisfaction, quality, and financial paybacks, as well as for the time commitments required for Lean healthcare initiatives to become durable successes.
—David Mann, PhD, Principal, David Mann Lean Consulting

Nelson’s great service in this book is to approach Lean healthcare from the practitioner’s perspective and provide a very valuable and thoughtful approach which simplifies and organizes the steps needed to effectively and successfully take advantage of the significant contributions Lean management can make to their practices with the minimum expenditure of time and financial resources.
—Edward D. Martin, MD, Co-Founder and Chairman Emeritus, Martin Blanck & Associates, Inc.

Over the years, I have read a number of books on Lean implementation. Dr Nelson's approach is clear, practical, easy to read and prescriptive. Efficient use of resources and time are some of the most important directives for leaders to survive in these reforming times. Lean has become a critical predictor of successful systems going forward. Sustaining Lean in Healthcare is the book to get this done. Well done, Dr. Nelson. I learned a ton.
—Stephen C. Beeson MD, Author of Practicing Excellence, A Physician's Manual to Exceptional Health Care & Engaging Physicians, A Manual to Physician Partnership