Melanie Cline
Melanie Cline
Assistant Director, Lean Services


Funding for this project was made possible by Flex funding, HRSA Grant # H54RH00042, from the Department of Health and Human Services Health Resources and Services Administration (HRSA) to the Indiana State Office of Rural Health.

Learn more about the impact of this program by viewing the following:

Webinar: Effective Implementation of Lean Methodologies in Rural Healthcare (PHA webinar presentation for the National Rural Health Association)

Webinar: Lean Healthcare Transformation Initiative: A Case Study on Two Critical Access Hospitals (PHA webinar presentation for the National Rural Health Association)

Lean Healthcare Transformation Initiative


Enrollment Status: Full/closed

About the Program

Indiana State SealThe Lean Healthcare Transformation Initiative (LHTI) got underway in 2015 when Purdue Healthcare Advisors (PHA) recruited 15 Indiana Critical Access Hospitals and Rural Hospitals and began to work with them to identify areas of “waste” or inefficiencies, and to eliminate anything that did not add value for patients. The intent of the grant work was to develop lean thinking within the organizations by applying PHA's Lean First methodology. Program Year 1 provided a foundation for improvement management and introduced improvement events; Program Year 2 utilized value stream analysis and strategic planning for a systematic approach to improvement; and Program Year 3 introduced the tools of Lean Leadership and Lean Daily Improvement (LDI).

Extended funding for Cohort 1 and formation of new cohort

At the end of the third year, the Indiana State Office of Rural Health (INSORH) Program extended LHTI grant funding for Cohort 1 to a fourth year to help several participants stand up their own Certified Lean Office. At the end of the fourth year, a sustainment plan was negotiated with INSORH to reserve a designated pool of funds to support Certified Lean Offices by offering preferential access to ongoing training in order to sustain a pipeline of certified lean expertise. Additional funding from INSORH allowed for the formation of a second LHTI cohort of five organizations in 2018 with the aim of making operational their own internal lean offices. Eligibility to participate in this cohort was opened up to behavioral health organizations. Cohort 2 is working on Program Year 2 in 2019-2020. 

First Cohort in Review

Following the initiative's first-year focus on the foundations of improvement management, PHA turned its attention in Year 2 to Value Stream Management (VSM), which utilizes value streams for a systematic approach to improvement. With guidance from PHA lean experts, each hospital’s lean team took ownership of their selected value stream(s), identifying opportunities that led to Rapid Improvement Events (RIEs) and “Just Do It” projects with the goal of maximizing the value created for the customers of each stream. Improving the revenue cycle was a popular theme for hospitals, with four concerned about reducing the claim errors that lead to delayed reimbursement and even write-offs. Other focus areas included Patient Throughput and Experience in Hospital’s Medical Practices; Patient Safety / Discharge Planning & Outpatient Scheduling; Operating Room (OR) Throughput; Laboratory Turnaround Times; Supply Chain; Patient Satisfaction / Outpatient Services; and Addressing Pain Points. Participating hospitals gathered in Indianapolis on August 17, 2019, for an event showcasing their Year 2 progress that kicked off with praise in response to an HHS report naming for Indiana’s CAHs and RHs the 8th best in the country for 2017. 

During the third year of the initiative, PHA focused on Operational Excellence with the goal of improving VSM for these hospitals as well as assuring their competency for change management and their depth of lean expertise. The year included Lean Leadership training, remote coaching and onsite gemba coaching as well as optional PHA-facilitated RIEs and Advanced Lean Practitioner training. Each regional team met to learn what it takes to be a lean leader, and to undergo a Strategic Doing workshop aimed at guiding stakeholders to innovative, grassroots solutions that will build a culture in which lean can thrive and grow. The workshop was followed by Lean Daily Improvement (LDI) training to teach leaders to implement small-scale change through the execution of rapid-cycle learning loops that facilitate group learning and use data to evaluate and measure progress. Coaching at the gemba drives and sustains lean improvement work at all levels of the organization, and included observation of work in progress at the front line with LDI huddles and Value Stream Improvement Team (VSIT) meeting as well as work with team members and key leaders engaged in Strategic Doing efforts.

Year 4 focused on the Certification of Lean Offices with evidence of essential elements to include a Certified Lean Leader; an executed Enterprise Lean Strategy A3; an Enterprise Command Center; and trained Lean Coaches. Throughout the year, the training of lean coaches occurred at all levels of the lean model ― Executive-, Value Stream-, and Process Owner-level ― to ensure that the hospitals had essential skills needed to support team members as they navigate complex and adaptive-change challenges. Training included development of adaptive leadership skills to enhance change-making for complex problems that require adaptive coaching and technical solutions. To be certified as a Lean Office at the basic level, the organization must demonstrate competency of team members to execute in LDI and RIEs. Certification at the advanced level denotes demonstrated competency at all levels of the Lean First methodology including the capability to deliver and execute the most complex tool a Value Stream Analysis which produces a 12-to-18-month plan to re-engineer a process from start to finish. 

The idea of ownership of a value stream is a major shift for the organization.

The tools available to visually see the process from the time our patient calls for an appointment to the time the bill is sent have been incredible.

The arsenal of tools in our toolbox increased significantly through the Value Stream Analysis process.

Team members have expressed that reviewing data on paper only tells one side of the story, but actually seeing the data in action gives meaning to those metrics.

We are making the commitment to take the time needed for the prep, RIE, and through follow-up so gains are sustained. We actively are looking for opportunities to make improvements rather than waiting for problems to occur and then react.
Harrison County Hospital

Harrison County Hospital in Corydon, Ind., awarded Lean Office-Advanced Level certification.

Cameron Memorial Community Hospital

Cameron Memorial Community Hospital in Angola, Ind., were awarded Lean Office-Advanced Level certification.

Franciscan Health Rensselaer

Franciscan Health Rensselaer in Rensselaer, Ind., awarded Lean Office-Advanced Level certification.

Putnam County Hospital

Putnam County Hospital in Greencastle, Ind., awarded Lean Office-Basic Level certification.

Rush Memorial Hospital

Rush Memorial Hospital in Rushville, Ind., awarded Lean Office-Basic Level certification.

At the end of the first Lean Healthcare Transformation round, five organizations were shown to demonstrate competencies in facilitating and sustaining process improvement for increased efficiency and improved patient care, and were certified lean by PHA.

Awards were announced at the initiative’s annual conference in August 2019.

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