Massachusetts Hospital Lean Network
Senior Fellow, Lean Enterprise Institute
Author, “Lean Hospitals: Improving Quality, Patient Safety, and Employee Satisfaction”
• Overview of LEI and Healthcare Value Leaders Network
• Staff engagement in continuous improvement
• Systems and processes for preventing errors
• Role of senior leadership in “strategy deployment”
• Lean Enterprise Institute, Inc. (LEI) is a nonprofit
education, publishing, conference, and research
organization founded by James Womack, Ph.D. in 1997
to promote and advance the principles of lean thinking in
every aspect of business and across a wide range of
• Through its publications, summits, conferences,
workshops, webinars, online forums, and website
resources, LEI helps organizations transform themselves
into lean enterprises, based on the principles of the
Toyota Business System.
Our mission is to fundamentally improve healthcare
delivery through lean thinking.
We educate leaders in lean thinking, facilitate networks of
practioners, host an annual conference and provide resources at
1st Network- Members
• Group Health Cooperative
• Gundersen Lutheran Health System
• Hotel-Dieu Grace Hospital
• Iowa Health System
• Johns Hopkins Medicine
• Lawrence & Memorial Hospital
• Lehigh Valley Health Network
• McLeod Health
• Mercy Medical Center
• Park Nicollet Health Services
• St. Boniface General Hospital
• UCLA Health System
• University of Michigan Health System
2nd Network- Members
• Akron Children's Hospital
• Alberta Health Services
• Beth Israel Deaconess
• BJC Healthcare
• Christie Clinic
• Cleveland Clinic
• Harvard Vanguard
• Kaiser Permanente
• Seattle Children's Hospital
• St. Joseph Health System
Documenting & Celebrating
Kaizen Wall Date:
What was the Problem?
• What was the problem?
For disposal of pipette tips, the only containers we had were “sharps” containers. This
Adds extra disposal cost, as the tips are not sharp. The contai ner hole was also
Hard to get tips into.
What was changed, improved, implemented?
Create biohazard bag holders out of urine jugs, cut the tops off.
• What was changed,
• What were the benefits?
What were the benefits? Safety? Quality? Time? Waste? Cost?
Reduces cost since we aren’t doing unneeded sharps disposal and we aren’t throwing
the containers away each time. No safety risk.
Easier to get tips into container (less motion and less arm strain, since the
Container is lower and easier to get into). Tips can be dumped into a larger
Biohazard bin or we can replace the bag. • Who was involved?
Who was Involved?
Gretchen, Beth, Janie, Franke
Value of Kaizen in a Hospital?
• $4,000 per employee (Toyota)
– Just the quantifiable benefit
• What about benefits from:
– Better Quality
Less Waiting Time
= $$ ?
“This is the best thing
we’ve done in my 20
years. We’re finally
Data From Children’s Medical
Before Lean 12 Months
3. I have the opportunity to do what I do 3.11 3.92
best every day.
8. I feel free to make suggestions for 2.84 3.48
10. I feel secure in my job. 2.32 3.42
13. Stress at work is manageable. 2.43 3.23
17. I am satisfied with the lab as a place to 2.51 3.43
18. I would recommend my work area as a 2.38 3.46
good place to work to others.
Grand Average 2.96 3.69
• “You respect people, you listen
to them, you work together.
You don’t blame them. Maybe
the process was not set up well,
so it was easy to make a
– Gary Convis, President TMMK
(Toyota Motor Manufacturing
Many Errors are Preventable
• Nosocomial Infections
– a.k.a. “Hospital-Acquired Infections”
– 5 to 10% of hospitalizations
• 10% of these are serious bloodstream
• 87,000 to 350,000 die annually
– “Can be prevented through improved
hygiene and proper line insertion
• Allegheny: reduced bloodstream
infections by 68% through standard
methods and supplies
• (1): U.S. Centers for Disease Control
Make Errors Less Likely to Occur
The Quaid Case –
“This was a preventable error,
involving a failure to follow our
standard policies and procedures,
and there is no excuse for that to
occur at Cedars-Sinai.”
Was this the first time
the policies and
procedures were not
The Quaid Case – Heparin/Hep-
• Virginia Mason Medical Center (2004)
– Mary McClinton died after cleaning solution was injected (not
– Identical looking clear syringes together on tray
• “Mistakes will happen,” he said, sadly. “We are exceptionally
– Knew about same color syringes 2 YEARS before fatal error
• Had switched from brown cleaning solution to clear
– Radiology tech MENTIONED the problem to a supervisor 2
MONTHS before the fatality
• Why does this happen? How can we prevent this?
• Hoshin = “compass”
– Pointing the direction
• Kanri = “management” or “control”
• Hoshin Kanri
– A process for embedding strategy and aligning an organization
toward common goals
• Developed by Yoji Akao (non-Toyota)
• Using PDCA cycles to:
– Create goals
– Choose measurement points
– Link daily activities to high level goals
Top Down and Bottom Up
Source: Lean Hospitals, Graban
Purpose: What’s True North?
Quality Decrease Defects and Waiting Time
by 50% each year
Increase Productivity No. of Suggestions
10% each year Implemented
ThedaCare Code STEMI
• Starting Point 2002
– “Did not have a clear,
standardized response to heart
• Studied each process step in
– Convinced cardiologists to let ER
MD call heart attack
• Reluctant, but only two false
positives in two years
• Posted standardized work in
– Clear process steps and toll-gates