by Mark Clare, M.A., M.S., LSC, LSSMBB, Principal Advisor for Strategic Initiatives and Service Line Leader for Process Improvement, Purdue Healthcare Advisors, an IHA Strategic Partner
HEARING THE VOICE OF THE CUSTOMER
When I arrived at Purdue University three years ago, Purdue Healthcare Advisors had been using lean six sigma to help hospitals in Indiana and a few other states for about a decade. I wanted to know what was working and where we could improve our service. I was able to determine through surveys and dozens of discussions that the story was mixed. Clients were moving through the steps of lean six sigma but not applying the statistics. In fact, hardly anybody I spoke to was “using the math.”
Six sigma uses DMAIC, a data-driven improvement methodology for improving, optimizing, and stabilizing processes. Many of our clients told me that they were using “DMAIC light,” and that gave me insight into what they found useful and what they discarded from our training. They were still applying lean tools such as the SIPOC, the 5 Whys, and eliminating waste, but the stats part of six sigma had fallen by the wayside.
I began to understand that, with the exception of certain niche areas, such as lab work, radiology, and med management, applying six sigma to health care may not be the best way to go because health care processes are just too immature. They have high levels of natural and artificial variation that make them too unstable for many of the techniques of statistical process control. We would need to do a lot of lean work first to stabilize the processes, and that’s where lean without six sigma comes into play.
PUTTING LEAN FIRST
I reached out to colleagues around the U.S. and the U.K. with my findings and they, too, felt the health care industry was shifting away from six sigma and toward lean. I talked to job recruiters who told me requests from hospital clients were for people who possessed lean skills. At the same time, we were noticing that the sustainability of lean-related success was only as good as the capability of the organization to sustain it (i.e., if they had only a few lean experts, their gains were not likely to hold). Additionally, our clients were asking for a program that would give their employees lean in smaller bites, with less time off the floor.
We’d traditionally trained for lean six sigma belt certifications. Yellow Belts understand lean and act in a supporting role, Green Belts do pieces of project work, and Black Belts master the entire methodology. Now we needed a model that emphasized lean and did a better job of democratizing it across the employee spectrum to give more staff valuable pieces of the puzzle and permission to participate in the journey. We needed a model that gave people the skills to make and sustain their own gains but did it in smaller chunks through an interactive curriculum.
In comes Lean First, a program that ditches the belts and brings in training levels that make sense to our clients from an operational and financial perspective. Lean First, by its very name, focuses entirely on lean methodologies. Six sigma is saved for another program we plan to offer on how to use data science to make better decisions, manage patient populations, optimize scheduling, etc.
PROVIDING SCALE-DRIVEN SOLUTIONS
Lean First offers four new certification levels: 1) Lean Daily Improvement (LDI) Facilitator; 2) Lean Practitioner, 3) Advanced Lean Practitioner; and 4) Lean Leader. Each level addresses making change and improvements at a different scale.
LDI Facilitators are focused on learning how to make small continuous improvements at the point of service while you work. Lean Practitioners are skilled at facilitating cross-functional teams dedicated to making larger improvements that take several days of concentrated effort. Advanced Lean Practitioners look at making transformational change for an entire service line over a 12-to-18 month period. Finally, Lean Leaders are responsible for guiding the lean effort across an entire organization, which can take years.
Our new curriculum reflects our belief that lean never stops. It means learning to make improvements at many levels in the organization while service is being delivered. Clients can master these different levels of change-making through training as well as through observing Purdue-run events before they run their own event with the help of a Purdue coach.
BUILDING CAPACITY FOR CONTINUOUS CHANGE
While six sigma is focused on expert solutions delivered in a project approach, Lean First focuses on team solutions delivered as events aimed at solving the different types and scales of problems hospitals face on a continuous basis. It offers solutions to address improvement on every level and improvement work that touches every employee. Not everyone needs to know how to perform a total lean transformation, but all can benefit from the daily huddles, run charts, and other lean tools that LDI introduces.
As part of a land-grant university, Purdue Healthcare Advisors’ mission is to work with health care organizations to build their capacity for change. Lean First answers our mission and our belief that improvement should never stop and offers powerful tools to keep employees engaged and motivated to make and sustain change.