Today's post is an interview I conducted via email with Justin Holland, Managing Principal of GE Healthcare Americas. Before joining GE, he was most recently Vice President of Business Performance at  Cleveland Clinic.
In this interview we cover topics including how GE integrated lean with six sigma, how healthcare organizations are striving to have a “lean culture,” and some of the successes and challenges facing hospitals and other healthcare organizations.
GE is known primarily for Six Sigma. When did lean become part of the approach at GE Healthcare?
Lean started to be a key focus within GE Healthcare around 2004. Part of the impetus was looking at examples set by Toyota and Herman Miller and other organizations to improve customer impact and productivity.
From our success with implementing Lean internally, we've also found parallels and opportunity for our clients. Helping hospitals implement Lean practices supports our commitment to working with healthcare providers to address some of their greatest challenges and provide more efficient and effective care.
Generally and broadly speaking, how has GE Healthcare benefited from lean? Can you share a specific example?
Lean has focused our leadership on improving our strategic capabilities. We found that much of what gets in the way of operational excellence is when information falls through cracks because we aren't working cross-functionally. For example, we took a more critical look at the whole of our operations, from initial customer inquiry through to order fulfillment and lastly payment remittance. This external focus approach is aided by a more proactive culture of employee problem solving. Again, we are able to share with our clients in healthcare what we have learned through projects like improving our installation cycle time, next generation product development cycle and contact to transaction process, as well as many others.
How does GE Healthcare integrate lean and Six Sigma methods and principles? Is it a matter of using lean tools in the DMAIC model and Six Sigma culture or is it different than that?
Over the years, GE Healthcare has incorporated a number of continuous improvement methodologies, including Lean and Six Sigma, into our pursuit of operational excellence. Â Today, as performance improvement work is being done, our experts have a larger bag of tools to pull from. But what we've found underlies all of these efforts is the need for a culture based on a commitment to improvement that starts and ends with our customers. In other words, the people part is essential – both in terms of seeing things from our customers' perspective and fostering a climate that subordinates our individual interests to those of the broader organization. A strong change management process underlies the use of all the tools used in GE.
In implementing Lean, we've found there is a shift to the customer dictating the process, rather than debating between two internal departments. When the cue is taken from the customer, efforts become unified and grounded in literal feedback. We've found a lot of value getting people together who are on the front line and closest to the customer to gather that institutional knowledge and debate ideas, learn new perspectives and get a better understanding of where bottlenecks happen. This information isn't necessarily statistical analysis, but is extremely valuable.
Many organizations talk about moving toward a “lean culture.” Are you seeing this trend increase in the healthcare setting? How do you see the culture or management system changing with lean within healthcare?
A strong example is the concept of evidence-based medicine, which calls for more than simply a clear process and standard approach to measurement, and also involves providers that are committed to letting data drive decision-making seek to prespecifiy anything that makes problems visible. And the best providers do this not just in the clinical setting, but also in admissions and the business office – anything that touches the patient in a material way. Taking a Lean approach means thinking about the patient as the customer, and viewing process as the journey of their care — from the time that patient enters the ED, or is first seen by the admitting physician, to when they are discharged and later have a follow-up appointment. Medicine is highly specialized, but it is also a system that requires all moving parts working together to be truly effective. This seems very obvious when you look at it from the perspective of the patient. When hospitals take a patient-centric view of improvement decisions, they stand to increase patient satisfaction in addition to operations or quality and safety. More and more hospitals are focusing on the patient perspective for driving a more holistic and integrated strategy. (interview continues below the ad)
Can you share an example of GE Healthcare working with a hospital to teach them and work together on lean improvements?
GE Healthcare has worked with hospitals across the country to improve their operations and the care they provide patients by implementing lean strategies.
Brigham and Women's / Faulkner Hospitals teamed with GE Healthcare for training on lean practices in early 2009. A key change in their approach was involving front line staff rather than relegating lean projects to a small, select team of upper management. This led to a lean culture at the hospital and more comprehensive process improvement, resulting in significant gains. In one specialty practice, staff was able to improve patient phone access by recognizing and addressing the underlying sources of dropped calls. The hospitals were also able to increase the number of copays collected by 21 percent and decrease prescription refill turn-around by 88 percent, which increased patient satisfaction and had a true bottom-line impact.
Ochsner Health System in New Orleans weathered millions in damages and lost staff following Hurricane Katrina. In its recovery, Ochsner sought to eliminate waste and improve the patient experience in nursing units (unnecessary overstock of supplies, safety issues with expired supplies, improperly used space, non-standardized RN stations and excessive RN search travel). On one floor alone, Ochsner has been able to further reduce on-hand supplies from $4,500 to under $1,500, which also freed space, improving capacity. Ochsner's overall Lean initiative has resulted in $200,700 in savings and $400,000 in cost avoidance.
Huntington Hospital in Pasadena, California, recently implemented Lean Six Sigma framework for two projects: freeing up Critical Care Unit (CCU) capacity by ensuring patients in the nursing unit met the criteria for care and stemming financial losses in the spine sub-service line through cost reductions. Within six months, CCU bed identification cycle time decreased from four hours to 40 minutes on average and the patient discharge process was accelerated by three-plus hours. The annual cost savings from more effective patient flow is projected to be $1.3 million.
What are the biggest challenges hospitals face implementing lean?
Traditionally, healthcare providers are accustomed to “triaging highest risk” and taking a wait-and-see approach. Implementing Lean practices requires challenging this conventional wisdom.
Hospital leadership often needs to take a leap of faith and embrace the lean journey fully. The initial investment of training and implementing Lean, a fear they will have to add staff to make it happen and the time commitment from leadership dissuades some organizations. But, the reality is that the return on investment in Lean can pay dividends when a hospital commits to it fully.
Why do some healthcare institutions fail in their implementation of lean?
Some healthcare institutions may fail with implementing lean because managers may bring in some lean tools, but do not fully commit to changing the culture and overall process. Over time, this lack of cultural commitment renders these tools less and less effective. Another pitfall is keeping information and tools for lean projects in a silo and only training a few people rather than engaging all staff. Some hospitals fail because they think they're done once they complete a few rounds of Kaizen events. In other words, Lean is viewed as a means to an end, or a project/certification to be checked off a list, rather than an ongoing commitment.
What is your favorite piece of advice for hospital leaders or those who are just getting started with implementing lean practices?
Figure out who your customer is and what's important to them. It's important not to get too wrapped up in jargon and philosophy regarding Lean, because it's not significant to the customers, the patients. What matters is how long they had to sit in the waiting room at the ED, or how easily they could make a follow up appointment after an acute episode. Perhaps it's human nature to get caught-up in pedantic nuisances and terminology in the course of developing proficiency in Lean. But this is to miss the very point – it's not about us. It's about the patient. The interests of every other type of healthcare “customer,” whether it is the referring physician or payor, exist for the purposes of the wellbeing of the patient.
Thanks to Justin for taking the time to be interviewed! I'll try to engage Justin in comments discussion and a follow-up interview if the comments and questions merit it.
GE Healthcare has recently started blogging actively, including this post on Lean and waste in healthcare: “I spy with my Lean eye.” Here is a post written by Justin: “Evidence-Based Management: Are Hospital Administrators learning from their Physicians?“
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