Autonomous Technologies: Driving Digital Lean in Health Care
Karen Wolk Feinstein, PhD (CEO & President, Pittsburgh Regional Health Initiative - Jewish Healthcare Foundation)
The Effects of Work Environment Barriers on Problem-Solving and Agility: Results from a Canadian Study
Pierre-Luc Fournier, PhD, MS, P.Eng (Assistant Professor, University of Sherbrooke, Canada)
Scrum: The Art of Delivering Twice the Outcomes at Half the Cost in Healthcare
Jeff Sutherland, PhD (Founder & Chairman of Scrum Inc., Managing Partner of Tesla Investment Holdings LLC )
Using the Lean Healthcare Implementation Self-Assessment Instrument: Experiences from a Large Academic Hospital System in Helsinki, Finland
Elina Reponen, MD, PhD (Chief Anesthesiologist, HUS Helsinki University Hospital)
The Canadian Experience of Lean Implementation in Healthcare
Tom Rotter, PhD (Associate Professor, Queens University)
James Chan, PhD (Director of Innovation, Sault Area Hospital)
Lean Performance Improvement and Facilitators of Outcomes in U.S. Public Hospitals
Tyler Ramos Roey (CLEAR intern, Loyola University - Chicago)
Autonomous Tecnologies: Driving Digital Lean in Health Care
Presented by:
Karen Wolk Feinstein Ph.D., President and CEO
Pittsburgh Regional Health Initiative, Jewish Healthcare Foundation
A new era of Lean has arrived, deploying digital technologies to relieve clinicians of environmental disruptions, distractions, and threats of harm to themselves and their patients. Advanced operational systems paired with real-time information systems open new opportunities. As autonomous vehicles use advanced analytics, sensors and monitors to transport passengers safely and efficiently, healthcare settings could do the same for their workers and patients. Lean methods worked magic in productivity, efficiency, safety, and reliability in various industries before advanced technologies were available to support this work. In 2022, we can now leverage precise and timely information, artificial intelligence, machine learning, virtual reality, smart wearables, sensors and monitors to anticipate harm, enable rapid corrective action, and create sustainable solutions. Highlighting specific applications of technology-enabled Lean supports will suggest the many opportunities to build better “vehicles” within which our doctors, nurses, pharmacists and others can pursue traditional, problem-solving Lean methods for better care.
The Effects of Work Environment Barriers on Problem-Solving and Agility: Results from a Canadian Study
Presented by:
Pierre-Luc Fournier, Ph.D., M.S., P.Eng, Assistant Professor of Operations Management
Université de Sherbrooke Business School
Healthcare is a high customer-contact environment where providers are faced with high volatility and uncertainty. This reality has been exacerbated by the Covid-19 pandemic and the additional demand it has directed towards healthcare systems. In this context, the ability to rapidly reorganize work to cope with internal and external changes, also called agility, becomes a key driver of performance. While agility can be supported by management tools and practices, it is also a function of the problem-solving capabilities of teams and providers. Solving problems in a high-dynamism environment requires creativity and spontaneity to craft viable solutions to the challenges that are presented. While problem-solving capabilities are influenced by individual and team characteristics, they can also be influenced by organizations through managerial behaviors, systems, and tools, such as the PDSA approach advocated by Lean. However, problem-solving capabilities can also be stifled when organizations do not pay close attention to the barriers that prevent employees from speaking up and from valuable knowledge being shared. Notably, healthcare organizations are known for being environments where employees may not feel safe to suggest solutions to a problem or might fear the negative consequences associated with highlighting problems. These barriers can lead to workplace silence, which prevents problems from being identified, let alone solved, and opportunities from being seized.
Using survey data collected from over 2500 nurses in the Canadian healthcare system, this presentation will discuss the effects of such barriers on the dynamic problem-solving capabilities needed for operational agility and its effect on the quality of care provided to patients.
Scrum the Art of Delivering Twice the Outcomes at Half the Cost in Healthcare
Presented by:
Jeff Sutherland, Ph.D.
Founder and Chairman, Scrum Inc.
