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Transforming Healthcare is Complex, Start with a Model Cell

by John Toussaint, MD
April 3, 2014

Transforming Healthcare is Complex, Start with a Model Cell

by John Toussaint, MD
April 3, 2014 | Comments (6)

I’ve now visited over 130 healthcare organizations in 12 countries and seen many different approaches to lean transformation. What have I learned? If I were to begin another lean transformation today, in a healthcare organization or anywhere else, the first thing I’d do is work with my team to develop a model cell.

The model cell approach is best thought of as “an inch wide and a mile deep” (in contrast to an inch deep and a mile wide). We started our journey at Thedacare with this approach. In other words we did a lot of kaizen and a lot of value stream mapping. But in most cases our work was not tied to the important business goals of the organization. And since we didn’t have any knowledge of the management system required to sustain improvement or build a continuous improvement culture, most of our early work was for naught. In the early days we joked that we did a lot of “drive by Kaizen,” which was actually detrimental to our transformation.

At the ThedaCare Center for Healthcare Value we’ve been observing organizational transformations in healthcare, focusing lately on this question of “where do you start?” At the recent Lean Transformation Summit, John Shook and the team at the Lean Enterprise Institute explained how they’ve been studying lean transformation at a few different partner companies. Shook has identified five important questions:

  • What is our purpose or what problem are we trying to solve? (What value do we create)?
  • How do we improve the actual work?
  • How do we develop the people?
  • What role must leadership take, and how does the management system support this new way of working?
  • What basic thinking or assumptions underlie this transformation?

We start with this first question: “What is the business problem we must solve?” Then we apply lean tools and principles to create a model cell. Again, the key is tying that work to the business goals of the organization. This model cell experiment—tied to key performance targets—creates a new system with standard work that sustains improvement and aligns everyone on larger organizational goals.

Why build the model cell? First, it’s the best way to help people learn. In the process creating teams, people learn the tools, principles, and management system behaviors and characteristics required for transformation. Second, a model cell is the best way to help the organization learn; you want to use the model cell to show the rest of the organization what good looks like. This is the first step in “spread.” Spreading lean thinking or any improvement isn’t easy. But without a model cell, it’s impossible. The power of being able to go see a totally new way of doing things or approach to problem solving in your own organization cannot be underestimated. The model cell becomes the learning center for the organization. It creates the excitement within teams that fundamental change can occur and be sustained, and it lays the ground work for the next model cells that will solve other business problems.

The model cell approach requires senior leadership involvement and committed of resources from senior leadership. It’s most likely to be successful with a senior management sponsor. Depending on the business problem, putting together the model cell can take months. In our case, the redesign of inpatient care at ThedaCare took 6 months to design and 11 months to study, but then it led to zero medication reconciliation errors and 25% reduction in total cost of care. We’ve maintained these numbers for several years now with total cost per case running at $6,000 compared to average in the U.S. of $9,700. Read more about this project here.

The Lean Healthcare Transformation Summit this year (June 4-5 in LA) will focus on the “how to” aspect of transforming healthcare organizations. We’re proud to feature speakers such as John Shook and Kim Barnas who have both been deeply involved in exactly these kinds of transformations. John Shook, at Toyota and many other manufacturing and service organizations. Kim Barnas, at Thedacare where she led a team in creating the core components of a lean management system for healthcare. And I’ll be discussing the “how” from a senior leadership strategy perspective. Join us!

The views expressed in this post do not necessarily represent the views or policies of The Lean Enterprise Institute.
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6 Comments | Post a Comment
Jess Reyes April 03, 2014
3 People AGREE with this comment

Great Article! Model cell'ing is definitely a successful strategy for any organization.

Side note: It is interesting how Lean/6 Sigma use in healthcare has exploded with huge success! Yet our bias in talking about the benefits are still $ financial rather than talking about how it has dramatically saved lives (lower mortality rates) and improved quality of life.

Thanks for the article.

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Mark Graban April 03, 2014

I don't think it's accurate to lump Lean and Six Sigma together in terms of the adoption rates "exploding." Lean and Six Sigma are not one and the same. Lean and "Lean Sigma" are not one in the same. I hear directly from many organizations that have gotten discouraged with Six Sigma for a number of reasons...

It's interesting (and frustrating) to see books and articles about "Lean Sigma" claim ThedaCare and Virginia Mason Medical Center as "Lean Sigma Success Stories," when neither organization used Six Sigma.

I know that's not John's point (he's totally right about model cells and says it well), but I wanted to comment on the comment.


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Mark Graban April 03, 2014

And you're right that far too many talk about financial benefits or they incorrectly frame Lean (or Six Sigma) as "cost cutting."

John, to his credit, did (and always does) talk about benefits to the patients and staff.

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john toussaint April 03, 2014
4 People AGREE with this comment
Mark, you are correct my post is referring to the use of lean or the Toyota Production System applied to healthcare. I consider six sigma a tool set to study variation whereas lean is actually a methodology to transform the culture of an entire organization. As I discuss in the piece it's about leadership, management, principles and tools. That's a transformation not a project.

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Michael Bremer April 03, 2014


Your story fits very nicely with one I learned at OC Tanner.  When they were trying to prove one piece flow worked a number of years ago.  They also created a model cell.  They made no improvements to change-over time or any thing else.  They merely put the equipment needed to make one family of products together.  And the only rule was you could not make another piece until the next station was ready to receive it.  In terms of efficiency, through-put and quality the experiment worked, it performed much more effectively than their traditional operations.


Their only regret looking back was they did not bring in enough employees to see the sucess.  They had proven the concept to leadership and were then anxious to embark on the next stage of their journey.  In retrospect they were sorry they did not let more people see it, as it would have permitted more people to alter their perspective and gain a deeper understanding.  Ultimately the company got there, it is one of the more impressive organizations I have visited in terms of improvement effectiveness.

One of the mini-chapters in the new book we are working will talk about the mini (model) cell approach.

Great article, good insights as always.

Best wishes,

michael bremer 

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Mary Hageman April 07, 2014
4 People AGREE with this comment

My background in Lean is with a manufacturing / defense company.  I was recently hired by a hospital system to help guide a lean transformation.  I am thrilled at the opportunity and have received excellent buy in from our CEO and other upper management so far.  We are starting to discuss creating a model cell.  

Would you please provide some insight in where to start? How do you pick the unit / cell?  Is there criteria for the unit?  Leadership needs?  Employee satisfaction metrics? Volume? Type of unit?

We would like to create model cells for one business group and one inpatient unit.  In my manufacturing days, the worst performing cell would be offered in hopes lean efforts would bring the worst case to the best performing cell.  I often found a mountain of other issues (i.e. leadership conflict or lack of leadership, fear from the staff about job security, lack of clear expectations) to tackle before any lean transformation could happen.  How do you know the environment is conducive to the challenge?  Or am I being too cautious?

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