ADOPTION AND IMPLEMENTATION OF LEAN PHILOSOPHY, PRACTICES AND TOOLS IN U.S. HOSPITALS CENTER FOR LEAN ENGAGEMENT AND RESEARCH IN HEALTHCARE (CLEAR) SCHOOL OF PUBLIC HEALTH UNIVERSITY OF CALIFORNIA, BERKELEY
INVESTIGATORS Thomas Rundall, PhD Henry J. Kaiser Professor of Organized Health Systems, Emeritus Co-Director, Center for Lean Engagement and Research in Healthcare (CLEAR) Stephen Shortell, PhD, MBA, MPH Blue Cross of California Professor of Health Services Research, Emeritus Co-Director, Center for Lean Engagement and Research in Healthcare (CLEAR) Janet Blodgett, MSc Project Manager and Data Analyst, Center for Lean Engagement and Research in Healthcare (CLEAR)
ACKNOWLEDGEMENTS Research support was provided by: PETER KRALOVEC EXECUTIVE DIRECTOR, AHA HEALTHCARE DATA CENTER Funding for this research was provided by: CATALYSIS THE LEAN ENTERPRISE INSTITUTE RONA CONSULTING GROUP/MOSS ADAMS
DISCLOSURES CLEAR receives funding from Catalysis CLEAR receives funding from The Lean Enterprise Institute CLEAR receives funding from Rona Consulting Group/Moss Adams Dr. Shortell serves on the Catalysis Advisory Board Dr. Rundall serves on the Board of Directors of John Muir Health
STUDY PURPOSE There is growing interest in hospitals application of lean management practices and tools There is no national data on the extent of lean adoption and implementation in hospitals The purpose of this study is to assess the extent to which lean management philosophy, practices and tools have been adopted and implemented in U.S. hospitals
METHODS On-line survey of 4,500 non-federal, short-term, acute-care medical and surgical hospitals in the United States, including pediatric general and medical hospitals Survey was designed to assess dimensions of the adoption and use of lean philosophy, practices, and tools described in relevant books and articles and in consultation with our strategic advisory council members The instrument went through multiple revisions based on feedback from pilot testing with 12 practicing lean performance improvement specialists
METHODS Major topics covered by survey questions Adoption of lean management Extent of current use of lean management Model Cells General hospital policies and practices with respect to lean Central improvement team Daily management system Tools and methods used Finance department Human resources department Information technology department Lean training and staffing Self-reported performance improvements attributable to lean
METHODS USPS letter with the survey s login information was sent April 24, 2017 by the AHA to hospital CEOs with request that an appropriate staff member complete the survey Letter was signed by Dr. Jay Bhatt, CMO of the American Hospital Association and Dr. Stephen Shortell, Professor of Health Policy and Management, UC Berkeley Email reminder communications sent to the CEOs of all nonresponding hospitals on May 15, June 15, July 18 (with a copy to the CMO), and August 1st
METHODS From 6/28 9/8 phone calls were made to the executive and quality department offices of multi-hospital systems asking that they encourage their hospitals to complete the survey; voice mail messages left if no answer All state hospitals associations received a copy of the survey along with the original cover letter, were asked to encourage hospitals to complete survey Hospital leaders in CA, MN, WI, and OH personally contacted the executive offices of hospitals in those states to request completion of the survey
Final date for receipt of completed surveys was September 11, 2017 Respondent sample size = 1222 Response rate = 27%
COMPARISON OF RESPONDING WITH NON-RESPONDING HOSPITALS Hospital characteristic Categories Responding hospitals (n = 1,222) n (%) Non-responding hospitals (n = 3,278) n (%) Type of authority* Public 288 (23.7%) 704 (21.6%) Not-for-profit 830 (68.4%) 1928 (59.2%) Investor-owned 96 (7.9%) 623 (19.1%) System member? Yes 751 (61.5%) 2061 (62.9%) Core-based statistical area type Metro (urban 50,000 people) 699 (57.6%) 1916 (58.9%) Micro (urban 10,000-50,000 people) 208 (17.1%) 553 (17.0%) Rural 307 (25.3%) 786 (24.1%) Medical school affiliation?* Yes 391 (32.2%) 837 (25.7%) Member of Council of Teaching Hospitals?* Yes 107 (8.8%) 150 (4.6%) Region* Midwest 317 (26.1%) 724 (22.2%) Northeast 131 (10.8%) 418 (12.8%) South 470 (38.7%) 1528 (46.9%) West 296 (24.4%) 585 (18.0%) Bed size* 1-99 beds 569 (46.9%) 1664 (51.1%) 100-399 beds 481 (39.6%) 1298 (39.9%) 400 or more beds 164 (13.5%) 293 (9.0%) * p <.05 in Pearson's Chi-sqared test
IS YOUR HOSPITAL CURRENTLY ENGAGED IN ANY OF THE FOLLOWING TRANSFORMATIONAL PERFORMANCE IMPROVEMENT APPROACHES?
