“gemba walk” (lean thinking term) to go to the actual place where value is added + “walkabout” (Australian aborigine) a short period of wandering bush life engaged as an occasional interruption of regular work
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I will be making a presentation at the 37th Annual Operational Excellence Conference at Utah State on September 29. I’ve been procrastinating rehearsal, but thought that by putting my thoughts down here it would be about the same.
The title of my presentation is: “Providing Value in Healthcare: I Can’t Tell You That There is Hope, But I Can Tell You That There’s Hope That There’s Hope”. I don’t recall the source for the subtitle, but it is something that I have referred to personally over the years, and I have used it to give others encouragement as well. I hope that it will provide you some encouragement about the future of providing value in healthcare.
There are 3 Things I’d like to share in the presentation: 1. Why this (value in healthcare) is important - critical, I would say - for everyone (providers, businesses and consumers), 2. My personal reflections on the “pursuit of improvement” over time, And, 3. Why I think there is “hope that there’s hope”.
When I was invited to present at this conference, I was asked to talk about “transporting the principles and tools of lean manufacturing to a healthcare environment”. I intend to discuss that as requested, but I would like to do so in the context of an overall timeline of what I’ve experienced and learned over the years. I believe that teams and tools are necessary for improvement, but they are not sufficient. There are other factors – especially the readiness for true management and cultural transformation that are critical for success. While tracing my personal history and observations for the application of quality improvement principles in healthcare over the last 37 years, I hope to explain why I believe fundamental change (transformation) is critical for not only providers, but for businesses, payers and consumers patients as well. I will also describe how my personal hope for true change has gone up and down over the years, and why I think it is now at the highest point it has ever been. So, I do believe that there’s “hope that there’s hope”.
I’d like to start with the concept of “value” (as defined as quality divided by cost), which might be best explained with the example of “flat screen TVs”. Who has purchased a flat-screen TV in the past few years? Our oldest son just purchased one, so I’ve got some recent data on the subject. What have you noticed about the quality? What have you noticed about the cost? I can recall when flat screen televisions were the latest thing, but also quite expensive. Now, as in my son’s experience, the quality is quite good (if not better than it was in the beginning) and they are affordable and accessible for the young post-graduate student just starting his career.
The relationship between quality, cost and value for flat-screen televisions over time is shown in this next slide. While quality has improved, cost has gone down, and as result – value - has increased.
Now, what can we say about value in healthcare in this country? Has it increased over time? My experience tells me “no”. It is my contention that I have not seen an increase in value in healthcare in the United States and I would venture to say that you have not seen an increase in value either. I’d be interested in your thoughts.
I’d like to explore this with you over the next few minutes and explain why I believe this to be the case. I’d also like to share some examples of what some healthcare leaders are doing to reverse this trend by systematically improving value in their organizations. So, again - I think that there is hope that there’s hope.
I have some data for the denominator of the value equations. The blue-dotted line on this next graph represents the percentage of gross domestic product (GDP) that the U.S. economy has devoted to healthcare expenditures from the mid 1970s to the present. As you can see, costs have steadily increased.
I have not yet been able to find a readily available metric for the numerator (quality) for the healthcare value equation; otherwise I would have included it on the graph. Now I must admit that for some aspects of care, and some providers we can locate measures (usually process measures) such as those developed through the work of the National Quality Forum and other organizations.
The solid red line on this graph represents an approximation of my “hope” level, which has increased and decreased over the years, much like a “sine wave”. My presentation will include some reflections about cost, quality and value but also “hope”.
My earliest recollection of experiencing the healthcare system was going to see the doctor, which is probably the same that can be said for many of you as well. What I remember the most was reading issues of “Highlights” magazine for kids. I have no idea how long I waited in the designated rooms. It was just the way things were. Waiting was (and still is) built into the healthcare delivery experience. I will venture to guess that you all know this to be true. Clinics and hospitals have various sizes of rooms designated for the waste we call “waiting”. Who are we waiting for? The doctor, or the nurse, or the x-ray tech, or the lab tech – in short – we wait for the provider. The system was and is built around the provider. As it relates to the “value equation” in the 1960s (when I was a kid) the denominator (cost) was a fraction of what it was now, and I don’t recall any discussion about quality. We didn’t question it.
