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Improving a Complex Process that Saves Lives: Lean Transformation at LifeShare Donor Services of Oklahoma

by Jeff Orlowski & Lex Schroeder
April 7, 2015

Improving a Complex Process that Saves Lives: Lean Transformation at LifeShare Donor Services of Oklahoma

by Jeff Orlowski & Lex Schroeder
April 7, 2015 | Comments (0)

At this year’s Lean Transformation Summit, I had the opportunity to sit down with Jeff Orlowski, President and CEO of the nonprofit organization, LifeShare Transplant Donor Services of Oklahoma. We spoke about the unique challenges LifeShare team members face every day, how lean helps his team deliver on its nonprofit mission, and how his own views on leadership have been informed by lean thinking and practice.

LEI: How did you stumble upon lean, how did you get started, and how long have you been practicing?

Jeff Orlowski: I read On the Mend on an airplane, several airplanes over the course of about a month. I got in on Kindle and read it because it sounded interesting and found the whole concept to be great. Organizationally we’re fairly new at Lean… Myself and our VP of Quality started doing education for our leadership team last summer/early fall. Since then we’ve built a war room and have three project teams that are still wet behind the ears, just starting out on one of our first pilot projects.  

The first challenge for us was to narrow down our list of process issues and come up with things we felt were reasonable for us to pilot. We’re a nonprofit and 24/7 business. The organ donor process is very complex. It goes on for a day and a half, and there are a lot of logistics and people involved. And so trying to identify the core projects and do a real value stream map on the bigger scale (and say here’s where we really want to focus) was important. [We needed to define] what’s the product, what’s the process, what’s pulling things through the process? That’s been the biggest challenge, but from there the challenge has been keeping people from getting too excited! Our staff think it’s great, and they’re all wanting to be a part of lean improvement projects. But we can’t have 95 people be a part of those projects.

What is your organization’s purpose?

Our core purpose is that we save lives. We do that by recovering organs and tissues for transplant. We’re one of 58 organ procurement organizations (OPOs) that are Medicare designated monopolies. Medicare designates an organization to serve a geographic region of the country that’s defined by counties. Within those counties, we work with all the hospitals to educate about donation and facilitate the donor process and work with all the transplant centers to get the organs to them for transplant. We’re also part of a national network that’s all linked by the national computer system to allocate organs from across the country that we recover.

What do you think your business organizational need was for doing lean?

The thing driving us was that in our business we have minimum performance standards we have to meet to be accredited and designated by Medicare (CMS) and also by the organ donor transplant network of the government. Those two sets of standards are about getting over the bar. Then we have two voluntary accreditations from the trade associations we are part of. But at the end of the day those things are the minimum necessary level of performance. When I assumed my position at Life Share in 2012, my goal was to build the leadership organization in our business. To do that we needed to go beyond just what was required to doing the very best we could. So we started looking for models that fit our process and industry well, and Lean really just stuck with me. I read a lot of things. I had read Deming back in grad school, and Lean just kept jumping off the page as the model that fit well with service and healthcare.

What does lean thinking in practice look like at your organization at different levels?

First of all, the work is coordinating the flow of information. A big part of determining who gets that heart or who gets that liver (or if that heart or liver can be transplanted at all) is based on information. There’s information we have to provide that the transplant center has to evaluate and clear. So there’s a tremendous amount of information.

The second part is the flow of the actual care of the donor up until the recovery. That’s very hands-on. There’s lots of process there – labs, charting, diagnostic testing, samples that have to be drawn and sent to off-site labs. It’s a hands-on process, again, but there’s definitely a product. We’re starting with someone that at 8am in the morning was alive and now we’re trying to get as much as information and testing as fast as possible to maximize the benefit of that person’s donation.

