The Power of Ideas to Transform Healthcare
Engaging Staff by Building Daily Lean Management Systems
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Many companies conduct Lean training and projects, but few have tapped the wealth of ideas in the minds of their staff like Baylor Scott & White Health. This book documents the path Steve Hoeft and Robert Pryor created at Baylor Scott & White Health and shares what worked as well as what didn’t—illustrating over seven years of successes and failures in detail.
Providing easy-to-follow guidance for deploying Lean and TPS in healthcare, The Power of Ideas to Transform Healthcare focuses on what needs to be done and who needs to do it. It explains that the new "currency" for 2015 and beyond will be ideas—ideas brought out in projects, problem solving, and especially in "Huddles." The most significant concept in this book is not huddles. Instead it’s who builds the systems around them and why.
- Supplies the understanding required to build a Lean management system in any industry
- Explains how to align staff around common goals and cascade and translate those goals using Hoshin Kanri
- Demonstrates how daily Lean can reduce the cost of healthcare
The authors share hundreds of pictures, forms, tools, and tips. Describing how to engage all staff and draw out their ideas in daily huddles, the book offers ways that staff can try out their ideas without spending too much time away from their work.
Although the book focuses on healthcare, the management systems described, along with the lessons learned and best practices, will work in almost any industry.
Table of Contents
What Can Lean Do for My Organization?
Why Lean? Why Now?
The Healthcare Desert Oasis
Healthcare Challenges Nationwide
New Challengers: Non-Traditional Healthcare Providers
A Process for Dealing with Change
S&W’s Particular Challenges
S&W’s Growth Era
S&W’s Financial Model
S&W’s Secret to Low Costs—Integrated Health Delivery
How S&W’s "Secret Sauce" Helps Improve Population Health
Rapid Growth and Pride
Confusing Leaders—Management Systems and Gurus Everywhere
Systems Thinking: Big and Small
Lots of Operating Systems: Which One?
A System that Ties Together Other Good Micro-Systems
Bob’s Bold Statement
Toyota Changed the Value Equation (aka Only One Way to Thrive)
What Percentage of Your Creative Brainpower?
Countering the Two Biggest Excuses
The Improvement Philosophy for Healthcare
Bob Finds His People-Based Lean Philosophy
Go, No-Go #1: CEO-Driven
Go, No-Go #2: No Layoff Policy
It’s All About People
The Goal: Building a Culture of Continuous Improvement
Investing in People
The Toyota House
The Toyota Way Principles
Toyota’s Patience—San Antonio
All Staff Need to Develop "Eyes for Waste" (Downtime)
Lead Time and Value Added Time
The Customer Determines Value
Types of Work
Lean Thinking Penetrates Every Part of the Organization: Baldrige Framework
Tensions are Natural in Every Transformation
Standardize vs. Improve: Defending Standardized Work
(Forced) Standard Improvements vs. Team-Based Improvements
Detailed Standard Work or General
Do It This One Best Way vs. Figure Out Best for You (Rigid vs. Flexible)
SMART vs. Stretch Goals
Problem Solver vs. Problem Finder
No Layoff Policy vs. Layoffs in the Face of Volume Imbalance or Major Cost Pressure
Not Big Enough vs. Too Big
How S&W Did It—Applying TPS to Healthcare
Step 1. Lean Training and Tools
Orientation and Two Hats
Continuous Improvement Training
Common Core Training and Applications for All Staff
Advanced Development Tracks for Select Staff
Lean Steering Council
Sausage Diagram and Project Identification—System-Wide Value Stream Mapping
Project Prioritization and Selection Matrix
Maintaining the Matrix: How Detailed?
Step 2. Major Lean Projects: Self-Sufficiency Plan
Many, Many Projects
Tracking Return-on-Investment (ROI)
Lean Project Example—Chemo Infusion (VSM Workshop)
Re-Casting a VSM Vision
Spreading Ideas from One Area to Another
Why Doing Lean Projects Only Will Not Work
Step 3. Align all Staff through Hoshin Kanri
Catchball and Contribution to the Leaders’ Goals— Different for Everyone
S&W’s Hoshin Forms
Linking Human Resource-Led Backward-Looking Annual Reviews with Forward-Looking Hoshin
Advanced Practice Professionals (APPs)
S&W Strategy Development
Step 4. Daily Lean: Lean Management System-Building (LMS)
Unleashing Ideas—the Iceberg
Three Parts of Lean Management System (LMS)
Part 1: Leader Standard Work
Part 2: Visual Controls
What Do You Put on a Huddle Board?
Workers Need Input or In-Process Measures to do Experiments
Close-Up of a Hand-Tracked Measure
Close-up of All Three Sections of Huddle Board
Part 3: Daily Accountable Process
More Gemba Walks, More Time
Nursing—Labor and Delivery (L&D)
Temple Memorial—Overall Patient Satisfaction Effort Using Huddles
Quotes from Nursing Leaders
Monthly LMS Huddle Success Stories
Temple Environmental Services (EVS
Everyone at Every Level Huddles—A Tier-3 Leader Huddle
S&W’s Employee Engagement "Outlier"
The Huddle System (LMS)—In Detail
Keep it Simple: Two Guardrails to Guide all Daily Lean Ideas
Leadership, Gemba, and PDCA Cycles
Small "l" Leadership First
Faith not Feeling
Slow Data Feedback to Team Means Slow PDCA Experiments
Lean Leadership (LMS) Course
More on Gemba Walks in the LMS Class
Leader Standard Work
Chaining all Huddle Boards Together—No Weak or Missing Links
Keep it Simple
Daily Accountability Process (Huddles)
Part A: The Huddle
Part B: Leader Gemba Walks
Part C: Increased Floor Time for Leaders
Leaders Must Keep Teams Moving up the Stairs
Examples of Huddle Boards (Old and Newer)
Medical Intensive Care Unit (MICU)
Surgical/Trauma Intensive Care Unit (STICU)
Cardiothoracic Intensive Care Unit (CTICU)
Temple HR Recruiting
Taylor POS Collections
Temple Orthopedic Clinic 2C
Temple GI Procedures
McLane Children’s Hospital Physical Therapy/Occupational Therapy (PT/OT)
McLane Children’s Hospital Imaging
McLane Children’s Hospital Lab
Llano Nutrition Services
Hillcrest Baptist Physical Therapy (Re-Evaluations)
Temple Pulmonary Lab
Entering a Huddle: Senior Executive Committee
Elevation System—the Strong Chain
Colored Card System to Track Elevated Ideas
Interventions to Accelerate Ideas
Huddle Tracking System
Tracking Huddles Two-Deep
Huddle Board Audit System; Layered Audits.1 Layered Audits
Lean Tools S&W Uses in Huddles.1 Tools
Rebalance and Workshare in Huddles
To the Huddle
Same Day Access (SDA) Effort—Using Huddles
Tips and Techniques
Tip 1: To All Leaders: Have Patience!
