Hawkeye Business Solutions

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Lean and Six Sigma Are Transforming Healthcare

Maybe you’ve heard of Lean.  It’s the name we give the philosophies, tools, and systems originally developed by Toyota to build highly reliable and consistent cars.  Lean isn’t just for cars, though.  It’s been adopted by thousands of companies worldwide and is a proven catalyst for improving quality, reducing costs, and boosting employee morale.  It’s sister discipline, Six Sigma, developed at Motorola in the 1980s and popularized at General Electric in the 1990s, leverages statistical tools to understand and improve business processes.  Together, Lean and Six Sigma (typically called “Lean Six Sigma”) have proven to be a powerful driving force for improvement in healthcare.

In his book “Lean Hospitals,” author Mark Graban quotes a senior leader at a prestigious university hospital as lamenting, “we have world-class doctors, world-class treatment, and completely broken processes.”  That senior leader is not alone.  Hospital leaders across America struggle every day with operational challenges like adjusting staffing to varying volumes, finding equipment and supplies when needed, and even starting surgical cases on time.  Moreover, hospital administrators are challenged to improve both employee engagement and patient satisfaction in this very challenging environment.  Practically none of those challenges are caused by bad or uncaring people, though.  Instead, the root cause is almost always ineffective or wasteful processes that sap employee energy and deliver sub-par experiences for patients.  Lean Six Sigma can change that.

Lean is primarily focused on eliminating waste.  That is to say, it aims to get rid of things that take employee time and energy, but don’t add value to patients.  It offers not just tools to find and eliminate waste, but a philosophy that respects and empowers the people who care for patients.

Six Sigma is primarily focused on reducing variability.  That is to say, it aims to deliver consistent, repeatable, and reliable results within certain statistical limits.  It offers powerful statistical tools that get beyond simple graphs and intuition to quantify what kind of results processes are really capable of producing.

Together, Lean Six Sigma combines the insights of front-line staff members, the voice of the customer, and rigorous statistical analysis to deliver consistent patient experiences with efficient processes performed by engaged employees.  And that’s not just hyperbole.  ThedaCare in Appleton, Wisconsin and Virginia Mason in Seattle, Washington have been practicing Lean Six Sigma for more than a decade and can cite innumerable improvements.  For instance, Virginia Mason credits their Lean-based VPMS (Virginia Mason Production System) with increasing the amount of time nurses spend in direct patient care from 35% to 90%.  Hospitals across the country are adopting Lean Six Sigma and seeing results from reduced patient walk-outs in the Emergency Room to improved lab result turnaround times to shorter response times for patient transports with no additional staff required.

As simple as it may sound, one of the most powerful and important Lean concepts is: Respect for People.  Hawkeye Business Solutions was founded on a core belief in the power of people.  We take the time to listen to the people who do the work.  No one knows the real way your hospital runs better than your employees.  And while we’d like to say we have all the answers, the reality is your employees often already know how to fix many of your biggest problems.  They’re just not engaged enough to tell you.  At Hawkeye, we use a Lean Six Sigma process known as a Rapid Improvement Event (RIE) to reengage staff and develop solutions that unlock the power and creativity of your workforce.  We spend time in the “gemba,” the place where work is done, and involve those who do the work in designing, testing, and implementing solutions in a rapid, iterative learning environment.  You might be surprised; a day on the work floor might provide more fresh ideas than ten days in a conference room.

If you want to learn more about how Hawkeye Business Solutions uses Lean Six Sigma in its engagements, please contact us at 540.232.9920 or info@hawkeyebusinesssolutions.com.  We’re excited to help you discover the innovativeness of your employees and reach your organization’s potential.

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Achieving Excellence in Healthcare Using Baldrige

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Healthcare leaders have been hearing a lot about the Malcolm Baldrige National Quality Award over the last fifteen years, and for good reason.  Baldrige has become an increasingly common framework used by top performing hospitals, and has become one of the dominant industries represented in the national annual quality award competition administered by the U.S. Department of Commerce’s National Institute of Standards and Technology (NIST).  On May 16, NIST announced that 34 businesses across 5 business sectors are vying for the prestigious award in 2016.  Of those, a whopping 62% (21 of the 34) were healthcare organizations (16 of 26 applicants were in healthcare in 2015, also 62%).  Every year since 2002, there have been at least 10 healthcare applicants and at least one healthcare Baldrige Award winner.

