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!