THE CENTER FOR LEAN ENGAGEMENT AND RESEARCH (CLEAR) IN HEALTHCARE BUILDING THE EVIDENCE BASE AND DEVELOPING ACTIONABLE KNOWLEDGE

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1 THE CENTER FOR LEAN ENGAGEMENT AND RESEARCH (CLEAR) IN HEALTHCARE BUILDING THE EVIDENCE BASE AND DEVELOPING ACTIONABLE KNOWLEDGE Stephen Shortell, PhD, MPH, MBA Blue Cross of California Distinguished Professor of Health Policy & Management Co-Director - Center for Lean Engagement and Research in Healthcare (CLEAR), School of Public Health, UC Berkeley Thomas Rundall, PhD Henry J. Kaiser Professor Emeritus Co-Director - Center for Lean Engagement and Research in Healthcare (CLEAR), School of Public Health, UC Berkeley Janet Blodgett, MSc Research Analyst/ Project Manager - Center for Lean Engagement and Research in Healthcare (CLEAR), School of Public Health, UC Berkeley Lean Healthcare Research Symposium JW Marriott Desert Springs Resort, Palm Desert, California June 6, 2017 OUR CORE FUNDERS 1

2 STRATEGIC ADVISORY COUNCIL MEMBERS Kathryn Correia Chief Executive Officer HealthEast Care System James Hereford President and Chief Executive Officer Fairview Health Services Alice Lee Executive Director, Strategy and Administration Lean Enterprise Institute John Toussaint, MD Chief Executive Officer Catalysis Craig A. Vercruysse, MBA Principal Chief Executive Officer Rona Consulting Group Peter Ward, DBA Richard M. Ross Chair in Management Chair, Department of Management Sciences Director, Center for Operational Excellence Fisher College of Business Ohio State University Helen Zak Chief Development Officer Catalysis RESEARCH ADVISORY COUNCIL MEMBERS Ross Baker, PhD Professor and Program Director: Quality Improvement and Patient Safety Institute of Health Policy, Management and Evaluation University of Toronto Michael Howell, MD, MPH Associate Professor of Medicine Associate Chief Medical Officer for Clinical Quality Chief Quality Officer University of Chicago Medicine Dorothy Hung, PhD, MA, MPH Associate Scientist Palo Alto Medical Research Foundation Research Institute Affiliated Faculty Institute for Health Policy Studies University of California at San Francisco Lori Pelletier, PhD, MBA Vice President, Operational Excellence Center for Innovation & Transformational Change UMass Memorial Health Care Assistant Professor of Quantitative Health Sciences Division of Health Informatics and Implementation Science University of Massachusetts Medical School Joseph Restuccia, DrPH, MPH Professor of Health Care & Operations Management Department of Operations and Technology Management Questrom School of Business Boston University Sharon Schweikhart, PhD Associate Professor Health Services Management and Policy College of Public Health Ohio State University 2

3 OUR MISSION CLEAR s mission is to conduct timely, relevant, and actionable research on lean whole system transformation initiatives in healthcare. OUR VISION The vision of CLEAR is to transform healthcare delivery by providing the knowledge to help organizations eliminate waste and create greater value resulting in the continuous improvement of patients outcomes and experience of care, population health, and reduced growth in the cost of care. 3

4 WORKING DEFINITIONS OF LEAN Lean is the leadership/operating/management system for implementing evidence-based care delivery The development of a culture that enables an overall management system to create value for customers by eliminating waste, empowering frontline workers, and solving problems through the daily application of the scientific method in creating standard work The core idea is to maximize customer value while minimizing waste. Simply, lean means creating more value for customers with fewer resources (Lean Enterprise Institute) A new way of leading and managing an organization From: Presentation by David Munch, Vizient West Coast Board of Directors Meeting, March 10,

5 From: Presentation by David Munch, Vizient West Coast Board of Directors Meeting, March 10, 2017 FRAMEWORK FOR CONDUCTING LEAN RESEARCH IN HEALTHCARE ORGANIZATIONS 5

6 THREE MAJOR INITIATIVES Annotated bibliography National survey of lean adoption and implementation in US hospitals Lean Action Research Learning Collaborative NATIONAL SURVEY MAJOR CONTENT AREAS Hospital Overview Model Cells General Hospital Policies and Practices with Regard to Lean Central Improvement Team Daily Management System Tools and Methods Finance Human Resources Information Technology Lean Training and Staffing Hospital Performance 6

7 LEAN ACTION RESEARCH LEARNING COLLABORATIVE Purpose To work with 8 to 10 hospitals/health systems to accelerate the impact of lean on creating greater value for their patients through research that provides actionable knowledge Three to five years at $50k per year LEAN ACTION RESEARCH LEARNING COLLABORATIVE Value proposition If lean is working in your health care organization, do you understand why? If it isn t, do you understand how to diagnose the problem? Research results generated by the Lean Action Research Learning Collaborative will enable you to answer these questions. The Collaborative s research will assess the extent of lean implementation in participating health care organizations, identify lean interventions that improve their performance, and identify ways to improve existing lean interventions that are underperforming. In this unique collaboration among hospitals, health systems, and academic researchers, special attention will be paid to identifying breakthrough innovations to enable health care organizations to get performance improvement results faster and with greater impact. With the Collaborative s lean research in hand, you will be able to make lean implementation recommendations with confidence to your clinicians, management team, and board of directors. 7

8 ORGANIZATIONS COMMITTED TO DATE Carolinas HealthCare System (Charlotte, NC) Indiana University Health System (Indianapolis, IN) Lancaster General Hospital (Lancaster, PA) Sutter Health (northern CA) Zuckerberg San Francisco General Hospital (San Francisco, CA) SOME EXAMPLES OF TOPICS/QUESTIONS TO BE ADDRESSED Do organizations that are further along in implementing lean have better quality, patient satisfaction and cost outcomes? What types/approaches to leadership development are most effective in launching lean transformation for given organizations? What criteria should be used in the selection of model cells for beginning improvement work? How might early successes be more quickly spread to other parts of the organizations? Do organizations that apply lean leadership practices and methods have more or less burnout of clinicians, managers, and other staff? What are effective methods for sustaining lean initiatives over time? 8

9 ON OUR WEBSITE Annotated bibliography Past presentations Highlights of key articles, think pieces, and case studies Upcoming events WHAT WE WILL WORK TO PROVIDE More rigorous evaluation designs to rule out alternative explanation for study results Experimental and quasi-experimental Measures relevant to the intervention Detailed description of the intervention Thorough examination of contextual effects Assessments of sustainability over time longitudinal study designs Studies of spread diffusion to other units, other organizations will require effective partnerships between lean organizations and researchers 9

10 THANK YOU! Stephen Shortell, PhD, MPH, MBA Thomas Rundall, PhD Janet Blodgett, MSc /CLEARberkeley 10