1st Edition

The Power of Ideas to Transform Healthcare Engaging Staff by Building Daily Lean Management Systems

By Steve Hoeft, Robert W. Pryor, MD Copyright 2016
    422 Pages 143 B/W Illustrations
    by Productivity Press

    422 Pages
    by Productivity Press

    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.

    Introduction
    What Can Lean Do for My Organization?
    Bob’s Background
    Steve’s Background

    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)
         The Promise
    What Percentage of Your Creative Brainpower?
    Countering the Two Biggest Excuses

    Philosophy
    Toyota’s Philosophy
    Patient Centered
    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
    Philosophy—Inclusiveness
    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
         Scientific Method
    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
         Leader Roles
         Self-Sufficiency Philosophy
         Many, Many Projects
         Setup Checklists
         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
         All 13,000?
         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
         Strategy
         Advanced Practice Professionals (APPs)
         S&W Strategy Development
         Population Health
    Step 4. Daily Lean: Lean Management System-Building (LMS)
         Unleashing Ideas—the Iceberg
         "Ultimate Arrogance"
         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 
              Must-Haves
              Could-Haves/Should-Haves
              Close-Up of a Hand-Tracked Measure
              Close-up of All Three Sections of Huddle Board
         Part 3: Daily Accountable Process
              Huddles
              Gemba Walks
              More Gemba Walks, More Time
              Daily Experiments
         LMS Examples
              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
    Building LMS
    Lean Leadership (LMS) Course
         Required Courses?
         More on Gemba Walks in the LMS Class
    Idea Lists
    Leader Standard Work
    Visual Controls
         Chaining all Huddle Boards Together—No Weak or Missing Links
         Three Tiers
         Keep it Simple
         Execute!
    Daily Accountability Process (Huddles)
         Part A: The Huddle
         Huddle Tips
         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)
         Memorial ICUs
              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
         Taylor Lab
         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
         Analysis
         Interventions
         A3 Waves
         Results
         Major Projects
    Huddle Tracking System
         Hand-Written Trackers
    Managing Two-Deep
         Spread
         Communication
         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
         Process
         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

    Forms

    Appendix: Acronyms and Some Terms

    Biography

    Steve Hoeft, Robert W. Pryor MD

    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 lineand 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