Grand Hospital Center has 214-beds and is one of three campuses under its parent organization. At Grand, as in other institutions, Lean has been implemented at several levels. It is viewed as an organization-wide initiative and part of a larger quality improvement (QI) strategy that predates Lean.
In 2008, Grand suffered a $38 million loss. This was one of the factors that generated support for Lean as a means to reduce waste. An executive experienced in Lean implementation at other hospitals in the system was appointed as CEO of Grand and assigned to lead the Lean initiative. Grand selected an external consultant to launch and implement Lean. The consultant conducted four waves of Lean training and project implementation, with six teams participating in each wave. A fifth wave in 2011 was facilitated by Grand staff without the use of the external consultant.
To implement Lean, the leadership at Grand assessed the organization, defined priorities, identified departments for inclusion, and selected Lean project teams. The Lean teams then carried out activities related to their specific project.
As part of a multi-site study of Lean implementation, we conducted a rigorous case study of Grand Hospital Center. We selected two Lean projects for analysis: Hip and Knee Replacement Costs (retrospective) and Cardiology Follow-up Appointment Scheduling (prospective), both of which involve processes relevant to frontline staff. Thirty-one interviews with 20 staff at various levels in the organization were conducted between February and November 2010. Data were collected during two site visits through digital diaries recorded by Lean project participants and through phone interviews.
Interviewees reported that the medical center had experienced relative improvements in patient experience, staff satisfaction, and efficiency. In FY 2009, there was a shift from a negative to a positive operating margin. This improvement in the center's financial status may have reflected steps such as making expense management a high priority; reducing administrative costs, filling only essential new and vacant positions; placing constraints on capital spending; streamlining of business processes to improve efficiency; and restructuring of employee pension and postretirement plans, as well as the contributions of the center's Lean projects. Several staff interviewed, particularly at the management level, also noted a positive cultural shift within the organization during this period.
This medical center's case highlights the importance of correctly positioning Lean to be successful:
- Alignment: Align Lean with the organizational goals, and engage physicians so they are on board.
- Leadership: Make support of Lean by hospital leaders visible to frontline staff.
- Team membership: Include multidisciplinary teams in Lean projects.
- Resources: Ensure adequate staff time, data, information technology, and Lean expertise to implement and sustain Lean projects.
- Communication about Lean: Ensure communication about changes resulting from project occurs.
- Staff engagement: Include physicians in Lean projects, while ensuring openness to multiple staff views.