Hospital leaders not currently using the Baldrige framework often worry that adopting Baldrige means jettisoning their current strategic plan, performance improvement methodology, and/or balanced scorecard.  In fact, none of these is the case.  Baldrige provides a framework within which to structure and align strategies, methodologies, and measurement, not a replacement for them.  The Baldrige criteria don’t specify how to operate your business; they encourage you to define and evaluate your business within an internationally-recognized and proven framework.  According to NIST, the Baldrige Excellence Framework “helps you evaluate performance, assess where improvements or innovation are most needed, and get results.”

The Baldrige framework is composed of seven parts within a 1,000-point structure:

  1. Leadership (120 points)
  2. Strategy (85 points)
  3. Customers (85 points)
  4. Measurement, Analysis, and Knowledge Management (90 points)
  5. Workforce (85 points)
  6. Operations (85 points)
  7. Results (450 points)

For healthcare leaders, the first thing to notice about the structure is its focus primarily on results and secondarily on leadership.  Today’s leaders know that in this fast-paced and ever-changing healthcare landscape, nothing is more important than achieving results.  Our communities and our stakeholders demand and deserve great healthcare outcomes.  Baldrige places nearly half of the framework’s focus on achieving and maintaining superior results.  And, of the six remaining framework areas, notice what plays the biggest role in achieving results: leadership.  Baldrige focuses on important leadership factors like vision, values, and mission; communication and organizational performance; governance; and legal and ethical behavior.

A common question among leaders new to Baldrige is: Is it really an accurate gauge of performance excellence?  The answer is overwhelming “yes.”  A 2011 Thomson Reuters study compared Baldrige hospitals (award winners and applicants receiving site visits) to 100 Top Hospitals award winners and found:

  • Baldrige award recipients are significantly more likely to win a 100 Top Hospitals national award.
  • Baldrige hospitals were significantly more likely to display a faster pace of performance improvement over a five-year period.
  • Baldrige hospitals were 83% more likely to win a 100 Top Hospitals national award for excellence in balanced organization-wide performance.
  • Baldrige hospitals outperformed non-Baldrige hospitals in practically all individual performance measures used in the 100 Top Hospitals composite score.

Finally, healthcare leaders are often concerned that Baldrige won’t fit with other performance improvement initiatives like achieving Magnet status, maintaining accreditation with The Joint Commission, or participating in Institute for Healthcare Improvement (IHI) initiatives.  The good news is that Baldrige’s non-prescriptive approach is 100% compatible and congruent with these approaches.  The Baldrige framework allows leaders to organize and integrate multiple approaches to improve patient outcomes and achieve and sustain performance excellence.

If your organization is looking for a proven way to guide operations, improve performance, and achieve sustainable results, consider integrating the Baldrige framework into your organization’s DNA.  According to Eric Fletcher, Senior Vice President of Strategy, Marketing, and Business Development for Mary Washington Healthcare and an Alumni Baldrige Examiner, “One of the undersold benefits of the use of the Baldrige framework is its impact on organizational alignment and integration.  Devoted use of the framework leads to the tearing down of silos, and a true harmony among the processes and systems which propel an organization forward.  It’s not an easy journey, but world-class results await those who successfully implement the framework.”

If you need a little help starting your Baldrige journey, try beginning with some of the great (and free) resources offered by NIST at www.nist.gov/baldrige.  In particular, if you’d like to learn more about the criteria and how it improves organizational performance, a great place to start is Baldrige 20/20: An Executive’s Guide to the Criteria for Performance Excellence (available for free download at http://www.nist.gov/baldrige/publications/baldrige_20_20.cfm).  If you think you’re ready to take a crack at assessing where your organization stands today using a simplified version of the Baldrige framework, try the quick and easy Are We Making Progress? tool (available for free download at http://www.nist.gov/baldrige/publications/progress.cfm).  And, when you’re ready to progress in your performance excellence journey and don’t want to go it alone, contact Hawkeye Business Solutions at 540.232.9920 or info@hawkeyebusinesssolutions.com and we’ll help you jump-start your efforts.

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Why Everyone Else’s Grade Matters As Much As Yours

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So, we can be a little geeky here at Hawkeye.  And while the topic of percentiles sounds pretty dry, it’s actually something everyone in business should know a little bit about.  And we promise, we’ll make it easy and fun to understand.  By the way, we’re just impressed that you clicked on a post about percentiles!  That might mean your inner geek needs some attention.