Has anything really changed about the patient’s experience? To help us reflect on this, I would like to offer a quote from Jim Womack & Dan Jones’ book Lean Thinking. “When you visit your doctor you enter a world of queues and disjointed processes. Why? Because your doctor and health care planner think about health care from the standpoint of organization charts, functional expertise, and “efficiency”. Each of the centers of expertise in the health care system – the specialist physician, the single-purpose diagnostic tool - the centralized laboratory – is extremely expensive. Therefore, efficiency demands that it be completely utilized. To get the full utilization, it’s necessary to route you around from specialists, machines, and labs to make sure they are always fully occupied. (And as medical costs spiral, the pressure for full utilization steadily increases. Lines lengthen, often as rationing in disguise). Elaborate computerized information systems are needed to make sure you find your place in the right line and to get your records from a central storage to the point of diagnosis or treatment.” End of quote.
Now I must admit that I have recently witnessed some exceptions of this – some experiments for true change – so, there’s hope and I’ll share some of these examples with you in a few minutes.
Let’s move to the 1970s. My experience of actually working in the healthcare system began in 1974 when I was an orderly in the small Catholic hospital in our town. My mom (a nurse) was my inspiration, and she was really my first beacon of hope that things could be better. To this day I have people tell me that the way she cared for people years ago made such an impact and impression on them. But over time my hope and optimism decreased as I learned that much of her time was spent fighting fires, creating workarounds and being engaged in heroic efforts. The system she worked in did not really support her and her colleagues in a manner so that she and they could take joy in their work. I later learned that she suffered from the actions of what I could only describe as “misfits” who were part of the medical and administrative hierarchy so prevalent in healthcare and other industries. She died much too young, and I think that a major factor was that “she worked herself to death” by working around the system in order to do the best she could for her patients.
In the 1970s, the cost of healthcare continued to rise, but I still do not recall discussion about quality and therefore no numerator to calculate “value”. I think people had faith that the caregivers were doing their best and that the care you received was the best available. We had assurances that clinicians were qualified, following standards of care and there were essentially inspection systems (I recall hearing about the Joint Commission) to make sure quality was high. But I don’t recall discussion of any data about quality. The numerator was still elusive. Were there deaths? Yes. Were some avoidable? I have no doubt. I just don’t’ recall talking about it or hearing about it. Where there errors? Probably, but again, we usually didn’t talk about them. In the rare occasions that we did talk about this, the focus was on the person - “who screwed up”? I believe that we had (and still have) a culture of “blame and shame” in healthcare.
In the late 70s, inspired by my mom and my hope that perhaps I could make a positive impact, I enlisted in the US Navy and became a medical technologist. On some days I was hopeful that I was making a difference (usually when heroic efforts were required or I came up with an ingenious workaround to make the work better). I recall one of my first inklings that the processes were very broken and also that there was really no interest to make them better.
I remember getting up very early to gather blood specimens from patients at the hospital. We took paper bags with us on our rounds and attached the test requisition to the tube of blood with a rubber band. Back at the lab, we emptied our bags to prepare the samples for testing. Sometimes the rubber bands broke. Sometimes they became separated. There were no labels on the tubes themselves (the tubes were labeled back at the lab). Which tube went with which requisition? Uh-oh. What to do? As I recall, we did our best to guess which went with which. I remember telling someone that this was not the way to do it. There had to be a better way. But I quickly learned that I was not there to change things. My job was just to do what I was told.
Was this a phenomenon unique to the Navy or the military? No. I later worked in civilian labs and it was essentially the same. Now, over time we have seen some improvement. When you get your blood drawn now, there will be a label. Usually. But are there still mistakes? My experience tells me “yes”. And what about a willingness to listen to the ideas of the workforce to improve the process? Unfortunately, my experience tells me that openness to suggestions for improvement is not the norm.
This was my first real indication that I had some data to show that the numerator for the value equation (quality) was not as good as I thought it was. And my hope went down as I realized that pointing this out and suggesting improvement was simply not my job.
