Leading The Lean Healthcare Journey: Driving Culture Change To Increase Value, Second Edition (4x45)

This book reveals and describes the leadership and culture change required to remove waste from healthcare processes and eliminate the root cause of soaring costs, poor quality and safety, and limited access. The book's delivery strategy revolves around personal and organizational stories and case studies told by physician and administrative leaders, all students of the Toyota Production System. This revised edition uniquely blends updated case studies with practical theory to describe how the healthcare value proposition can be changed by reducing waste, variation and complexity in healthcare. New to the book are chapters on clinical standard work and integration of lean and safety. Cover 1 Half Title 2 Title Page 4 Copyright Page 5 Dedication 6 Contents 8 Preface to the First Edition 16 Preface to the Second Edition 18 Acknowledgments 20 About the Authors 22 Contributors 24 Chapter 1: Introduction 28 Chapter 2: The Continuous Performance Improvement (CPI) Journey: A Long and Winding Road 32 Epilogue 39 Chapter 3: Creating High-Powered Healthcare Improvement Engines 42 Brutally Honest Leadership 42 Imagining a Different Approach to Defects and Waste 43 Beginning to Build the Engine 44 It’s Not about the Tools and Methods 45 It Takes a Leadership Mind-Set 46 The Management System Provides the Dance Steps 48 How to Get Started 51 Epilogue 57 Chapter 4: Leadership and Culture Change: What We Need Most We Can’t Buy 60 Changing a Culture 61 Critical Success Factors for Cultural Transformation 62 Executive and Faculty Leadership 62 Community Physician Participation 62 Patient and Family Participation 63 Staff and Faculty Engagement 65 Board Support 65 Financial Investment 66 Infrastructure Support 66 Values 67 Revealing the Simple Rules 67 Stealing Shamelessly 67 Methods for Cultural Transformation 67 Learning from Toyota: The Philosophy of Continuous Improvement 68 Learning from the Gallup Organization: Engagement Matters 68 Learning from the Studer Group: Hardwiring Matters 68 Tools for Cultural Transformation 69 Participating in CPI Activities and Experiencing Results 69 Learning Strategies 70 Human Resource Systems 70 Leadership in a Continuous Performance Improvement Culture 70 Leadership Presence 71 Knowledge 71 Leadership Participation 71 Tenacity 71 Patience 72 Implications for Leadership Development 72 Conclusion 74 Notes 74 Epilogue 74 Chapter 5: Strategy Deployment and Daily Management: Implementing a Lean Management System at Nemours 76 Implementing a Lean Management System to Sustain Gains 76 Reading the Writing on the Wall 77 Beginning Our Journey 78 Monitoring Gains with Daily Management 78 Visual Controls 78 Daily Accountability 79 Leadership Discipline 80 Leader Standard Work 81 Addressing Barriers to Daily Management 81 Reaping the Rewards of Daily Management 82 Strategy Deployment: Cascading Enterprise Goals and Soliciting Feedback 83 Looking to the Future: What Still Remains to Be Done? 85 Chapter 6: Leadership and Lean Transformation at Seattle Cancer Care Alliance: If We Knew Then What We Know Now 88 Introduction 88 The Case for Change 89 Bias for Action: Misapplications and Mishaps 92 Time for Reflection: Mixing Mind-Set with Methods 95 Master Plan: An Unconventional Strategy Emerges 96 Nobody Said It Was Easy: Hard-Fought Lessons of Breakthrough Change 99 Perseverance Understood: Failure Is Part of the Equation 103 Spinning Many Plates in the Air: We Can Do It All 105 Storytelling: A Deeper Connection than Data 107 Delays, Distractions, and Dilemmas 108 Becoming the Leader the Organization Requires 109 Conclusion: The Journey Continues 112 Note 113 Chapter 7: Transforming Doctors into Change Agents 114 Case Study 1 116 Case Study 2 122 Note 127 Epilogue 127 Chapter 8: Clinician Engagement: Continuous Performance Improvement (CPI) Applied in a Not-So-Touchy-Feely Environment 134 Early Struggles 135 An Organization Mandate 136 “Our Department Is Different” 137 Creating Some Initial “Wins” 138 Departmental Training 139 Building Momentum 140 Recognizing Shared Goals 141 Coming to Grips with Standard Work 141 Improving the Quality and Consistency of Inpatient Stays 142 An Ongoing Journey 143 Epilogue 143 Chapter 9: Asthma: Continuous Improvement (Kaizen) of Clinical Standard Work 148 The Case for Standardizing Care 148 First Wave of Change 149 Second Wave of Change 150 Third Wave of Change 156 Note 157 Chapter 10: Supply Chain: Ensuring Clinical Staff Have What They Need 158 Our Burning Platform for Change in Supply Chain Management 159 Implementing a Reliable Process for Managing Supplies 161 Using a Kanban Inventory Control Process 162 A Carefully Planned Implementation 163 Maintaining the Gains: Daily Management of the Supply Chain 165 Engaging Associates and Addressing Barriers 166 The After State: A Highly Reliable, Efficient Supply Chain 167 What We’ve Learned 168 Chapter 11: Intensive Care Unit: Developing and Implementing Pull Systems 170 Ensuring Comfort during Critical Illness: A Question of Balance 170 Love, Medicine, and Chaos 172 Homeostasis as a Pull System 172 On the Bus along a Yellow Brick Road 172 Rain, Mud, and Potholes 173 The Importance of Multidisciplinary Leadership 175 Physician Leader 175 Process Owner 176 Clinical Nurse Specialist 176 ICU Pharmacist 176 Designing and Marketing the Standard Work Product 177 Education Phase 178 Creating Consensus (“Buy-In”) 179 A Remarkable Story 179 Other ICU Pull Systems 181 Conclusions 184 Notes 185 Epilogue 185 Chapter 12: Patient Rounding: Delivering Compassionate Care through Clinical Standard Work 190 Inpatient Rounding: Why Are We Doing This? 190 The Inpatient Medicine Service: The Players 191 Rounding: Where We’ve Been 191 Solution: Reliable Method for Rounds 192 Why Was This So Difficult? 