The Management Brief | Improving Patient and Caregiver Outcomes with Lean in Healthcare 

Two leaders of the Cleveland Clinic’s lean improvement function — Dr. Lisa Yerian, Executive Vice President and Chief Clinical & Operational Improvement Officer, and Chad Cummings, Vice President of Lean Transformation & Continuous Improvement — speak with Josh Howell, LEI President, and Mark Reich, LEI Chief Engineer Strategy. The podcast continues our focus this month on the role of continuous improvement (CI) groups in lean management. 

The Cleveland Clinic consists of 23 hospitals, 280 outpatient locations, approximately 83,000 caregivers, and nearly 16 million patient encounters annually. The vision at the not-for-profit healthcare system is to be “the best place to receive care anywhere and the best place to work,” says Lisa. “We have integrated the expectation of excellence, the aspiration for excellence, in everything we do right in parallel with being the best place to work.”   

Chad came out of manufacturing and first encountered lean in the 1990s, working for a Japanese-owned auto supplier, and has been working in healthcare for more than a decade in a CI capacity. Lisa started her career in healthcare, after growing up in a rural area that did not have access to high-quality healthcare and wanting to change that. At the Cleveland Clinic she was getting pulled into meetings about recurring problems, and eventually got connected to an internal team focused on using lean principles. “I saw lean as an opportunity to do what I had initially wanted to do, which was make a bigger difference for more people.” She then landed a new medical director role with the improvement team and began learning through “small amounts of coursework and books but really through doing, a lot with Chad and others on our lean team and with members of LEI.” 

The two executives discussed the many challenges facing healthcare today. Chad cites macro issues of high demand for care, fiscal difficulties, and finding skilled labor. The pandemic contributed to those challenges, says Lisa, resulting in high turnover and a subsequent need to develop people for their changing roles and build the capability for effective problem solving, huddle management, and understanding data. She also says workplace violence has risen in healthcare, contributing to burnout and turnover and adding security costs to fiscal woes.  

Lisa and Chad also discussed: 

• How to work with those in healthcare who have rejected the efficacy of lean: “If you are asking someone to support or believe, that’s too big, it’s too broad. Nobody knows what that means,” says Lisa. “What is it that you really need to get out of this interaction? Do you need them to commit to going on a gemba walk with you? What is it that your ask really is?… You need to get specific quickly in order to try to address that. And then what are you trying to accomplish here?” 

• A need to revisit some lean improvement practices following COVID: “We did a lot of work to develop a culture of improvement prior to COVID; we had built a tiered daily huddle system, kaizen system, a lot of problem-solving capability and awareness,” says Lisa. “In my role I realized we need to go back and reinvigorate some of that work, repeat some of that work, redo some of that work,” and re-educate leaders on how to perform their roles. 

• How an adherence to the lean transformation framework helps to point CI actions to problems that need to be addressed: This starts by asking, “What is the problem we’re trying to solve, what’s our true value-driven purpose?” notes Lisa. 

• The importance of developing people: “If we want to make a change in our culture, we have to really think about what behaviors, right behaviors or correct behaviors, we want to drive, but even prior to that thinking about routines,” says Chad. “Do we have the right routines in place that help to establish those behaviors. And to establish those routines you have to build capability in people. You have to give them the knowhow of what good looks like.”