The third thing is really getting the efficiency back into the process because logistically the [whole process] is a lot of work. It’s very labor intensive. For one donor, we talk to 50 or 60 people – between transplant centers, donor hospitals, evaluating physicians, consulting physicians, charter companies, ambulance companies, labs, etc. Pulling all that together makes for a big opportunity for things to go wrong. So that feedback after every process – to stop and say, “What could we have done better? What did we learn?” – is very important because it can get lost. You’re on to the next donation quickly. And three or four days later when people who were really tired had that great idea [for improving a process] – they don’t remember that idea anymore. So we needed a real-time process where people could say, “Hey, wait a minute!” and [make improvements].

How has lean thinking changed your understanding of leadership (if it has)?

One of the things I’ve had to recognize is to not try to eat the elephant in one bite. We have to build a foundation. People have to understand the concepts. And we need to have some people who are expert. You can only get there by taking some time and really developing that. You can’t just say, “Ok, here’s a new checklist, have at it.” It’s conceptual, it’s in your head, it’s not just on paper. It’s a way of doing things and a way of being; it’s not just another form or another procedure. So being patient about that when you’re in a very hands-on, action-oriented, life and death type of environment isn’t always easy. As a leader, I’ve had to take a deep breath and say, “Ok, we’re not getting Baldridge next year.” [Laughter]. We have to work at it.

What has surprised you about this work?

The biggest surprise for me was that as a leader and CEO, I’ve had the experience many times of saying “Boy, this is a great idea” and a lot of people look at me like I have another head or three eyeballs. But with Lean, pretty much universally my team at LifeShare has taken lean thinking in the doses it’s been fed to them. Whether it’s been reading On the Mend, absorbing take-aways from the last Summit, or learning about the A3 – everybody immediately gravitates to these things. People think this can work for us. That’s been surprising because I’m used to having to build more energy or support. But either my timing is really good or I’ve built the right team, which I think is part of it for sure… But I do think part of it is that [Lean] just makes a lot of sense. You watch a couple of the videos of the Toyota model and people go, “Of course, that all makes perfect sense!” It’s pretty logical… The hardest thing for us has been keeping people from running to their teams and trying to implement it before we’re ready.

We actually had a 2 day training with a trainer from ASQ… and at the end of it – I wasn’t there – I got an email from my managers [about rolling out three new programs]. In this case, starting those improvement projects was putting the cart before the horse a bit. So the energy is there, but alignment is sometimes hard to keep… Like many organizations, my organization has been through a lot of change. I think what’s important to remember is that [Lean] is something people can really pick up, light a torch for and get united behind. Our team has had a couple of years of great operational success on a fundamental level, now we’re ready for Lean.
 

What are three characteristics you think a lean leader needs in order to be effective? 

First, they have to be motivated by the vision and purpose, not their own ego. You can’t be caught up in doing lean to control things. This is a model, like a lot of good leadership models, where you teach people the thinking and then need to get the heck of the way and let them do their job. That’s extremely true in this environment. Lean is not a top down thing; Lean has to have top down buy-in, but it’s got to be owned by everybody. 

Second, I think leaders have to be understanding of the fact that this isn’t necessarily a quick fix. So much of our society is about needing a quick fix right now. I’m fortunate working in a nonprofit that I don’t have stockholders; I have a board that wants me to provide a community service. I can afford to say, “This is the path and in 3 years we want to be here and next year we want to be here.” When you’re trying to sell stock, that can be hard, I’m sure. When you’re trying to compete for a very tight healthcare market in a city that’s full of hospitals, that may be hard. But for us we can afford to be patient. I think patience is required for lean.

Lastly, it’s ok not to be the expert in your own organization. I’m not trying to be the lean expert; I’m trying to be a champion for it. I want my COO and VP of Quality to be the experts that are pushing this forward. Realistically speaking, this is about the people in the trenches… So you have to let go, which is hard for really successful people to do. (Fortunately, I’m not really successful). [Laughter] I can see why it would be really hard for some people!

Join other lean thinkers at the Lean Healthcare Transformation Summit, June 3-4, in Dallas!

The views expressed in this post do not necessarily represent the views or policies of The Lean Enterprise Institute.
Keywords:  leadership
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