"We've trained a gazillion belts in healthcare. Why aren't things any better?"
Originally published by Mark Graban on LinkedIn: "We've trained a gazillion [Lean Sigma] belts in healthcare. Why aren't things any better?"
My guest for episode 274 of the Lean Blog Podcast was Jay Arthur, author of Lean Six Sigma for Hospitals: Simple Steps to Fast, Affordable, and Flawless Healthcare (now in its second edition) and Breakthrough Improvement with QI Macros and Excel: Finding the Invisible Low-Hanging Fruit.
Jay spent 21 years at a telephone company building software and computers of all sizes until 1990 when the VP of IT operations said to him, "I'm going to get into this total quality improvement game," hiring Florida Power and Light to train staff in Total Quality Management (TQM). Unfortunately, after a year, it was discovered that only about three out of 100 teams had succeeded, but Jay, who found the training to be the best he had ever taken, became a team leader and instructor. Over the next five years, Jay worked on various projects, ultimately finding himself in the finance department.
“We had led a team that saved $20 million in postage and $16 million in adjustments. Then, in 1995, our leadership team said, ‘Wait, we're not getting any return on investment (ROI) out of this total quality department,’” Jay said. “They shut us all down.”
Jay said that, when it comes to solving and prioritizing problems that matter, he believes healthcare has spent too much time “admiring the problem" instead of working to fix it.
While the length of stay in emergency departments has remained unchanged for a decade and the report To Err Is Human: Building a Safer Health System said a hundred thousand people a year die unnecessarily, not enough progress has been made, except in a few exemplar hospital systems.
“How do we get [more hospitals] on board? I believe Medicare is forcing changes through payment [reform]. That's one thing,” Jay said. “We're seeing a slow shift towards a patient‑centric model in the exemplar hospitals and not so much in other places. It's this horrifically slow transformation.”
“Because half the hospitals are in some sort of financial problem, I believe that somebody offshore is going to figure out a model that will drive costs down and deliver great quality of service. They will come in and just buy up hospitals, take them over, and teach them how to run. And I think they're going to force it down people's throats, and I think that will be an ugly day for healthcare, but I think it's coming.”
Despite the slow transformation, Jay believes these problems are solvable, and that every problem is solvable.
“In 2004, Robert Wood Johnson Hospital out in New Jersey won the [Malcom] Baldridge [National Quality] Award. In their emergency department, they set a goal; they said you're going to see a nurse in 15 minutes, a doctor in 30 minutes, or your visit is free. Guess what? They didn't give away any money or very little money,” Jay said. “What that did was everybody figured out, I can go there, and get my kid in and out in, or whoever it is, in and out in a very timely fashion.”
“I was talking to some people from there a few years ago, and they said, ‘Yeah, we had to add another wing on the hospital, because there was so much volume coming through the emergency department, it needed a whole new wing, to meet the need. We didn't have to transport people to other hospitals.’ That's Lean. That is Lean at warp speed, driving improvement, growing possibility. It's just amazing.”
Jay explained that this approach, even though it’s not focused on cost-cutting, leads to savings.
“Every company, according to Juran, throws away 25 to 30 percent of their revenue, fixing stuff that shouldn't be broken and trashing stuff that can't be fixed. The same is true in healthcare."
"Out of the $2.9 trillion we spend in healthcare, a trillion dollars is for waste and rework. That's a lot. $250 billion of that is for unnecessary tests and treatment. That's overproduction. That's a plain old, Lean overproduction thing. There's this huge opportunity.” Jay said. “There were estimates that said that if we cut that by 20 percent it would pay for Obamacare. If we cut it by 80 percent, it would clear the national debt."
Jay said that he believes a dramatic improvement could be made in just 18 to 24 months by reducing what he calls the “three silent killers of productivity and profitability: delay, defects, and deviation.
However, instead of just taking out the axe when times get tough and cutting without reason, Jay said that using Lean to increase speed so that there is no chance to make a mistake, because the patient file is never put down, is a more effective solution.
“If we use Lean to simplify and streamline, then we use Six Sigma to optimize, to find the things you can't find, necessarily, through a Lean approach,” Jay explained. “Then we can start to really chop away at that cost.”
Jay said that he tries to make Lean and Six Sigma simple enough to empower people to do it.
“One of the things that I observe is we try and teach people things they don't need, to solve problems they don't have. In healthcare, you need a much smaller toolkit than you need to do things on a factory floor,” Jay explained. “Even Deming, I saw him many years ago. He said, ‘I have no idea why anybody put the word 'total' in Total Quality Management.” Deming reminded people to focus on the vital few, not the trivial many.
Jay went on to say that through Total Quality Management or Six Sigma people sometimes get the idea that they have to go floor to ceiling, train a billion belts, and tackle everything on the planet, but all that accomplishes is wasted time and energy
“Most of my projects get done in an afternoon. I helped one local hospital save $5 million dollars in denied insurance claims in an afternoon. They implemented the changes in the process the next Monday morning,” Jay said.
“I think the Six Sigma world has done a disservice by over‑complicating what we're trying to do and what problems we're trying to solve.”
Jay pointed out that, for 25 years we've been teaching Lean and Six Sigma in the same way, and wondered if there's a better, faster way to teach it today.
“It's become one of those things where people are chasing a belt so they can add it to their resume. We've trained a gazillion belts. Why aren't things any better?” he asked.
If you want to find out more about Jay and his books, you can find him at qimacros.com. Jay also has a free Lean Six Sigma Yellow Belt training with healthcare examples. That address is lssyb.com.
To listen to the whole podcast and to read a PDF summary with this content and more, please click here.
See Part 2 of this discussion:
These 5 Mistakes Can Kill Your Lean or Lean Six Sigma Program in Healthcare
Mark Graban (@MarkGraban) is a consultant, author, and speaker in the “Lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals (the 3rd edition was released in 2016) and Healthcare Kaizen. He is also theVP of improvement and innovation services for the technology company KaiNexus and is a board member for the Louise M. Batz Patient Safety Foundation. Mark blogs most days at www.LeanBlog.org.
