Spectrum hosts ‘Gemba’ visit for health care leaders


Katelin Aris, associate process improvement engineer, explains the rapid assessment zone at Spectrum Butterworth. Photo by Rachel Weick

Representatives from national health care organizations were given a tour to see how manufacturing techniques are being implemented at a Grand Rapids-based health system.

Spectrum Health hosted a Healthcare Value Network Gemba visit June 26-27 at four sites throughout the system to see lean principles implemented in its daily processes.

The Healthcare Value Network was created in 2009 by the ThedaCare Center for Healthcare Value and the Lean Enterprise Institute in order to leverage knowledge of lean principles to improve the delivery of health care. According to an Institute of Medicine report “Best Care at Lower Cost,” the organization’s committee estimated the national health care system wasted $750 billion in unnecessary spending in 2009.

Kurt Knoth, vice president of process improvement at Spectrum, said the network’s mission is to improve health care through the application of the Toyota Production System, using lean principles and eliminating inefficiencies.

“We joined this organization about two years ago and really, in the beginning, our journey was to learn from others who have gone before us within the health care industry, and what techniques and lessons learned could we apply to Spectrum Health,” said Knoth. “This time around, other organizations are actually coming to learn from us.”

According to Healthcare Value Network, a Gemba visit, a term derived from the Japanese language, allows members to visit the host organization in a structured learning and interaction environment to learn about strategy deployment, managing standard work, or spreading lean process improvement across an entire system. The theme for the Gemba visit at Spectrum Health focused on the system-wide spread of process improvement and moving from localized implementation of lean principles to an enterprise-wide culture.

A group of representatives from various health care organizations visited the Helen DeVos Children’s Hospital’s Pediatric Specialties, Butterworth Hospital’s Emergency Department and Surgical Services, and the new Integrated Care Campus on East Beltline Avenue.

Some of the organizations participating in the event included Bronson Healthcare, University of Michigan Health System, Michigan Blood, BloodCenter of Wisconsin, Henry Ford Health System, St. Boniface Hospital, Stanford Hospital and Clinics, Ingalls Health System and ThedaCare Center for Healthcare Value.

Jenn Burkett, system director of performance improvement at Henry Ford Health System, said as a philosophy, lean principles are applicable to everything in health care.

“When you can go and see where the work is happening, then it becomes more real and you begin to build personal relationships with people that you can reach out and connect with, and you realize that you are all kind of in the same boat working toward the same thing,” said Burkett. “Really, the way we are going to get health care to where it needs to be lies within those lean principles.”

Some of the results from process improvement in the departments included increased access for patients in the DeVos Children’s Hospital clinics, reduced patient wait in the emergency department, improving patient flow in the post-anesthesia care unit and optimizing the sterilization process of surgical instruments.

Knoth said the operating model in the emergency department was completely altered to create an additional rapid assessment zone. The RAZ functions similar to an urgent care center, where patients are triaged by nurses and then seen by a physician but within a quicker timeframe than an emergency room.

“The analogy that I use is if you go to Meijer and you have a gallon of milk and you want to get in and out, you go to the 12-item-or-less line,” said Knoth. “We didn’t have one of those, so if you came to the emergency department with a splinter in your hand, you were thrown into the same process as someone who had more acute needs. 

“We basically created a fast lane and we call it a RAZ zone.”

He said the health care delivery improvement process also included receiving feedback from the Hospital Consumer Assessment of Healthcare Providers and Systems Hospital survey, four-day focused rapid improvement events with staff, and involving patient perspectives through patient and family advisory councils.

“The centerpiece of this initiative or methodology is always looking at how we do things in the eyes of our customers,” said Knoth. “From a patient’s perspective, this is the right thing to do, but we have also seen from our staff and our physicians that it actually has had a positive impact on morale. We have made a commitment to our staff that nobody is going to lose their job because of any process improvement work that we are doing, and in fact it makes their job and their life easier.”

Burkett said the progress Spectrum Health has made in a short period of time to implement lean principles in the various departments is incredible, and the level of leadership engagement is an instrumental role in the system’s progress.

“It seems pretty obvious that they have placed a great amount of importance on it and they have made a significant difference for the patients, for the staff, and I am sure for their strategic vision, as well,” she said. “They have a goal to become a leader in national health care. I think it has really helped them — perhaps been a critical piece of their journey in achieving their vision and their mission.”

Incorporating lean principles used in the manufacturing industry, Spectrum Health developed the Spectrum Health Performance Improvement System to improve and reduce non-value-added activity, create a teamwork environment and focus on patient satisfaction.

The improvement efforts and reduction of non-value-added activities has resulted in more than $2.1 million savings for the 2014 fiscal year, according to Spectrum.

ThedaCare Center for Healthcare Value, founded in 2008, is an education-based institute located in Wisconsin. The Lean Enterprise Institute provides methods for organizations to implement lean thinking models. Founded in 1997, the nonprofit organization is located in Massachusetts.

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