Using Lean to Improve Workplace Culture in a Time of Sweeping Change

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Five years ago, senior management at Indiana University Health had a sobering realization: Our definition of leadership needed to change to respond to changes sweeping through healthcare. If we relied solely on existing leaders to solve challenges, we would be woefully unprepared for what was to come.

Reductions in reimbursements from private and federal payers, the rise of consumerism in healthcare, the advent of Obamacare. These profound changes – and more – required new approaches to caring for patients in a much more complex, dynamic environment. We needed to free leaders to set new strategies, cultivate fresh talent from within and improve coaching throughout the organization. In short, we needed to improve the workplace culture.

IU Health’s answer was to turn to a powerful workplace tool forged in post-war Japan. It’s called Lean and, much like it did with Japanese industry, it has transformed the culture, the way we lead and the way we work at IU Health, by turning employees into problem-solvers. While Lean is often recognized by a familiar set of tools, its staying power is really in the mindset, methodology and servant leadership philosophy it fosters

Since the introduction of Lean, IU Health has engaged more than a third of its 33,000 employees in Lean process improvement. Without a doubt, seeing Lean’s success in transforming IU Health’s workforce and our leadership practice has been one of the highlights of my career.

Consider what Lean has helped do:

     • Empowered employees to define problems and solutions without waiting for top-down instruction. More than 1,200 Lean events, where employees brainstorm for days or sometimes weeks to confront a workplace issue, have brought widespread process improvements at every level of the IU Health system. Once defined and put in place, process improvements become the new norm. Employee buy-in is a given because they’re the ones driving the change.

     • Created a workplace culture trained to interpret and use data to improve work processes. Lean teaches employees to look for meaningful data and leading metrics and avoid being distracted or led down the wrong path by anecdotes or someone’s personal agenda. Root-cause analysis, anchored in actionable data, allows employees to focus on the truly key issues.

     • Strengthened the concept of teamwork. Lean events draw in all involved, which in healthcare means everyone from managers, doctors and nurses to medical assistants and maintenance staff. The lesson being pounded home: Smooth-functioning teams are essential when running complex systems.

The bottom line for IU Health’s journey with Lean has been improved patient care. After every Lean event, teams write up the results in articles heavy with charts and graphs. I love reading the new articles and the success stories from the past, which paper the walls of a conference room in the executive offices.  They send a powerful message of workplace improvement that translates into significant gains for the more than 1 million people IU Health cares for every year.

While it’s hard to pick favorite stories (because behind each one are patients in need and passionate team members), these two are representative:

At University Hospital, the digestive and liver disorder clinic used Lean to attack patient wait times. By revamping operations, patient visit times were cut from 210 minutes to 75 – without reducing face time with physicians. This improvement has not only helped current patients but the clinic is now better able to serve many more patients.

At Riley Hospital for Children, the emergency department relied on Lean to boost operational efficiency even while caring for many more young patients in need. The Riley Lean team redesigned the entire ED, including relocating nurse stations and re-arranging supply cabinets. The payoff: Wait times to see a doctor have fallen by 45 percent since 2011, to 29 minutes, even as ED visits jumped almost 40 percent, to over 40,000 a year.

You can see how Lean involves tracking the data!

A few keys to the success of Lean at IU Health:

     • Leaders had to be willing to change the way they lead, by empowering employees to solve problems.

     • Honesty is required. Employees must acknowledge that problems exist, identify the root causes and agree on a course toward better outcomes.

     • Experimentation pays off. Lean participants earn their stripes as problem-solvers by being vulnerable, trying out a solution and, if needed, trying again and again until they hit on an approach that works.

     • Mutual respect and shared responsibility are the way to go. Since everyone’s in it together, this enables higher performance and drives better outcomes.

Five years into it, IU Health is committed to its investment in Lean. With 12,000 employees engaged in Lean so far, we still have 20,000 minds yet to mine for more great ideas to improve efficiencies and patient care.

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