Presence Health rethinks its Lean initiative

Just six months after taking over the head office at Presence Health system, CEO Michael Englehart is rethinking being "Lean."

The Chicago-based system's 11 hospitals had been practicing a manufacturing industry management style known as Lean. The goal was to address challenges to delivering high-value care.

Former CEO Sandra Bruce brought the concept in 2012. Bruce retired last fall.

A Presence Health spokesperson said in an e-mail that it "is in an ongoing process to position all system hospitals for long-term growth and viability." Upon evaluation of the Lean program, "we saw ways to enhance it and align it in a more focused way to serve our patient and business needs."

The changes include combining key strategic teams to improve productivity and reduce costs.

Sources close to the situation tell Modern Healthcare that new leadership was "not a fan of Lean" and that the program has been disbanded.

The nation's healthcare facilities are scrambling to improve quality and boost efficiency amid increasing calls for industry transparency. Over the past decade, a number of hospital leaders have turned to concepts such as Lean quality improvement and Six Sigma, which seek to standardize and improve processes.

However, it's not uncommon for the programs to be dropped because of the amount of staff and time it takes to make them work. Last year, Modern Healthcare attended a weeklong “breakthrough improvement event” at Presence Health. About a dozen operating room staffers were pulled away from their jobs to figure out how to shorten the length of time it takes to turn over a surgical suite.

The staffers were able to drop turnover time from an average of more than 30 minutes to less than 25. The system estimated that reducing those turnover times by 6.5 minutes had the potential to increase revenue by $600,000 over the course of a year.

A Presence Health spokesperson did not say whether the system's new direction would still include those weeklong breakthrough events.

Experts in process improvement say it is often difficult to get leadership to commit to such programs, which rely upon engaging lower status, front-line staff in problem-solving. Already the industry struggles with creating a culture where employees feel empowered to flag mistakes and speak up.

Mark Graban, a Dallas-based consultant and author of several books on Lean, said it is not uncommon for hospitals to drop Lean when a new CEO steps in. Englehart, former president of Advocate Physician Partners, joined Presence Health in October.

Cost-cutting is often a major reason for ditching a program. “It's a catch-22,” Graban said. The cost of investing a week's worth of an employee's time in fixing problems may be offset by the money saved by improving efficiency, quality and having a more satisfied staff.

Leadership arrogance, he said, is often another factor.

“People think that through the force of their personality or financial wizardry that they are going to be able to fix a hospital without engaging employees in the improvement,” he said.


Sabriya Rice

Sabriya Rice reports on quality of care and patient-safety issues. Rice previously wrote and produced for the medical unit of CNN, where she contributed to the Empowered Patient column and the weekly medical program formerly called “Housecall with Dr. Sanjay Gupta.” She earned a bachelor's degree in film and television from the University of Notre Dame and a master's in communication studies from the University of Miami in Coral Gables, Fla. She joined Modern Healthcare in 2014.

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