Notes from #IHI09 Day 2: MemorialCare

What an invigorating and exciting time at the Institute for Healthcare Improvement‘s 21st National Forum.   Highlights from Day 2 included a talk on Lean at the MemorialCare system in California and a talk on social media and healthcare quality from Paul Levy, CEO of Beth Israel Deaconess in Boston. This first post covers MemorialCare. Come back later for a post on Levy's talk.

You may remember hearing about Long Beach Memorial in my podcast with their COO, Tamra Kaplan. At IHI, Kaplan co-presented with Helen Macfie, a Senior VP for the system. Their speaking proposal is on-line here, but not their slides. They talked to a packed room of 250 to 300 people (and the room was full when they repeated their session immediately after). Lean was certainly a big trend at IHI, between Donald Berwick's keynote mentions of Lean and Toyota, the presentations, and exhibitors.

Kaplan and Macfie walked the audience through the three years of their journey, leading into their fourth year in 2010.

Year 1 (2007) was a “proof of concept” year, where they provided initial Lean leader training, including how to do gemba walks. How great that they would start with leadership behaviors and not just tools. A big part of their focus:

“Engaging staff to eliminate waste and make our work better / easier every day.”

In Year 1, they ran 17 improvement events, admittedly “point improvements.” That's a good start, but they realized that they needed to look at whole value streams to avoid suboptimizing or not reaching the full potential of their Lean efforts. They did their first value stream analysis.

They chose not to lead with the term “lean”.   They called it “MC-21” (Memorial Care for the 21st Century. That's a very reasonable strategy, considering some of the baggage that can come with the term “lean” (fear of layoffs, etc.) They said that people have gotten more comfortable with the term over time as MemorialCare has proven that Lean won't be a bad thing for the staff.

In Year 2, they more closely aligned the events with their strategy through the value stream focus. Year 3 included more of a focus on metrics, holding people accountable, and “hard wiring” the reporting of results. This kind of stuff can be hard to measure, but they claim 22% of their events had a direct impact on patient or employee safety. Kaplan and Macfie also emphasized another key Lean point:

“Lean is all about the customer, putting the customer (patient) at the center of care.”

MemorialCare, like many leading hospitals has a “no layoffs due to Lean” policy, which requires a process for planning the redeployment of staff. Their focus remains on 5S, hoshin kanri (or strategy deployment), developing people, and measuring results.

Their long-term goal — they want to get hospital costs in line with expected 2014 Medicare rates, which means they have to cut $2800 per patient stay. ThedaCare, as reported in Health Affairs, has reduced cost per patient by $2300 in pilot “collaborative care” units — so maybe that audacious goal is possible. With Lean and the right leadership mindset, I wouldn't bet against MemorialCare, based on what I heard.

You can also read my notes and comments from Day 1 here.

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