Heights Hospital is part of a large set of hospitals and clinics operated by a safety net system in an East Coast city. The hospital has 341 beds and provided 351,160 clinic visits and 61,393 emergency department (ED) visits in 2009. This full-service safety net hospital provides care primarily to low-income, uninsured, and vulnerable populations. In 2007, the corporation initiated Lean at the corporate office. A new executive director, appointed in 2008, is extremely committed to Lean (called "Project Advance" or just "Advance" by the corporation [our pseudonym for the actual name]) and to an open and participatory culture.
To examine Lean implementation at the hospital and other locations, a rigorous case study methodology was used, and 26 interviews with staff at all levels of the organization were conducted between April and October 2010. Two projects were selected for closer study: a retrospective study of the Emergency Department (ED) value stream project and a prospective study of pediatric continuity of care.
An expert consultant conducted a weeklong visit once per month during the first 12 months of the Lean initiative in 2008–2009, later tapering off to every other month and then to as-needed visits. The consultant worked with the hospital executives to identify six departments or areas of focus from which Lean projects would be selected. Heights Hospital uses "rapid improvement events" (RIEs) to implement Lean projects and provides just-in-time training on Lean principles and tools during these events. RIE teams examine each work step and reduce or eliminate as much non-value-added time and effort as possible over a 4.5-day period, guided by a step-by-step, problem-solving process.
As a result of Lean, the hospital reports direct financial benefits of $9.6 million over the 3 years since the safety net system began Lean deployment in late 2007. A stronger sense of teamwork and connection to others and increased efficiency on a number of projects and overall are also reported.
From the experiences of Heights Hospital, several lessons learned for potential Lean adopters are:
- Alignment: Align Lean with organizational goals and closely monitor the progress of Lean projects.
- Leadership: Make support of Lean by hospital leaders visible to frontline staff. Leadership should expect that building internal expertise will take time and that there will be a learning curve with setbacks, particularly early on.
- Team membership: Include multidisciplinary teams from all levels of the organization in Lean projects.
- Resources: Ensure adequate staff time, data, and Lean expertise to implement and sustain Lean projects.
- Communication about Lean: An organized communication plan about changes resulting from Lean projects is needed to reach frontline staff.
- Staff engagement: Include physicians in Lean projects, while ensuring openness to multiple staff views.
- Scope: Multiple small projects in one area can result in major gains, but this must be balanced with the challenge of not overwhelming staff. Project goals must be clear and realistic.