On Lean

Lessons from an aspiring lean leader

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This week I will be sharing lessons I’ve learned as a lean leader and champion – in particular around visual management. The Lean Enterprise Institute (LEI) holds an annual Lean Transformation Summit canstockphoto16267629where experts and practitioners come together from all industries to learn from one another.

My talk will cover a multi-year journey that has involved learning from others both in and out of healthcare, site visits, training classes, lots of reading, and experiments with my leadership team. Most of my talk is based on my experience and lessons learned at the University of Michigan Health System.

I was delighted to see that University Hospitals where I’m currently the interim CIO has been on their own lean journey since 2011. At our hospitals you will see huddles and visual boards throughout. Thousands of staff have been trained in lean concepts and methods. In contrast, there have been limited experiments with lean at the corporate office. I have a few allies in my IT leadership team who have experience with lean in other organizations. A good start!

I would have been making a mistake to arrive at UH as the interim CIO and start introducing lean methods week one. I needed to see and hear the problems that need to be addressed. Continue reading →

Keep it simple and visual

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CIO Board 11-2015The past month has been a particularly busy one for me. I have spoken locally a few times and gone out of town on business several times as well. I’ve been to the CHIME Fall Forum, made a site visit at Duke, and attended an AAMI board meeting. During that same period, I’ve given a talk on “Women in Technology” and participated on a CIO panel at the Midwest Fall Technology Conference in Detroit. I spoke on “High Impact IT” at the 2015 ICHITA Conference sponsored by the Center for Health Information Technology Advancement at Western Michigan University in Kalamazoo. I was one of two CIO guests on the CIO TalkRadio Show last week. And we published our monthly newsletter and held one of our twice a year department all staff meetings.

I have a busy schedule of meetings at multiple UMHS locations every day, so how did all these commitments come off without a hitch? The visual board my support staff and I started some weeks ago has made the difference! The only commitment that I scrambled on at the last minute was the one that hadn’t made it onto the board. That’s telling.

Prior to our visual board, I sometimes scrambled at the last minute to finish a presentation or finalize flight arrangements in time to get a reasonable price. Now, as a team, we can see into all the major events and commitments and take an organized approach to the shared tasks involved.  Continue reading →

Quality month: sharing improvement stories

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Root Cause wideRecently I wrote that October was Quality Month and I highlighted Dr. Richard Shannon’s excellent talk, part of our Lean Thinker’s Series. I “teased” that I would comment on the Quality Month poster sessions in an upcoming post.

For two days, 48 quality improvement teams displayed their stories as posters. I spent about an hour checking out the posters and talking with people from the teams. I targeted the ones with potential scalability or an IT connection.

Jennet Malone, a manager at The Briarwood Center for Women, Children and Young Adults, explained how they increased use of the portal.

Here are a few worth noting:

Got Portal? –The Briarwood Center for Women, Children and Young Adults

We rolled out our patient portal more than 3 years ago. Patient enrollment has been fairly successful  with over 200,000 active users but this is still not at the level we need. This health center established specific goals for making portal functionality part of everyday clinic workflow and used by patients and families. They increased their marketing efforts and established staff incentives for meeting short term goals. They purchased iPads to help staff sign up patients. They added the portal metric to their daily huddle. The result: Briarwood Center for Women, Children and Young Adults has the highest percentage of patients on the portal when compared to other clinics! Continue reading →

October is Quality Month!

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Each year UMHS celebrates Quality Month and this year is no exception. Last week as part of our Lean Thinker’s Series, Dr. Richard Shannon, EVP Health Affairs, University of Virginia Health System, gave an excellent talk titled “Patient Safety and Quality: The New Currency in Academic Health Centers”.

It was good to hear how another academic medical center is approaching similar challenges and applying lean. Some of my takeaways from his talk and the lunch discussion that followed:

  • Dr. Shannon described their Be Safe initiative – “Our Be Safe initiative is advancing our status as a high performing organization by systematically applying the scientific method (Lean Principles) to improve the safety of our patients and workforce through real time problem solving.” He shared examples of how they have reduced the incidence of hospital acquired infections, a problem for all hospitals.
  • Senior executives hold a “situation room” and digital report out each morning. They spend 15 minutes reviewing critical problems that have been reported and then spend the next 45 minutes actually going to the units to understand the specific problems more deeply. And they do it on Saturdays as well.
  • Their IT team plays a central role in providing data and reporting in support of their daily management system. They have developed the “Be Safe” reporting system. It is a common platform that supports daily manual entry from any employee and takes automated updates from other feeder systems. He emphasized the importance of having actionable data. All of their A3s are done online and uploaded to a library that can be queried. Patient safety events are documented with an online form as part of the system. I plan to reach out to their CIO, Rick Skinner, who has shared some of their lean stories with me in the past. Having heard Dr. Shannon’s talk, it’s time to get a much better understanding of their system.

Continue reading →

Are we ready for the business of the day?

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“Huddles, not just another meeting;” I wrote that when we started our twice a week IT leadership huddle in April. How true! And as of three weeks ago, we have another leadership huddle experiment in progress – the daily hospital leadership huddle. It is part of our developing lean Daily Management System.

