“How did you get trained in Lean? Is it something you think a team should go through? What was different in the way you approached things back when I worked with you; you seemed fairly competent then?”
My recent modernhealthcare.com post had piqued the interest of a colleague. This article is the first in a series to share in more detail an example of how one integrated delivery network’s CIO and IT team started its Lean journey of rooting out waste and creating more value for its physicians, employees, patients and community.
Contrary to popular misperception, Lean is applicable not only to manufacturing, but also in other industries like healthcare and IT services. Lean principles, methods and tools applied in a healthcare setting “remove waste from processes which improves quality, lowers cost and improves employee morale,” said Dr. John Toussaint, CEO of the ThedaCare Center for Healthcare Value, at the 5th Annual Lean Healthcare Transformation Summit. Dr. Toussaint also pointed out that to maximize the value a healthcare organization delivers to patients, “support functions need to support Lean, too.”
I first began applying Lean to IT in 2011 while serving as CIO of a multi-hospital integrated delivery network in Arizona. We had already begun a Lean journey in the clinical areas but not yet in IT. We had just selected a new EHR software vendor and were preparing to begin staffing-up the project team and kicking off the program. My IT team lacked Lean know-how and, inundated with a large-scale program of EHR and technology infrastructure transformation, had little free time. The health system’s Continuous Improvement (CI) team was focused primarily on deploying Lean in the ED and inpatient clinical areas. Eager to jump on the Lean bandwagon and transform IT project execution and service delivery, we sent our leaders to a week-long Lean Leadership course and decided to bring in an outside coach. We were fortunate to find an exceptional consultant — a former CTO with impeccable credentials in not only the process improvement frameworks of Lean and Theory of Constraints, but also the IT-oriented bodies of knowledge favored by technology practitioners and auditors alike: IT Infrastructure Library (ITIL) and Control Objectives for Information and Related Technology (COBiT).
From the Lean Leader training and teachings of the consultant, the IT management team began to understand the philosophy, principles, and methods of Lean and other improvement frameworks. “The role of leaders in a Lean world is to assure the front line understands the mission of the enterprise and has clear line of site (with Key Performance Indicator) to True North,” Julie Bartels, VP of the ThedaCare Center for Healthcare Value noted. “The leader is also responsible for making sure that employees or teams are capable and have sufficient capacity to manage the work and knock down barriers if needed.”
In a Lean organization, managing equates to improving. Good performance is never good enough. One can always do better. Lean is constant striving for perfection, upgrading of performance targets and improvement activities at the front lines, engaging every staff person every day in solving each problem.
If leaders were to give clear direction to the staff on True North, they would need to have clarity it first in their minds. The consultant engaged the IT managers in a robust discussion to define value from the perspective of IT’s stakeholders. We reflected on the mission and strategic goals of the health system, which focus on patient care and community health, and concluded that the purpose of IT was to contribute to these enterprise-wide True North objectives. IT value, we decided, could not be determined solely by direct hard-dollar ROI.
In its current primary role as an internal service provider, the value of IT is in its provision of technology services and information to clinicians, employees, patients, and family members that improve patient safety, access, quality of care and affordability. In order to fulfill this mission, IT would need to deliver highly reliable systems, real-time meaningful information and timely, efficient, high quality technology projects and services, as well as contribution to financial stewardship initiatives to respond to near-term margin pressures and long-term health system sustainability.
These early IT leadership conversations about business value informed later decisions in shaping the technology department’s vision and mission statements, annual goals and performance metrics. More immediately, these discussions were important to identify, cultivate consensus and increase urgency about opportunities for performance improvement in areas under IT’s control or influence. The next step was focusing efforts, diagnosing the current state of IT operations and building a coalition of IT staff to launch a formal process improvement initiative.
[Part 2 of this series will be published soon]
Robert Slepin is Director of Electronic Health Records (EHR) at Johns Hopkins Aramco Healthcare (JHAH), the result of a joint venture between Saudi Aramco and Johns Hopkins Medicine. JHAH provides integrated and patient-centered care to Saudi Aramco’s employees and health care beneficiaries. Slepin’s role is to lead the Epic@JHAH program, a transformation initiative to digitize patient data and automate patient-care processes at JHAH’s Dhahran hospital, satellite clinics and remote area clinics across the Kingdom of Saudi Arabia. Previously, he served as CIO at John C. Lincoln Health Network.