Transforming healthcare is complex: start with a model cell

I have visited more than one hundred and thirty healthcare organizations in twelve countries and have seen many different approaches to lean transformation. What have I learned? If I were to start another lean transformation today, in a healthcare organization or anywhere else, the first thing I would do is work with my team to develop a model cell.

The model cell approach can be understood as “an inch wide and a mile deep” (as opposed to an inch deep and a mile wide). We started our journey at ThedaCare with this approach. In other words, we did a lot of kaizen and a lot of value stream mapping. But, in most cases, our work was not tied to the organization's important business objectives. And, since we had no knowledge of the management system needed to sustain improvement or build a culture of continuous improvement, much of our early work came to nothing. In the beginning, we joked that we did a lot of “drive-by kaizen”, which was, in fact, harmful to our transformation.

At the ThedaCare Center for Healthcare Value, we observe organizational transformations in healthcare, focusing recently on the question “where do you start?”. At the last lean transformation Summit, John Shook and the LEI team explained how they are studying lean transformation at a few different partner companies. Shook identified five important questions:

• What is our purpose, or what problem are we trying to solve? (What value do we create)?
• How do we improve the actual work?
• How do we develop people?
• What role should leadership take on, and how does the management system support this new way of working?
• What basic thinking or assumptions underlie this transformation?

We start with that first question: “What is the business problem we need to solve?”. Then we apply lean tools and principles to create a model cell. Again, the key is to connect this work to the organization's business objectives. This model cell experiment – connected to key performance objectives – creates a new system with standard work that sustains the improvement and aligns everyone on larger organizational goals.

Why build the model cell? First, it is the best way to help people learn. On process design teams, people learn the tools, the principles and the behaviors and characteristics of the management system needed for the transformation. Second, a model cell is the best way to help the organization learn; you want to use the model cell to show other people in the organization what good looks like. This is the first step of “spreading”. Spreading lean thinking or any improvement is not easy. But without a model cell, it is impossible. The power of being able to go and see a totally different way of doing things or an approach to problem solving in your organization cannot be underestimated. The model cell becomes the learning center for the organization. It creates enthusiasm within teams in such a way that fundamental changes can take place and be sustained, and it lays a foundation for the next model cells that will solve other business problems.

The model cell approach requires the involvement and commitment of resources from senior leadership. Success is more likely with senior management sponsorship. Depending on the business problem, setting up the model cell can take months. In our case, the redesign of patient care at ThedaCare took six months to design and another eleven to study, but then it resulted in zero medication reconciliation errors and a twenty-five percent reduction in the total cost of care. We sustained these numbers for many years with a total cost per case of around six thousand dollars, compared with the US average of nine thousand seven hundred. Read more about this project here (in English).