Managing Partner, Tesla Investment Holdings LLC
Virtually all successful companies are implementing an Agile transformation today and 77% of these transformations are based on Scrum, which leverages principles of LEAN rapid cycle improvement that are foundational to success in arenas such as software and product development. Major opportunities exist in health care. For example, one of the largest hospitals in Boston implemented Agile Scrum in their surgery center and cut turnaround time by 50%. This increased the number of surgeries per operating room 20% and opened up a $700M new annual profit stream within two weeks. Similarly, on a small scale, the speaker opened up an innovative clinic that doubled the number of clients treated within two months of starting Scrum. The driving factors that enable these exceptional gains are LEAN process efficiency, combined with the innovation cycle taught in all U.S. War Colleges. Scrum adds to this patterns proven to generate hyperproductive teams and the ability to scale to thousands of teams as we see at companies like Microsoft, Apple, Amazon, SAP, and other leading organizations. The challenge for healthcare is implementing financial incentives to adopt a continuous improvement mind set. This is easiest in healthcare companies paid for number of patients in a plan, rather than fee for service. Keeping people healthy lowers cost per patient and increases profitability, a win-win for both patient and provider.
Using the Lean Healthcare Implementation Self-Assessment Instrument (LHISI): Experiences from a Large Academic Hospital System in Helsinki, Finland
Presented by:
Elina Reponen, M.D., Ph.D.
Chief Anesthesiologist, HUS Helsinki University Hospital
Lean management is growing in popularity in the healthcare sector worldwide, yet healthcare organizations are struggling with assessing the maturity of their Lean implementation and monitoring its change over time. Most existing methods for such assessments are time consuming, require site visits by external consultants, and lack frontline involvement. The Lean Healthcare Implementation Self-Assessment Instrument (LHISI) was developed by the Center for Lean Engagement and Research in Healthcare (CLEAR) at the University of California Berkeley as a Lean principles-based survey instrument that avoids the above problems. Using data collected from over 6,000 employees of the Hospital District of Helsinki and Uusimaa, Finland, this presentation will discuss the validation of the LHISI in the context of Finnish healthcare. It will also highlight how actionable knowledge collected with the LHISI can be utilized to guide the path towards Lean maturity across organizations.
The Canadian Experience of Lean Implementation in Healthcare
Presented by:
Thomas Rotter, Ph.D., Associate Professor
Queens University
James Chan, Ph.D.,
Director of Innovation, Sault Area Hospital
While many healthcare organizations are implementing Lean in the United States, there is not strong evidence of continued spread or maturity of Lean across Canada. This presentation aims to outline Lean implementation in Canadian healthcare using an anthropological and pan-Canadian approach. Drawing on a combination of lived experience and their published as well as grey literature, the authors describe the rise of Lean in Canadian healthcare beginning with an account of implementation activities on the west coast leading up to the largest Lean transformation in the world. Perhaps one of their most salient contributions is the development of an operational definition of Lean in healthcare to help guide implementation and discourse. Specific qualitative and quantitative literature will be summarized to focus the dialogue on techniques used to study Lean implementations. Major implementation of Lean in Canadian healthcare occurred between the years of approximately 2010 to 2020. Lean is still used in pockets of Canadian healthcare. By and large, Lean seems to have been absorbed into the general fabric of health quality departments across the country.
Canada prides itself on its universal healthcare system, however, this system is not immune from the influence of politics on the publicly-funded social welfare state. Following an apparent shift in public opinion regarding Lean implementation in Canadian healthcare, several questions remain for the future of research and practice alike. For instance: Who should conduct investigations of Lean interventions in healthcare – is this the exclusive domain of health services researchers? What role can scientist-practitioners play? The presentation will conclude with a discussion about what we can learn from the Canadian experience overall, and what methods/designs can and should be used to study Lean in healthcare going forward.
Lean Performance Improvement and Facilitators of Outcomes in U.S. Public Hospitals
Presented by:
Tyler Ramos Roey, CLEAR intern
Loyola University - Chicago
Public hospitals face substantial pressure to deliver high quality care while operating at lower costs. Prior research shows that Lean can improve some measures of hospital performance, but more study on Lean specifically in public hospitals is warranted. We performed multivariable regressions using data gathered from a National Survey of Lean/Transformational Performance Improvement in U.S. hospitals, linked to publicly available hospital performance data from the Agency for Healthcare Research and Quality (AHRQ) and the Center for Medicare & Medicaid Services (CMS). We examined 11 different outcomes measuring financial performance, quality of care, and patient experience, and their associations with Lean adoption among U.S. public hospitals. We also explored potential drivers of positive outcomes by examining their associations with the extent of Lean implementation, measured as the number of hospital units that had implemented Lean; leader commitment to Lean principles; Lean training and education among physicians, nurses, and managers; and use of a daily management system among C-suite leaders and managers.