WHICH, IF ANY, OF THE FOLLOWING TRANSFORMATIONAL PERFORMANCE IMPROVEMENT APPROACHES IS THE PRIMARY APPROACH USED IN YOUR HOSPITAL TO IMPROVE QUALITY, SAFETY, EFFICIENCY, AND PATIENT SATISFACTION?
WHEN DID YOUR HOSPITAL FIRST BEGIN IMPLEMENTING LEAN? N = 778 Mean number of years since implementation: 5.2 Standard Deviation: 3.6 Range: 0-22.5
WHICH OF THE STATEMENTS BELOW BEST DESCRIBES THE APPROACH USED IN YOUR HOSPITAL TO BEGIN LEAN IMPLEMENTATION? Approach N Percent Some elements hospital-wide 296 36.9% Some elements in a small number of departments 326 40.6% Some elements in a single department 48 6.0% Comprehensive DMS hospital-wide 91 11.3% Comprehensive DMS in a small number of departments 29 3.6% Comprehensive DMS in a single department 13 1.6%
DID YOUR HOSPITAL INITIATE ITS USE OF LEAN WITH ONE OR MORE MODEL CELLS? Yes: 542 (66.9%) No: 268 (33.1%)
AT THIS POINT IN TIME, WHICH OF THE STATEMENTS BELOW BEST DESCRIBES YOUR HOSPITAL'S JOURNEY TOWARD OVERALL TRANSFORMATIONAL PERFORMANCE IMPROVEMENT?
WHICH OF THE FOLLOWING HOSPITAL UNITS ARE CURRENTLY USING THE PRINCIPLES AND TOOLS OF LEAN? Of all 29 units presented Mean (SD): 14.2 (7.3) Range: 0-29
HAS YOUR HOSPITAL DEVELOPED A VISION FOR ITS FUTURE THAT IS USED AS THE "TRUE NORTH" FOR ITS LEAN TRANSFORMATION? Yes: 451 (58.6%) No: 319 (41.4%)
GENERAL HOSPITAL POLICIES AND PRACTICES WITH REGARD TO LEAN
DOES YOUR HOSPITAL OR THE SYSTEM TO WHICH YOUR HOSPITAL BELONGS HAVE A CENTRAL IMPROVEMENT TEAM OR EQUIVALENT GROUP? Yes: 581 (75.5%) No: 189 (24.5%)
WHICH OF THE FOLLOWING ACTIVITIES DO LEADERS ROUTINELY DO?
TO WHAT EXTENT HAS YOUR HOSPITAL IMPLEMENTED EACH OF THE FOLLOWING TOOLS AND METHODS?
APPROXIMATELY, WHAT PERCENTAGE OF YOUR HOSPITAL'S STAFF HAVE BEEN TRAINED IN SCIENTIFIC APPROACHES TO PROBLEM SOLVING, SUCH AS THE USE OF PLAN-DO-STUDY-ACT (PDSA) CYCLES?
PLEASE SELECT THE ANSWER CHOICE THAT BEST REPRESENTS YOUR HOSPITAL'S STAFFING RELATED TO PERFORMANCE IMPROVEMENT (PI) Staffing plan N Percent No performance improvement staffing plan has been identified 88 11.9% Initial lean performance improvement staffing requirements have been 40 5.4% identified PI trained staff members are leading A FEW improvement initiatives 263 35.5% PI trained staff members are leading MANY improvement initiatives 232 31.4% PI trained staff members are leading MOST improvement initiatives 117 15.8%
WHAT, IF ANY, PERFORMANCE ACHIEVEMENTS IN YOUR ORGANIZATION CAN BE PRIMARILY ATTRIBUTED TO IMPLEMENTATION OF LEAN? Of 16 achievements presented Mean (SD): 9.0 (4.0) Range: 0-16
NEXT STEPS Adding data on each hospital s performance on processes of care, patient outcomes, and operational efficiency (hospital-wide, ER, and OR) from Hospital Compare, Medicare Cost Report, and AHRQ publicly available data sets Constructing indices of the central improvement team, maturity/comprehensiveness of lean implementation, use of a daily management system, the strength of development of the 4Ps, leadership commitment to lean, lean training and staffing, and other characteristics of lean deployment in hospitals Conducting analyses of the associations among the characteristics of lean deployment and hospital performance Identifying potential strategies to increase the beneficial effects of lean deployment on hospital performance Delivering presentations at conferences and meetings, webinars, and journal articles to relevant audiences
THANK YOU! Stephen Shortell shortell@berkeley.edu Janet Blodgett janet.blodgett@berkeley.edu Thomas Rundall trundall@berkeley.edu