Tip 2: Make it Visual!
Tip 3: Be Flexible
Tear ‘em Down
Tip 4: Understand How Change Affects People
Tip 5: What You Measure is What You Get; So, Be Careful What You Measure
Tip 6: Put some "Teeth" into Hoshin Goals
Tip 7: Get Flow
Tip 8: Partner with a Lean Leader—Even in Another Industry
Tip 9: Steve’s Sensei Folder
Tip 10: Using Assessments or "Scores" to Grade One’s Progress
Overall Lean Maturity Score
Lean Assessment by Tool or Principle with Radar Chart
Baldrige (or Several Other) Framework
Tip 11: Tip of the Week Emails and Intranet Fresh Articles
Top Five Lists for Huddles
Top Five Reasons to Huddle
Top Five Things We Huddle About (Focus Topics)
Tip 12: Building the Internal Lean and LMS Toolkit
Tip 13: Using Videos to "Get the Message Out"
Tip 14: Have a Bias for Action
(Story 1) Must Cut Inventory in Half—a Bias for Action
(Story 2) Door Here!
Tip 15: Stop Lean during Epic or EMR Rollout?
Tip 16: Stop Lean during a Merger?
Tip 17: The ROI Trap and Role of Training
Tip 18: Kaizen or Kaikaku: Redirecting Labor
Flexing Staff to Other Sites
Appendix: Acronyms and Some Terms
The joint wisdom and experience of Hoeft/Pryor makes this book both fun to read and a great resource for organization leaders and internal consultants tasked with improving processes. While the fit for healthcare is obvious, the practices they have so succinctly described will benefit any workplace.
—Cindy Jimmerson, Author and Founder of Lean Healthcare West
Lean healthcare has become a buzzword and as such often gets mired in the bureaucracy of ineffective programs. Steve and Bob give us deep insight into the philosophy and thinking essential to making Lean healthcare a way of putting innovative ideas to work to achieve breakthrough performance for patients, team members, and the institution.
—Jeffrey K. Liker, Ph.D., Shingo Prize-Winning Author of The Toyota Way
This book is built upon rock-solid foundations, bringing the daily Lean management system to life through their stories and examples. Hoeft and Pryor colorfully demonstrate how staff ideas and a broader Lean management system greatly benefit patients, staff, physicians, and the health system. Lean is not just a set of tools or a series of projects, and this book is full of inspiration and practical advice for everybody who needs to participate actively in a Lean transformation, starting with the CEO and other senior leaders. This is a must-read.
—Mark Graban, Shingo Prize-Winning Author of Lean Hospitals and Co-Author of Healthcare Kaizen
... The Scott & White system, at the time this book was written, counted 2,000 implemented ideas for improvement from employees per week from their 16,000 employees, this in an environment that included recent budget and staff cuts. That number is unheard of in my experience outside of a few high volume, low variety automotive manufacturers, mainly Toyota and some of its suppliers.
That level of employee engagement is for me the sine qua non of a successful Lean implementation supported by a robust Lean management system. ... Steve Hoeft is a teacher and coach with firsthand experience in Toyota’s thinking and approach. Pryor knew the direction he wanted to go: sustained high levels of employee engagement in improving S&W’s performance. Together, they developed an approach to move in that direction. Either would tell you they’re far from done. But the distance they’ve traversed and the progress they’ve made stands as a significant achievement, chronicled in the pages that follow ... This book documents the path the authors created at Scott & White ... It’s a systematic approach, and it’s working.... It entails taking leaders through a process wherein they persuade themselves of the value of sharing, with front-line staffers, their managerial discretion to define problems worth working on. When that happens, it holds the promise to improve the entire organization’s performance in ways others will find difficult to duplicate. The goal is worthy, the journey is worth making.
—David Mann, Ph.D., Shingo Prize-Winning Author of Creating a Lean Culture, Third Edition
The Power of Ideas to Transform Healthcare is an invaluable tool for any organization seeking to align their objectives from the system level to the front line—and that should be all organizations. In it, Hoeft and Pryor describe a practical approach to developing a culture of continuous improvement by engaging employees in problem-solving and developing a management system to support it at all levels.
—Chris Van Gorder, FACHE, President and Chief Executive Officer, Scripps Health
The pursuit of Lean thinking is not a top down process, it is a way of allowing everyone to do what is best for the patient in the most effective and efficient manner. Bob and Steve’s book gives great insight on how this is done in healthcare.
—C. Courtland Huber, Ph.D., Past Director of the Executive M.B.A. Program at the McCombs School of Business, University of Texas at Austin