Hospital Impact: Healthcare leaders must learn difference between a set of tools and a system of improvement

Boardroom
For hospitals and health systems, long-term success hinges on developing a well-defined, highly reliable system of improvement with buy-in and accountability at all levels.

It’s an exciting time to be in healthcare. The industry is experiencing change unlike any other time in modern history, but that doesn’t come without its challenges.

The rising costs of care and those associated with new regulatory requirements are straining health systems’ bottom lines. With the shift toward value-based care and the rise of consumerism, patient expectations are changing and their voices are becoming stronger than ever. They, too, want higher standards of care, more information about their treatment, more involvement in decisions about their care and transparency of cost and performance data to help inform their care choices.

Together, these considerations are shifting the healthcare marketplace and forcing health systems to transform their clinical operations to improve the safety, quality and experience of the care they deliver and to reduce costs. To rise to this challenge, health systems have begun adopting and adapting effective practices from other industries to optimize efficiency and improve outcomes.

The Lean quality improvement methodology is an example. A hallmark of the Toyota Production System, Lean comprises a set of core principles for maximizing value from the customers’ perspective and eliminating waste. Many health systems have started applying Lean and similar methodologies with the hope of achieving breakthrough performance gains, but for some, the results have been mixed. This is not because the methodology is flawed—it is used successfully in most global industries and virtually all organizational sectors—but because the principles, which include a set of tools, are not being fully integrated into a system of improvement.

The reality is that it is wishful thinking to believe a set of tools such as a “six-pack of Kaizen events” or an “A3” tool will alone transform an organization into a model of efficiency and continuous improvement over the long term. The missing link for many organizations seeking a sustainable solution is the appreciation of the difference between a system of improvement and a standalone set of tools.

Establishing a system of improvement in healthcare that can realize continuous, sustainable operational and quality improvements requires a combination of the following elements:

  • A “True North”: An organizational strategy, championed by leadership, that is focused on a “True North” mission, to which all improvement work will be aligned
  • Organization-wide participation: Deployment of the strategy throughout the entire organization, from the boardroom and C-suite to the front line, with both outcome and process metrics established to evaluate progress at each level of the organization
  • Proven tools and methodology: Lean-related tools for driving improvement, such as Kaizen events, value stream mapping, root cause analyses, A3 problem solving, kanban and pull systems, 5S workplace organization methods and many others
  • Leadership accountability: Leadership Standard Work, which outlines the expectations and tasks for leaders to support the system of improvement at all levels of the organization
  • Ongoing monitoring and management: Daily management systems, which support the daily problem solving and execution of strategy throughout the organization
  • Educational support: Organizational development and training activities that are focused on teaching the tools and methods of the improvement system to everyone in the organization, as well as ongoing monitoring and coaching skills development in the cultural and management systems aspects of the transformation

As this list indicates, process improvement tools are an essential component of a successful transformation strategy—but they are only one part of what is required to meet the growing expectations of both patients and regulators now and into the future. Long-term success hinges on developing a well-defined, highly reliable system of improvement with buy-in and accountability at all levels.

Charles Hagood (PDF) is partner at Press Ganey in the strategic consulting division. Throughout his career, he has delivered a visionary approach to and has overseen the introduction and implementation of Lean Healthcare systems, process improvement initiatives, and system design activities to more than 400 healthcare organizations. Mr. Hagood is a co-author of the Shingo Prize winning book for Research and Publication, “Lean-Led Hospital Design: Creating the Efficient Hospital of the Future.”