On to the 80s. The solution (so I thought) was to get into management. That must be where I could make an impact. Now, how to go about doing that? In 1985 I applied to and was accepted into the health administration program at the University of Wisconsin-Madison. In 1985, the % of GDP devoted to healthcare was in the double-digits – 10%. I was still working as a Medical Technologist, and I also landed an internship with the Wisconsin Hospital Association. I was learning a lot. My level of hope was increasing.
Now, if you look closely at my UW diploma, you might notice something odd. The diploma that I was issued came with “Wisconsin” misspelled. Well this was quite embarrassing (and expensive) for the University. They asked me to return it so they could send another, but I declined. I viewed it as a “collectors item” and thought it might come in handy some day (and so it has). It’s also a nice introduction to where I believe some of my real learning occurred during this time period.
One of the professors in the UW statistics department became one of my mentors and he suggested that I come with him to a dinner meeting that was to be followed by a presentation at the Madison Area Quality Improvement Network. The keynote speaker was going to be Dr. W. Edwards Deming and the dinner was in his honor. That night changed everything for me. Over a period of 10 years I had what I would call a “correspondence” relationship with Dr. Deming (this was way before the era of e-mail communication). Dr. Deming usually called me “Mr. Stoecklein”, or sometimes as “Mike” as you can see from this letter where we are discussing yet another publishing defect in a book on “quality”.
Dr. Deming even corresponded with my son (Jerry) who was 10 at the time. I had recently explained Dr. Deming’s lessons of the “red beads” to Jerry and some of his friends in 4th grade and Jerry and I had co-published a paper on the lessons of the red beads and hazards of grading. I suggested to Jerry that he write to Dr. Deming to get permission to quote him in the article. Jerry did so and, as you can see, Dr. Deming wrote back and thought the paper was great.
I subsequently learned that Dr. Deming mentioned this in one of the last 4-day seminars he gave prior to his death in 1993. I don’t have a recording of the presentation, but I understand it sounded something like this as he spoke to the audience of executives: “Young Jerry Stoecklein. 10 years old. He understands the lessons of the red beads. Why can’t you?”
I had the good fortune to assist Dr. Deming in four of his 4-day seminars over that 10-year period. I played quite a minor role, but I was fortunate to have some access to Dr. Deming that others did not have. He was a great man, instrumental in what we now know about what has been called “lean thinking”. I would consider him to be a genius. He was always generous with his time and very patient one-on-one.
In the 80s and early 90s, I learned as much as I could from Dr. Deming and others during this time period. The lessons are too numerous to mention, but I will touch on some of the most poignant lessons as I proceed in this presentation.
As you might guess, my hope soared during this time period. I landed my first job as a Vice President and Imagined that all I needed to do was provide copies of Dr. Deming’s latest book (Out of The Crisis at first and later The New Economic) to members of the administrative team I would be working with and we would really make some progress. Of course, it was harder than that and the level of my hope waivered – especially after 1993 when Dr. Deming passed away.
Dr. Deming and other quality professionals appeared to be having an influence on healthcare leaders such as Paul Batalden, Don Berwick, Brent James and many others. In the late 1980s and early 1990s we began to see some evidence that there were indeed problems with the numerator of our healthcare value equation. There were some early experiments, such as the National Demonstration Project on Quality Improvement in Health Care.
The Institute for Healthcare Improvement was organized under the leadership of Dr. Don Berwick, and there appeared to be some hope that there was hope for healthcare redesign. Every December, thousands of people still flock to the IHI Annual Forum to hear the latest on efforts to improve healthcare. I think they go to hear that “there’s hope that there’s hope”. To be honest, that’s one reason I attend as often as I can and still do.
One of my main tasks during this time period was to educate and train leaders in the management philosophy that my employer (a multi-facility, not-for-profit healthcare system) was trying to learn and follow – Dr. Deming’s philosophy. Along with colleagues in a quality support department, I designed and taught a 3-day course combining theory with practice.
I learned about and shared a useful metaphor from Dr. Nida Bakaitis who worked quite closely with Dr. Deming. I later used this “iceburg” diagram in my contribution to a chapter in The Healthcare Quality Book published in 2003. The diagram describes the relationship between principles (theories), systems and tools. Similar to the part of the iceberg that is above the surface, we can see the tools and activities that individuals and teams undertake in order to make improvement. What we can’t see, immediately under the surface are the systems we have in place (sometimes by design, most of the time by happenstance). Deeper still under the surface are the principles (or theories) that drive the systems. What I learned was that most executives did not want to talk or think about theory or principles. Systems were also an elusive concept, but most did (and still do) gravitate toward tools. Teams and tools were very prevalent during the late 1980s and early 1990s - with a focus on measureable results.
