Algorithm No.1 TACKLE INEFFICIENCY

OUR HEALTH CARE SYSTEM IS UNDENIABLY BROKEN.

In 2013 alone, the U.S. health system will harm one in three patients during their hospital stays. And of the staggering $3 trillion Americans will spend on health care this year, an estimated $750 billion will be squandered on wasteful practices and unnecessary rework. 1

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The Efficiency Freak

THE EFFICIENCY FREAK

“If I’m going to speed up, I tell my techs that they’re going to need to slow down.”

— Norm Zabriskie, M.D., Vice Chair and Medical Director of Clinical Services and Director of Clinical Operations for the Moran Eye Center

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Zero Tollerrance Crew

CENTRAL LINE INFECTIONS: THE ZERO TOLERANCE CREW

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Lean Champ

THE LEAN CHAMPION

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The mandate for all health care systems is clear: Improve outcomes, reduce cost and eliminate waste. How to achieve these ambitious goals throughout a profoundly complex organization is much less obvious.

A good place to start is to give people hope that they can make things better. Health care professionals are arguably the greatest do-gooders around. Yet in a recent survey conducted by the Physicians Foundation three-quarters of 14,000 physicians stated that they were somewhat or very pessimistic about the future, and 82 percent of them said they have little ability to change the health care system.

If these physicians are representative of health care professionals in general, then the first order of business is to inspire and empower the millions of people who work in health care to believe they can be part of the solution. Working in the inherently inefficient worlds of medicine and academia has trained people to become masters of the workaround. “Those who are doing the work know where the waste is, where the inefficiencies are, and where there are opportunities,” says Robert Pendleton, M.D., chief medical quality officer for our hospitals and clinics.

It’s human nature to want to fix problems. So how is it that we can be so incredibly ambitious adopting cutting-edge technology and life-saving treatment options, and so surprisingly accepting of completely avoidable conditions, such as bedsores. Most of the time, it’s because they require more than one person doing the right thing—they require coordination between many people and a process in place to ensure best practices happen across the system. “If we could harness the imagination of the 12,000 people in our organization to improve our system, we could create an endless well of opportunity,” says Pendleton.

Is there really a single tool that can change culture and erase inefficiencies from our system—or at least significantly reduce them? Over the past few decades, many health care institutions have tried more than a few process improvement tools, some borrowed from lessons in manufacturing. Comprehensive, measurable and sustained success has been elusive for most. Part of the problem is buy-in. These tools are often perceived to be an assembly-line approach to the practice of medicine. Lean, for example, was developed in Toyota factories in Japan, and physicians take care of people, not cars. Hospitals deal with lives, not widgets. And academic medical centers are purpose-driven institutions, not profit-driven factories.

“If we could take all the harmful stuff we do out of our system, we wouldn’t have to worry so much about payment reform.”

—Robert Pendleton, M.D., Chief Medical Quality Officer

“People are in health care with their hearts, and methods like Lean can seem really impersonal,” says Quinn McKenna, M.H.A., chief operations officer for our hospitals and clinics, noting that efficiency and cost cutting have never been big motivators for people who have dedicated their lives to caring for patients. “We knew that we needed to show how efficiency connects with doing good and adding value.”

So with eyes wide open, this past year, we ventured on a journey to see what we could borrow from the automaking industry, and how we could personalize it to our culture to create more value for our patients. Here are a few of the things we’ve learned along the way.

“We’ve taken the Lean principles and reimagined them in the Utah vernacular. As a culture that likes options and thrives on innovation, an overly prescriptive approach wouldn’t work for us.”

—Chrissy Daniels, M.S., Director of Strategic Initiatives

The ultimate goal is to become the leading academic medical center in the value of care that we deliver to our patients: safe, effective and efficient. There’s a lot of learning and work left to do, and barriers that need to be removed. But change is clearly in the air. “The question we need to relentlessly ask is: Are we heading in the right direction?” says Entwistle. Pendleton agrees. “This isn’t about a beginning and an end. It’s about a journey. It’s about having a vision that we can always do better.”

12 Lessons we learned about launching Lean

  • JUMP-START MOMENTUM WITH ALL-IN EXECUTIVE SPONSORSHIP.

    Let’s be honest. What’s the most likely way to get a busy surgeon to spend 13 weeks learning how to more efficient? Have her boss ask her to do it. That’s how our Lean initiative was launched, with a clear-and-loud call to action from senior leaders, in particular Vivian S. Lee, M.D., Ph.D., M.B.A., senior vice president for University of Utah Health Sciences and CEO of University of Utah Health Care. Executive leaders received training, provided the time for their staff to do the same, and focused resources and attention on projects implemented by faculty and staff.

