Paul Levy
First posted 12/12/11 on Not Running a Hospital
I just listened to an extraordinarily well done webinar from MIT, presented by Dr. John E. Billi, associate dean for clinical affairs at the University of Michigan Medical School and associate vice president for medical affairs at the University of Michigan. John leads the Michigan Quality System, the University of Michigan Health System’s business strategy to transform clinical, academic, and administrative functions through development and deployment of a uniform quality improvement philosophy.
As noted in the webinar summary, the University of Michigan Health System (UMHS) has been on the lean journey for the past six years, creating the Michigan Quality System. UMHS has 20,000 faculty, staff, and trainees. The goal is to create 20,000 problem solvers who are finding and fixing root causes of problems they face daily. Dr. Billi described UMHS’ initial approach, results of early experiments, what leaders learned, and how they adjusted. The discussion covered the transition from scattered projects led by coaches to an integrated approach that incorporates people development and process improvement.
John’s presentation was one of the best I have heard on this topic. His slides, too, were clear and descriptive. I’d like to show you all of them, but let me pick a few. The thing I liked best was the modesty and transparency demonstrated. Even after years of doing this work, John felt comfortable starting with this slide, showing where is system still needs work:
That he would feel the need to do so is even more striking when you look at some of the successes. Here are some results from cardiac surgery:
I liked the story about increasing mobility of ICU patients. Here’s the summary chart:
But even better than the substantive results was the fact the Lean approach resulted in pull-based authority. Having achieved a broad consensus on objectives and experiments, the front-line team was able to exercise their discretion in how to carry out the improvement. You see them here accompanied by the grandson of a patient, another key participant.
John summarized other key lessons. The first is about how authority must devolve to make Lean work. “Leaders have to show respect, which means trusting people to solve their own problems if they are given the tools.”
Finally, to reach the goal of having 20,000 problem solvers, you need to design brilliant processes, based on creating standard work.
Part II
I want to add a couple of more items to the post above about John Billi’s MIT-sponsored webinar about Lean at the University of Michigan Health System.
When the Lean approach was first adopted at UMHS, there were some notable successes which I would term “projects.” For example, a rapid improvement event was held to redesign the carts used for blood draws, using the 5S approach that I haveoften referenced on this blog. Here’s the “before” view:
And here’s the “after” view:
This is all good stuff, but it is not a full-fledged implementation of an organizational philosophy. What UMHS found out is that the cultural change inherent in Lean takes a long time to become embedded in the firm. At BIDMC, we used to talk about “tortoise not hare” when we described that. In essence, the process of adopting Lean becomes a Lean process itself. It is one of modesty and constant learning. Look, for example, at what John presented for the coming agenda for his institution.
The other point John made is when a map is constructed to enable all to all aspects of the value stream, “it’s not the map that’s valuable. It the process of mapping, which produces a shared understanding of the value stream and which enables the front-line team to design improvement experiments together.”
Care And Cost 