Book: Leading the Lean Healthcare Journey

(CRC Press: Boca Raton, FL) -- In the book Leading the Lean Healthcare Journey: Driving Culture Change to Increase Value (CRC Press, 2010), by Joan Wellman, Patrick Hagan, and Dr. Howard Jeffries, every health care organization can learn from Seattle Children’s Hospital’s continuous improvement process. But this book is not an operator’s manual. Instead, it is a challenge to everyone concerned with health care to reexamine deeply held assumptions. While it is commonly believed that improved quality, access, and safety, and an improved bottom line are mutually exclusive, Seattle Children’s Hospital demonstrates that it’s quite possible to realize all these improvements concurrently.

The authors blend case studies with theory to describe how the health care value proposition can be changed by reducing waste, variation, and complexity. They emphasize that leadership and culture change must come from within and discuss ways to transform key personnel into change agents and how to engage all staff in a patient-focused culture dedicated to eliminating waste and improving all aspects of quality and care. Descriptions of cultural “interventions” that have helped support changes are provided. Invaluable outlines on how to get started using the Toyota Production System (TPS) are also included.

Contributing to the book are change agents from Seattle Children’s Hospital, Jefferson Healthcare, and The Everett Clinic in Washington; Memorial Care in California; and Minnesota Children’s Hospital and Clinics. Each one tells of challenges overcome through continuous improvement. Providing example and inspiration, these organizations stand as proof that effective mindful change is feasible.

Professionals in health care and quality share their reviews

“The story is really about the evolution of thinking by leaders [and their] deciding that a true commitment to customers (patients) meant going and seeing what was really happening to them at the front line,” says J. Michael Rona, principal of Rona Consulting Group, and former president of Virginia Mason Medical Center, where he introduced the TPS. “It is a story about leadership taking the long view and systematically improving. It is a story of humility and the courage to go outside of health care to learn.”

“Joan Wellman and her colleagues provide examples of dramatic performance improvements,” notes Ken Graham, CEO of El Camino Hospital in Mountain View, in California. “Using their practical examples, you can be on your way to becoming a leader who transforms your organization, empowers your team, adds value, and saves lives.”

Sharing this opinion is Mark Graban, author of the book, Lean Hospitals: Improving Quality, Patient Safety, and Employee Satisfaction (Productivity Press, 2008), for which he won the Shingo Research and Professional Publication Award in 2009. “Joan Wellman and co-authors Pat Hagan and Howard Jeffries are true pioneers in the lean health care world,” says Graban. “Their book, Leading the Lean Healthcare Journey, puts lean into the right context for health care leaders and change agents. [It] presents all of the aspects of a management system that will create alignment and improvement from top to bottom, from arrival to discharge, each and every day. Engaging and well-written, I recommend it highly.”

About the authors

Joan Wellman has spent more than 30 years consulting to large scale change initiatives in the aerospace, telecommunications, high technology, energy, and health care industries. She pioneered the application of lean principles in health care starting in 1995. Her most recent health care clients include Seattle Children’s Hospital, Children’s Hospitals and Clinics of Minnesota, The Fred Hutchinson Cancer Research Center, and several others. Wellman is also on the faculty of the Lean Enterprise Institute. She founded Seattle-based Joan Wellman and Associates in 2000 to bring lean consulting talent from industry to health care.

Patrick Hagan joined Seattle Children’s Hospital in May 1996 and currently serves as its president and chief operating officer. During the past 25 years he has held executive positions at children's hospitals in Ohio, Arizona, and Seattle. Learning from Joan Wellman and the experiences of Toyota, Boeing, Genie and other companies utilizing continuous-improvement principles and tools, Hagan has led and helped develop the continuous performance improvement strategy at Seattle Children’s Hospital. He has led several rapid process improvement workshops and teaches the Lean Leader Training course at Children’s.

Dr. Howard Jeffries is an attending physician and the medical director for continuous performance improvement at Seattle Children’s Hospital. In addition to co-authoring Leading the Lean Healthcare Journey, he has published book chapters and peer-reviewed articles with an emphasis on cardiac intensive care, informatics, outcomes assessment, and quality improvement. He sits on the advisory board for the Virtual PICU Performance System database and on the Washington State Healthcare Associated Infections Advisory Committee and is the co-chair of National Quality Forum’s cardiac surgical measures steering committee.

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