Waste Watchers: Getting Leaner in 2012

This month, I visited ThedaCare in Wisconsin to learn more about applying lean thinking to improve daily work. While the original concept is often connected with Toyota, the basic tenets of lean thinking – remove waste, reduce gaps, solve problems and be better each day – are applicable across industries, and certainly in health care.

My guide on this visit was our very own lean guru and leader of the Michigan Quality System, Dr. Jack Billi. Jack’s inspiring commitment to embedding lean thinking in our organization has been recognized nationally, including a recent “shout out” on Paul Levy’s blog, Not Running A Hospital.

The trip to ThedaCare provided me with deeper insight into successful system design: “going to the gemba” to experience problems where the work happens; building problem-solving knowledge and sharing that knowledge systemically; and engaging leadership and developing people.

The trip also got me thinking that while we communicate a lot about the importance of creating the Ideal Patient Care Experience at UMHS, we don’t communicate as often about the importance of creating an ideal experience for faculty and staff, and an environment where we design and use ideal clinical practices, even though these concepts have been areas of focus at UMHS for quite a while.

In order to achieve our strategic goal of IPCE, we must enable a culture in which you – our diverse and skilled faculty and staff – are engaged in designing how work is done. This is where the Michigan Quality System plays an important role.

MQS is a resource available to help faculty and staff identify problems, and design and implement workflow countermeasures to improve the UMHS experience for all constituents: patients, families, referring physicians, trainees, investigators, research subjects and coworkers.  MQS provides a framework by which we engage the people doing the work to determine how we can provide the right care at the right time and in the right setting.


MQS lean teams strive to improve quality, safety, efficiency, appropriateness and service by:

  1. Reducing steps in processes that don’t provide value to the customer
  2. Reducing unnecessary variation to improve consistency and value
  3. Reducing unreasonable expectations of people or equipment to work at a faster pace or expend greater effort than is necessary

Since 2009, UMHS has experimented with a new “Lean in Daily Work” model in which work teams learn basic problem identification and standard problem solving.  So far, more than 200 “everyday lean ideas” have been implemented in sites across UMHS, resulting in a 50% improvement in overall employee satisfaction among participating departments and units. Recent examples of lean improvement work include:

  • Neurosurgery Rounding Model:  Adding weekend discharges and evening rounds with house officers and floor nurses reduced Length of Stay by one day.
  • Emergency Department & Cardiology:  Door-to-Balloon Time for Myocardial Infarction went from 75% within 90 minutes to 93% within 90 minutes, with a current mean time of 56 minutes.
  • Early Mobility Project:  Teamwork between Nursing and Physical Therapy to get vented patients in the CCMU up and walking earlier reduced ICU Length of Stay by two days and hospital Length of Stay by six days.
  • Urology New Patient Access:  After implementation of the Lean in Daily Work model in Taubman Urology, the department sees 83% of new patients within four weeks, up from 60% at the beginning of FY11.

A recent U-M employee report indicated that we have 22,007 faculty and staff in the U-M Health System. This means that we have 22,007potential lean problem solvers in our organization; 22,007 people who can apply lean thinking to define the experiments that move us forward in creating the future of health care through discovery.

One of the ways to embed lean thinking deeper into our culture is by getting involved and sharing experiences and best practices.  Ways to do that include:

  • Taking one or more of the courses listed here to begin your lean journey (Note: links to internal site)
  • Watching a video of one of the brown bag sessions on A3 thinking and structured problem solving (Note: links to internal site)

If you have been part of a lean improvement effort, please share your story here, in the comments section of Medicine That Speaks. What was your “Ah-ha” moment? What MQS strategy was most valuable to you? What were your greatest challenges? How have you taken your experience forward?

Remember, the only worthless idea is the one you don’t explore. Let’s work together to make 2012 our best improvement year yet.

My comments on house officer allegations/internal review

Health System Community,

As you have likely heard, we are currently conducting an internal review stemming from allegations of child pornography possession by one of our house officers. Early findings have identified significant problems with how initial reporting of these allegations was handled. This is troubling to many of us, and, as CEO of the Health System, I wanted to share with you my thoughts and perspectives.

The creation, use and distribution of child pornography is appalling on every level, and in situations like this when there are mistakes in how such a situation was handled, human nature makes us want to quickly identify and resolve the problem. However, jumping to quick conclusions and making assumptions with partial information isn’t the answer. That’s why the University is engaged in a comprehensive review into what went wrong in this particular case. This review and taking appropriate action are top priorities for President Coleman, for me and for leadership across the Health System and the University. We will make improvements to prevent this from happening again.

In a recent message to the Health System community, I wrote that our obligation to promote and ensure health and wellness goes beyond caring for individual patients and their families. We also have a responsibility to ensure and promote the health and wellness of communities and to protect and care for the community’s most vulnerable members. This remains true.