  • PROCESS IMPROVEMENT ISN’T ABOUT REDESIGNING THE WAY PRACTITIONERS TAKE CARE OF PATIENTS.

    That’s a distinction that needs to be clear from the beginning, says Pendleton. “Lean can never replace the relationship with the patient. What it can improve is all the processes that surround those interactions, so that caring for the patient is more productive and meaningful.”

  • A STRICT, TEXTBOOK APPROACH TO LEAN HEALTH CARE WON’T WORK IN AN ENTREPRENEURIAL CULTURE.

    “We’ve taken the Lean principles and reimagined them in the Utah vernacular,” says Chrissy Daniels, M.S., director of strategic initiatives for our hospitals and clinics. She helps support and monitor the 300-plus Lean initiatives that are currently underway throughout our academic medical center. “As a culture that likes options and thrives on innovation, an overly prescriptive approach wouldn’t work for us.”

  • APPLYING BUSINESS METHODOLOGIES DEMANDS GOOD BUSINESS MINDS.

    Lee recognized an opportunity to cross academic boundaries and started a partnership with a whole team of Lean gurus at the University of Utah’s David Eccles School of Business. According to Glen Schmidt, Ph.D., M.S., interim chair and David Eccles Professor of Business in the Department of Operations and Information Systems, the partnership broke the mold to create something quite different: system-wide transformation. “We don’t just want to impact a single project,” he says. “We want to infuse Lean throughout the entire academic medical center.”

  • MAKE THE CONNECTION BETWEEN LEAN AND SCIENTIFIC METHODOLOGIES.

    “Health care professionals are used to applying the ‘scientific method,’ and at its core, that’s what Lean is all about,” says Schmidt. Lean requires providers to define the current problem, develop a hypothesis about how to improve it and measure the improvements that are made. “The idea is to find the best way to do something and then make sure you do it that way every time—while always looking to find the ‘new best way.’”

  • EMBRACE SMALL, CONSTANT IMPROVEMENTS AND LET GO OF PERFECTION.

    Trying to get the process perfect from the start can be paralyzing. Instead, nurture an inquisitive mindset that empowers staff to start small, even with one patient, and then refine the process and try it with two patients. Consider the medical center a laboratory and health care as a continuously learning organization.

  • CONNECT EFFICIENCY WITH SURVIVAL.

    “We have to show staff that Lean is actually one of our best economic preparation strategies,” says Daniels. Pendleton agrees. “If we could take all the harmful stuff we do out of our system, we wouldn’t have to worry so much about payment reform.”

  • REDESIGN HEALTH CARE DELIVERY AROUND THE PATIENT, NOT THE PROVIDER.

    Create a system of respect focused on the patient. Evaluate whether processes are offering value to the patients, and let their values help drive decision-making.

  • MASS PARTICIPATION REQUIRES MAJOR PRIORITIZATION.

    With total executive support, floodgates to innovation were flung wide open, and the Lean initiative launched a thousand ships to sea. At that point, another vexing problem naturally unfolded: How do you prioritize while still keeping people engaged? For David Entwistle, M.H.A., CEO of our hospitals and clinics, the filter is simple. “If it’s not driving a better clinical outcome, then we don’t need to do it.” As Pendleton puts it, “Process improvement takes discipline. We can’t just chase all the shiny things.” To ensure that, we created the Innovation Station (see description on next page), which helped us to “stop working on all the pretty good ideas, and to start working on the truly great ones,” says Daniels.

  • PROGRESS MUST BE MEASURED, TRACKED, AND SHARED IN A TRANSPARENT WAY.

    There’s a certain thrill about creating something new. The part that takes more discipline is monitoring and tracking. While collecting ideas, prepare the system to measure results through dashboards and analytic tools that determine which ideas increase the value we offer to patients through outcomes, cost and patient experience.

  • DON’T LEAVE ANYTHING TO CHANCE.

    “We can’t leave best practices to chance. We have to re-engineer the system so we can be certain they will happen,” says Sean J. Mulvihill, M.D., CEO of our faculty practice group and associate vice president for clinical affairs. Pendleton agrees. “We can’t settle for an academic medical center that’s safe, reliable, and efficient some of the time. We must build a system that’s all of these things, all of the time.”

    The ultimate goal is to become the leading academic medical center in the value of care that we deliver to our patients: safe, effective and efficient. There’s a lot of learning and work left to do, and barriers that need to be removed. But change is clearly in the air. “The question we need to relentlessly ask is: Are we heading in the right direction?” says Entwistle. Pendleton agrees. “This isn’t about a beginning and an end. It’s about a journey. It’s about having a vision that we can always do better.”