Building a Lean Network: Year 3 of the Lean Healthcare Transformation Initiative

Tuesday, August 28 2018

Lean Healthcare Transformation Initiative 2018 Annual MeetingAt this year's annual meeting of the Lean Healthcare Transformation Initiative, Critical Access Hospitals and Rural Hospitals met in Indianapolis to share insights gained and outcomes achieved in Year 3 of work facilitated by Purdue Healthcare Advisors (PHA) and funded by the Indiana State Office of Rural Health (INSORH) through the Medicare Rural Hospital Flex Grant Program.     

The title of this year's event, “Building a Lean Network,” reflected the year's goal to cast a wider net of engagement within each of the 14 participating hospitals, and to shift from a Purdue University-driven training process involving a small group of trainees to a broader organizational adoption of lean methodologies. The program's Year 3 curriculum focused on operational excellence with the introduction of lean leadership, a management model equipping leaders with an agile approach to strategy, and a daily continuous improvement tool for front line leaders. 

The meeting utilized a panel approach to spur idea sharing and breakthrough solutions while engaging attendees in the lean practice of reflective learning and dialogue.

Strategic Doing
The event kicked off with panel representatives from Rush Memorial Hospital, Franciscan Rensselaer Hospital, and Woodlawn Hospital whose executives had engaged in a Purdue University-facilitated Strategic Doing session. Strategic Doing is an agile strategy process that uses rapid cycles to enable a network to tackle complex problems without a known solution. Agile strategy is a flexible process at the tactical level characterized by a willingness to explore, experiment, and iterate to solve complex system problems by chunking challenges into short sprints better enabling organization to respond to a fast paced and changing environment.

Executives shared stories of implementing the goal they determined through Strategic Doing, with initiatives focused around influencing employee engagement within their hospitals and in community outreach as well as furthering lean work. Specific goals included:

  • building relationships with emergency department staff to engage them with the quality team to do lean process improvement;
  • selecting a platform for hospital telehealth services;
  • getting frontline staff more involved in community outreach;
  • building a center of excellence within the hospital;
  • establishing a wellness program for hospital associates;
  • creating a new leader toolkit;
  • implementing a formalized coaching program to improve processes; and
  • increasing the use of peer-to-peer recognition.

Rush Memorial Hospital Chief of Quality Deb Hummel said, "The use of Strategic Doing worked for us enabling us to make great improvements in quality this year in a very short period of time." The panel closed with a dialogue session with Ed Morrison, Director of the Agile Strategy Lab at Purdue, who challenged hospital executives and lean teams to continue to learn about agile strategy and to use the tool to improve the health of their communities.

Value Stream Management
The next panel highlighted Value Stream Improvement Teams (VSIT) engaged in organizational change across functional boundaries within the hospitals. Participants with key VSIT roles as Executive Sponsor, Value Stream Leader, Process Owner, and Advanced Lean Practitioner discussed barriers and "aha moments" as they worked together to break down silos and spread best practices with the goal of higher-level outcomes for customers.

This discussion was followed by a panel of Advanced Lean Practitioners who have spent the past 18 months working on revenue cycle improvement at Cameron Memorial Community Hospital, Putnam County Hospital, Woodlawn Hospital, and Pulaski Memorial Hospital. The results of their value stream work represents millions of dollars of additional revenue for their hospitals.

Lean Daily Improvement
The event also included a panel and poster session focused on the efforts of clinicians and administrators working toward Lean Daily Improvement Facilitator (LDIF) certification. Lean Daily Improvement (LDI) is a continuous improvement process run at the point of service. Participants learn how to choose a key performance metric; collect and display data visually; run team huddles to get to root causes; assign corrective actions; and keep the process moving. Members of the participating hospitals had the opportunity to talk with the creators of the 18 posters on LDI project work to pick up ideas they might be able to replicate. 

"We saw a trend toward a higher number of clinical process improvement efforts with LDI over the types of lean events we've facilitated previously," said Melanie Cline, RN, MSN, LPC, PHA's Senior Advisor-Lean Healthcare. "We think this is because RNs and clinical team members are more able to participate in LDI efforts since they can be accomplished while they work without disrupting staffing patterns to the same degree as the bigger tools (e.g. Rapid Improvement Events and Value Stream Analysis)."

Cline said Lean Daily Improvement was well received and extremely effective across the participating Critical Access Hospitals, "Participants collectively expressed a high level of engagement of front line staff, and felt LDI enabled team members to more quickly grasp the power of lean. Also, they were delighted with the speed of the improvements with LDI, and that front line staff could immediately see the value or effect on metrics or measures."      

Year 4 Look Ahead
The meeting closed with the introduction of Year 4, the closing year for this hospital cohort. Year 4 will offer selected participants the opportunity to earn certification as an Executive Lean Leader. The cohort also will focus on developing lean coaching model within each hospital. 

INSORH funding expanded Year 4 to include a second cohort of lean teams from five additional hospitals. The new cohort will be introduced to lean leadership and have the opportunity to earn certification as LDI Facilitators. Recruitment for the new cohort begins in September with the start of the new grant funding cycle.  


Writer: Melanie Cline, 317-389-0530,

Writer: Jeanine Parsch, 765-337-7047,

Tags: Process & Cost Improvement (Lean)

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