I want to take this opportunity to remind you – our valuable Health System faculty and staff – that it is our collective responsibility to be diligent in reporting behaviors and actions that are inappropriate, and that we applaud and support those who have the courage to do so. It isn’t always easy to speak up, but it is always the right thing to do. And it is my and all leadership’s responsibility to thoroughly and timely investigate reported concerns.

We accomplish great things here every day. And it is important to remember that there is no evidence of improper conduct with patients in this case.

This incident is a painful moment in our history. Undoubtedly, we should have done better. Moving forward, we will.

Ora honored at MBPA’s Annual Women and Leadership in the Workplace Conference

L to R: Rhonda Walker of WDIV-Channel 4, Dr. Pescovitz, Jennifer Kluge of the Michigan Business and Professional Association

Thank you to the Michigan Business and Professional Association for everything it does to promote a thriving business community in Michigan. It was an honor for me to be honored by you!

Complete list of 2012 Annual Women and Leadership in the Workplace Conference honorees

Water Main Break: A Study in Teamwork

We work in an unpredictable environment where the day’s priorities can switch at a moment’s notice. Like this week, with the water main break in Med Sci 1 and the resulting flooding to patient care areas in the Cancer Center and University Hospital.

Because of the teamwork demonstrated by so many – doctors, nurses, administrators, facilities staff, emergency response leads and others – we were able to maintain good patient care as we worked to reopen many of the impacted clinical areas today.

Throughout this effort, our resolve and ability to adapt as a team were never more prominent.

The team, the team, the team, as Bo Schembechler would say.

Your work to minimize disruption to care and help your colleagues is a poignant reminder of the integrity of our faculty and staff, the incredible community we have here at the University of Michigan Health System and the power of teamwork.

There is a piece of Chris Gryder art at NCRC that captures this moment and the spirit of collaboration.  Take a look:

Each of the 60 tiles that comprise this piece is a complete work of art in and of itself.  Together, the tiles create something even more profound, without diminishing their individual power and beauty.

In the words of NCRC executive director David Canter, “Individual excellence does not have to be at odds with collaborative efforts.” I would add that one inspires the other.

My thanks to everyone involved in the water main break effort.  Share your teamwork testimonial or post your thanks to colleagues here, on Medicine That Speaks!

Beyond The Superdome: Lessons Learned

Last night, the city of New Orleans and the fans inside and outside the Superdome were bursting with energy and excitement as U-M took on Virginia Tech in the 2012 Sugar Bowl. The streets and seats were filled with maize and blue, and how sweet it was to see the Wolverines make so many fans proud with an OT victory over the Hokies.

What most impressed me most, though, wasn’t the score, this win or the fanfare, though all were certainly impressive! What impressed me most was why Michigan was there in the first place. We were there because of the teamwork on that field, the camaraderie on the bench, the trust and respect between players and coaches, and the leadership of Coach of the Year Brady Hoke and his staff.

Leadership and teamwork are essential components of success on the field, in the office, in a family, in a social club, in the operating room, in the waiting room and in the clinic. In fact, it doesn’t matter where your game takes you. You won’t go far without great leadership and true teamwork.


On diversity and health care equality

Each winter, the University of Michigan celebrates the annual Martin Luther King, Jr. Symposium as a way to express the University’s commitment to equality among all individuals regardless of race, sex, economic status and religious belief. The U-M Health System shares this goal to promote diversity, cultural competency and satisfaction among faculty, staff and students.

Dr. King has said, “Of all the forms of injustice, inequality in health care is the most shocking and inhumane.” For far too long, social status and background have correlated with access to quality medical care in ways that have widened the health care gap and challenged the notion that all people are truly created equal.

That is why one of the UMHS strategic goals is to develop mechanisms for diversity and cultural competency among employees and trainees, including advancing clinical care and research that targets underserved populations and creating a workforce and student population that reflect the diverse communities we serve.

Part of this year’s MLK Symposium includes an event sponsored by the Health Sciences Program*, which I encourage you to attend. Dr. Brian D. Smedley, an expert in health equity and policy advancement, will deliver a lecture, “Building Stronger Communities for Better Health: The Geography of Equity and Human Rights.” He will explore how patterns of residential segregation and unbalanced health risks and resources across communities have led to poorer health in racial and ethnic minority groups compared to national averages. He offers approaches to promote the right to good health for all.

The event takes place Monday, Jan. 16, 2012, at 11:45 a.m. in the Dow Auditorium, Towsley Center.

In sponsoring this MLK Symposium event, the Health Sciences Program is helping our institution to fulfill its commitment to diversity and health equity. Creating this diverse culture and workforce is critical to the future of health care. Please consider attending this event, or other programs of the MLK Symposium, as a way to demonstrate your commitment to diversity.

*The Health Science Program includes the Schools of Dentistry, Medicine, Nursing, Public Health, Social Work, College of Pharmacy and the University of Michigan Hospitals and Health Centers.