195 Measured Improvements 196 Replication and PDCA (Plan–Do–Check–Act) 197 Epilogue 197 Chapter 13: Change That Nourishes the Organization: Making the Total Parenteral Nutrition (TPN) Process Safer 206 Notes 215 Epilogue 216 Chapter 14: Hand Hygiene at Seattle Children’s Hospital: A Call to Action 220 Using Continuous Performance Improvement to Implement Hand Hygiene at the Point of Care 222 The Results: Achieving Momentum for Greater Improvement 226 Spreading Hand Hygiene at the Point of Care and Sustaining Our Gains 229 What We’ve Learned and Where We’re Going 230 Chapter 15: Balancing the Line in Outpatient Pharmacy 232 Epilogue 237 Chapter 16: Rapid Changeover in the Operating Room 240 Starting with the Patient Experience 241 Leading Change, Encountering Tension 241 Continuous Performance Improvement Methods and the Realities of Change 243 Addressing Long Turnovers in Otolaryngology 245 Epilogue 249 Chapter 17: Lean in the Lab: No Culture Left Behind 256 Initial Successes in Autopsy Testing and Cytogenetics 257 Applying Continuous Performance Improvement to Microbiology 257 Starting with Blood Cultures 258 Next Step: Urine Cultures 261 Improving Viral Testing 262 Further Improvements in the Microbiology Lab: Faster Organism Identification 262 Lean Is Change Management 264 Increasing Capacity by Investing in Staff 264 Notes 266 Chapter 18: Registration to Cash Value Stream: Making the Right Call at the Everett Clinic 268 Mapping the Value Stream 270 Engaging Your People 271 Work Cell Design 272 Today’s Work Today 274 The Value of Standard Work 276 The Role of Leaders 277 Chapter 19: Integrated Facility Design at Seattle Children’s Hospital 278 The Approach 279 Phase 1: Project Management and Governance 281 Phase 2: Conceptual Design (System Level) 281 Phase 3: Functional Design (Value Stream Level) 283 Phase 4: Detailed Design (Operational Level) 286 From Integrated Design Events to Construction 286 The Payoff 288 Critical Leadership Implications for Facility Development 291 Lean Experience 291 Project Leadership 292 Core Team 294 Logical Sequence 294 The Value of Mockups 294 Alignment of Incentives 295 Conclusion 295 “We Did It!” 296 Note 297 Epilogue 297 Glossary 302 Index 308 Content: The continuous performance improvement (CPI) journey : a long and winding road / Patrick Hagan -- Epilogue / Patrick Hagan -- Creating high-powered healthcare improvement engines / Joan Wellman -- Epilogue / Joan Wellman -- Leadership and culture change : what we need most we can't buy / Patrick Hagan and Cara Bailey -- Epilogue / Cara Bailey -- Strategy deployment and daily management : implementing a lean management system at Nemours / David J. Bailey and Kellie P. Olmstead -- Leadership and lean transformation at Seattle Cancer Care Alliance : if we knew than what we know now / Michael Boyer, Elizabeth Poole, and Norm Hubbard -- Transforming doctors into change agents / Jeffrey Avansino, Ken Gow, and Darren Migita -- Epilogue / Jeffrey Avansino, Ken Gow, and Darren Migita -- Clinician engagement : CPI applied in a not-so-touchy-feely environment / Bryan King, Ruth Benfield, and Debra Gumbardo -- Epilogue / Bryan King and Debra Gumbardo -- Asthma : continuous improvement (Kaizen) of clinical standard work / Jeff Fti and Robert C. Atkins -- Supply chain : ensuring clinical staff have what -- They need / Robert Bridges and Charles Hodge -- Intensive care unit : developing and implementing pull systems / Kristina H. Deeter and Jerry J. Zimmerman -- Epilogue / Jerry J. Zimmerman -- Patient rounding : delivering compassionate care through clinical standard work / Glen Tamura and Darren Migita -- Epilogue / Glen Tamura and Darren Migita -- Change that nourishes the organization : making the total parenteral nutrition (TPN) process safer / Polly Lenssen, Eric Harvey, and David I. Suskind -- Epilogue / Polly Lenssen and Eric Harvey -- Hand hygiene at Seattle Children's Hospital : a call to action / Thérèse Mirisola and Karin Rogers -- Balancing the line in outpatient pharmacy / Steven D. Wanaka and Barb Marquardt -- Epilogue / Barb Marquardt -- Rapid changeover in the operating room / Sean H. Flack and Lynn D. Martin -- Epilogue / Sean H. Flack and Lynn D. Martin -- Lean in the lab : no culture left behind / Joe C. Rutledge and Xuan Qin -- Registration to cash value stream : making the right call at the Everett Clinic / Janeen Lambert and Iwalani Paquette -- Integrated facility design at Seattle Children's Hospital / Michael Boyer, Lisa Brandenburg, and Joan Wellman -- Epilogue / Mark A. Reed, Aaron Dipzinski, and Lynn D. Martin. "Blending case studies with practical theory, this book uniquely describes how the healthcare value proposition can be changed by reducing waste, variation, and complexity in healthcare. It reveals the leadership tenacity and culture change required to remove waste from healthcare processes and eliminate the root cause of soaring costs, poor quality and safety, and limited access. It provides practical, applicable advice alongside personal and organizational stories and case studies told by physician and administrative leaders, all students of the Toyota Production System"--Provided by publisher