While we do love a good statistics lesson, we’ll forgo an in-depth discussion of percentiles here.  Let’s just say that they’re a quick and easy way of understanding where you rank against everyone else.  Percentiles are based on a one-hundred point scale and tell you what percentage of other businesses rank below you.  So, if a report tells you that your client satisfaction is in the 80th percentile, that means that you scored better than 80% of all organizations on that same measure.  If that same report said your client satisfaction is in the 10th percentile, that would mean that you only did better than 10% of other organizations.

As anyone who ever took a class that was graded on a curve knows, your score on a test matters, but so does everyone else’s.  So, if you got a 50 on that Statistics test, but everyone else got 20s, 30s, and 40s, you might still snag an “A” for the course.  In that case, if you had the high score at 50, you’d be at the 100th percentile.  In other words, you scored better than 100% of the class.

So, what does all this have to do with business? Actually, a lot.  One important application is in customer and employee satisfaction.  If you average 9.0 on a 10 point scale in customer satisfaction, you’d probably be pretty proud.  But, what if that 9.0 equates to the 25th percentile?  Yikes!  You’d only be doing better than 25% of other businesses; 75% of other businesses are scoring better than 9.0.  What looked like a great score suddenly looks a little different.  The opposite can be true too.  Imagine a survey in which you get a low score, let’s say 5.0 out of 10, but a high percentile.  A great example of that might be an employee survey on satisfaction with pay.  A score of 5.0 could still be in the 90th percentile if no one is elated about their pay (and who every says that they’re paid enough?).

Understanding both your score and where you rank against others is not only important to your improvement efforts, but it might also be critical to your bottom line.  For hospitals, percentile rankings are already used to help determine reimbursement levels for payments from Medicare. And guess what happened within two years of implementation of that program?  It drove performance to near perfection on many measures.  In other words, anything less than perfect drops to the bottom of the percentile rankings.  So, you can get a 99 on the test, but if everyone else got a 100, you might still get an “F.”

Leaders need to know not only how their own business is doing, but also where that performance stands against others.  Neither piece of information stands alone.  You need both to truly understand your business.  So, if you’re ready to decipher all that data from your last employee or customer survey and use it to make some real meaningful improvements, contact Hawkeye Business Solutions at 540.232.9920 or info@hawkeyebusinesssolutions.com.

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Unlock Solutions Through Respect for People

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Maybe you’ve heard of Lean.  It’s the name we give the philosophies, tools, and systems originally developed by Toyota to build highly reliable and consistent cars.  Lean isn’t just for cars, though. It’s been adopted by thousands of companies in dozens of industries worldwide and is a proven catalyst for improving quality, reducing costs, and boosting employee morale.

One of things we at Hawkeye love about Lean is its core focus on a very important concept: Respect for People.

No one knows the real way your company runs better than your employees.  And while we’d like to say we have all the answers, the reality is your employees often already know how to fix your biggest business problems.  They’re just not engaged enough to tell you.  Lean’s focus on going to the “gemba,” the place where work is done, and involving those who do the work in developing solutions unlocks the power and creativity of your workforce.  You might be surprised.  A day on the work floor might provide more fresh ideas than ten days in a conference room.

If you want to learn more about Lean and how it can help jumpstart your business and engage your team, contact Hawkeye Business Solutions at 540.232.9920 or info@hawkeyebusinesssolutions.com.

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Means to An End: Keeping Your Mission in Sight

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There are moments that remind you what’s really important.  We at Hawkeye had just such a moment this week.

While at a meeting with a large regional healthcare provider, a respected leader in the organization was discussing the challenges they had faced over the last several years in adapting their organization to changes in the external environment.  Those external changes have meant this organization had to make more than $30 million in changes to its cost structures annually just to keep pace with declining reimbursements.  The leader noted that at times in their journey, it felt like the focus was on their finances.  If they could just reach their financial goals, they could consider themselves successful.

What she said next was powerful: “We had to stop and remind ourselves that money is just a means to an end.  Our mission is to serve the healthcare needs of our community.  There’s no doubt we need a healthy margin to do that, but the margin isn’t the end, it’s the means to the end.”

While some businesses do exist solely to make money, we bet your business has a higher purpose, too.  We should never lose sight of that purpose and the lives we touch in fulfilling the missions of our business.  It’s not impossible: we can make money and enrich the lives of our customers and employees.  Sometimes, you just need some perspective on which is the real goal of your company.

If you want to work a partner who understands that your business is more than just a profit and loss statement and who can help your business fulfill its mission and improve its profits, contact Hawkeye Business Solutions at 540.232.9920 or info@hawkeyebusinesssolutions.com.