Our Acting CEO and COO for the University of Michigan Hospitals and Health Centers, Tony Denton, runs the daily huddle. As Tony said in his initial communication, “The purpose of the leadership huddle is for senior leaders to have daily awareness of issues that may impede our ability to provide service. The leadership huddle is the “top tier” of a daily management system designed to surface issues and problems, assign leads for pro-active problem-solving efforts, examine trends and track progress. It is a key aspect of developing a more effective Michigan Operating System. If successful, we expect to see continuous improvement in our safety, quality, timeliness and financial results, and enhanced ability to deliver ideal patient and family care experiences through the engagement of our people.”

The value of these leadership huddles was clear the first week. Continue reading →

Reducing costs while increasing value

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Except for maybe start-up technology companies, there isn’t an IT department anywhere that has an open checkbook. In health care, we know all too well the need to manage costs while answering what seems to be an insatiable demand for technology solutions. CIOs need to understand the technical debt of a large application portfolio and the total cost of ownership (TCO) for systems. They need to find ways to reduce the cost of commodity services, and to create capacity for new work.

At UMHS, we have an initiative called Value and Margin Improvement, or VMI.  The VMI program is a multi-year effort across the health system.  UMHS leadership launched VMI to help achieve our financial stewardship goals by empowering collaborative teams to design and implement sustainable improvements that enhance value and financial results.

VMI aims at reducing duplication, inefficiencies and non-value added work in order to more effectively manage our costs, improve the value we provide and increase our margin.  A positive operating margin allows us to invest in the future and better serve our patients, referring physicians, students, the research community, and other key stakeholders.

VMI projects take a balanced approach to improve and sustain overall value while still maintaining the desired safety, quality, service delivery, and employee engagement metrics. The program promotes the use of lean methodologies and collaborates with our central lean team, the Michigan Quality System (MQS).

We are systematically moving through Continue reading →

Go to the gemba, seek to learn

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I’ve written about gemba walks. Gemba is the Japanese word for “the real place” or that place where the work is done.

I am fond of a quote from President Dwight D. Eisenhower: “Farming looks mighty easy when your plow is a pencil and you are 1,000 miles from the corn field.” Gemba basicsWhile I don’t know the specific context for the quote, it applies to business today. As leaders, unless we see the way work happens on the front line, we cannot understand the problems we need to solve and the barriers we need to remove. That doesn’t happen by just meeting in a conference room.

All hospital leaders were assigned to do at least three gemba walks this summer. The walks are supposed to be an example of each of the following:

  • patient and family experience such as observing check-in
  • front line staff experience such as shadowing someone or attending a unit’s daily huddle
  • “break out of your silo” experience such as observing one of your downstream customers or walking a “value stream” (a high level view of how work gets accomplished across multiple departments and physical locations)

We are expected to Continue reading →

Leaders learning lean — time for a field trip

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Say that title fast! We held our quarterly IT leadership retreat this week. As we continue on our lean journey, I decided a field trip was in order.

James Goebel explains how employee can see their scheduled tasks on the resource management digital board at Menlo Innovations.

We spent two hours at Menlo Innovations getting a private group tour from co-founder James Goebel. To prepare, we read the “The Joy of Lean Innovation: A Case Study of Menlo Innovations” and listened to a Gemba Academy podcast of an interview with Richard Sheridan, Menlo Innovation’s founder and CEO. Many others from University of Michigan Health System have visited Ann Arbor based Menlo over the years. I’d been encouraged to make a visit by my lean coach, Margie Hagene, and our internal UMHS lean champion, Dr. Jack Billi.

Menlo is a software design and development company. But we weren’t visiting to understand their approach to software. Rather, we wanted to understand how they have applied lean principles to run their business and create the culture that Richard Sheridan describes in his book, “Joy, Inc. – How We Built a Workplace People Love.”

Two of our new IT directors are in their third week, so we started the retreat by each describing the most effective leadership team experience we’ve had. The themes that emerged Continue reading →

So what’s the problem – A3 thinking

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If you don’t know what an “A3” is, don’t worry. When I started at University of Michigan Health System, I didn’t either.  When I first saw an A3 meeting on my calendar, I asked “What group is that?”

Plan, do, check, act. PDCA on white isolated background. 3d

There were so many groups with different acronyms!  Turned out it was a meeting with a few colleagues to update our status report on major UMHS IT initiatives. We were using an A3 format for our report.

So what is an A3? It is a tool used as part of Plan-Do-Check-Act (PDCA).  The A3 name actually comes from the paper size (11 x 17 sheet) that tells a story laid out from the upper left-hand side to the lower right.

Telling the story of a problem on an A3 includes looking at the background (why and what), describing its current condition (where things stand), and doing a root cause analysis. And then, establishing goals and targets, proposing countermeasures, making an action plan and determining success metrics.   Continue reading →

Leadership huddles: not just another meeting

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It’s huddle time! No, I’m not joining a sports team.  But along with my leadership team, we are taking the next step on our lean journey. In a few weeks we’ll be starting twice a week 30 minute leadership huddles. This is part of Lean in Daily Work which also includes key visual metrics, visual boards, Everyday Lean Ideas (ELI), and leadership walks.

In a post last summer, I talked about the lean journey.  It is important for leadership to set common expectations throughout an organization.  So if we’re going to practice lean thinking as a department, our leadership team has to set the example.

The goals of this lean experiment include the following:

  • Create a common understanding of what our performance is compared to what we want it to be so that we can understand the gaps and improve
  • Make our work visual and actionable
  • Understand our business more deeply by asking questions and looking at trends
  • Surface, track and trend problems
  • Gain experience and practice with lean

Continue reading →