My IT team had never taken on a challenge like this, but I was confident we would find a way to persevere. It was fortunate that there had been an existing strategic decision by IDN leadership to adopt Lean as a way of doing business. Lean—defined by the Lean Enterprise Institute as “creating more value for customers with fewer resources”—had begun taking root in the network's hospitals, but had not yet reached its corporate support functions. Having no experience with Lean, the IT directors and I were excited to learn and try something new.
IT performance needed improvement. The technology team prided itself on its loyalty, craftsmanship and service, but unfortunately, service quality was variable and customer satisfaction mixed. System outages were not uncommon. Projects ran late. End users complained about technical support and mocked the “helpless desk.” Department processes were immature. IT staff operated in a seat-of-the-pants firefighting mode that produced unpredictable results.
In the past three years, our application of Lean made IT operations better. We improved processes and increased predictability. Electronic health-record implementation, infrastructure replacement and data center migration were completed as promised. Both IDN hospitals achieved Stage 6 on the seven-stage HIMSS EMR Adoption Model scale. Most important, IT delivered solutions that hard-wired excellence and enabled value. IT performance enabled the organization to set internal records for clinical quality measures, double the size of the physician network, open a freestanding emergency center and realize millions in financial benefits.
These results might have been possible without Lean, but using its principles enabled the IT team to achieve much more than what is visible in success metrics. Several managers and I attended Lean IT workshops sponsored by the ThedaCare Center for Healthcare Value, and we were able to share what we learned internally. We taught staff how to distinguish value from waste, investigate root causes of problems and conduct “plan-do-check-act” (PDCA) experiments. We engaged team members in IT process improvement using Value Stream Analysis, Kanban and A3 Thinking. We integrated complementary management frameworks, including Theory of Constraints and Information Technology Infrastructure Library. We instituted a new department operating system based on strategy deployment and a visual daily management system, which helped illuminate and clearly link top-level business goals to IT department goals, and then to team and individual priorities.
Adopting Lean was not easy, especially for IT leaders. It takes time to form new habits, but with practice, we learned. Eventually, when projects became troubled, systems failed or services lapsed, we stopped finger-pointing and reacting with half-baked action plans. Instead, we visited the front lines to gather facts and engage staff in problem-solving and PDCA cycles to eliminate wasted steps and defects, improve outcomes and create value.
Given the scope of change that lies ahead for healthcare organizations, IT departments will need to take tangible steps to improve operations. Past practices are no longer sustainable and certainly don't benefit our organizations. My team's experience is evidence that Lean can be successfully applied to healthcare IT transformation. For CIOs challenged to transform IT operations and create more business value, adopting Lean merits serious consideration.
Robert Slepin is a member of the College of Healthcare Information Management Executives (CHIME) and previously served as a CIO at a Phoenix-area healthcare organization.