I also like to think about this table that came from Dr. Deming’s 1993 book, The New Economics. It points out that while improving processes that have measureable results is important, most of the important work (application by management in the design and redesign of systems) has yet to be tackled – and by and large, has not been addressed by healthcare leaders.
Healthcare spending in 1993 was now at 13.5% of GDP. There certainly were efforts to quantify the numerator – quality but (as I recall) these discussions were bogged done by arguments of how to define quality. Some believed that a common definition was not possible.
By 1995 our corporate improvement support team was “going strong”, primarily driven by the leadership and support from the CEO of our healthcare company. We educated many people (thousands in fact) and applied our improvement methods in multiple applications with some very good results.
This was the era some described as TQM and CQI (although you would dare not use those terms in a conversation with Dr. Deming) and my hope level was high.
But the hope did not last long when in 1999 the CEO of our organization left the organization, and I learned one of the hard lessons of what happens when the driving force behind an improvement effort is no longer there. If there had been a true “transformation of management” the successors to the CEO would have carried on the effort through systems they had put in place. Instead I learned that when an effort is dependent on the will of one (or a few people) and those closest to the CEO do not truly understand or embrace this new style of management, the effort will be labeled as a “failure” and people will simply carry on with their prevailing style of management.
I learned that true transformation of management is quite rare and much harder to achieve. Personal transformation - commitment (not just support) at the top of an organization is critical for sustained success. Another important lesson – education and training without application to a few strategically targeted areas is essentially “inventory” or pure waste – as wasteful as the waste in the waiting rooms. The next “shiny object” that management chased was “re-engineering” and then “benchmarking” (which involved breaking down the organization into parts and comparing the productivity performance to the parts of other similar organizations). In my experience, neither of these approaches has led to sustained improvement in value. I began to believe that in order to break free from the gravitational force of the prevailing style of management requires: commitment at the top of the organization (the CEO), sustained effort, and is really very, very, very rare.
Squirrel!!!!
For those of you who have seen the move “Up”, you may understand my reference and why I mention it here regarding management’s distractibility due to the “next shiny object”.
For those who did not see the movie, let me take a few minutes to explain. In the movie, a pack of dogs are attempting to get from point “A” to point “B”. Occasionally, they are taken off of their course by the apparent sighting of a squirrel.
In the movie, it’s funny. In real life, it’s tragic and wasteful. My hope level diminished with every “squirrel sighting” or promise of the “next shiny object”.
I found our company reverting back to (or having never really left) the prevailing style of management. I also found the prevailing practice to be the opposite style of management that I was still teaching and advising others to follow as summarized in this slide highlighting what “transformation of management” looks like. On the left side we see some of the characteristics of what Dr. Deming called “the prevailing style of management” (where skills only are required, short-term thinking and focus is prevalent, executives manage the organization as if it were additive – like a bowling team, and arbitrary numerical targets are prevalent).
In the right-hand column we can see what Dr. Deming proposed to be “better practice” (he disdained the term “best practice”). He saw these as natural outcomes of an understanding of what he called “a system of profound knowledge”.
I’d have to admit that at this time, my hope level was at an all-time low.
In the early 2000s, I found myself with a new position and some new hope when I joined the American Society for Quality as the healthcare market development manager. My charge was to help ASQ play a meaningful role in healthcare quality improvement. I did this through networking with leaders such as doctors Don Berwick, Martin Merry, John Toussaint and others.
“Six Sigma” was the latest approach for improvement, which had shown some apparent results and promise in other industries, and there was a lot of excitement, activity (and hope) around this approach in healthcare. Time and dollars were spent on more education and training and the creation of new jobs - black belts they were called – I have one myself.
While my hope level initially increased, I soon realized that this too had the risk of lack of sustainment. It might turn out to be the latest in the series of “shiny objects” (or squirrel) that healthcare leadership viewed as the panacea to their problems.
This was also the first time when we seemed to have access to some real data about what the measure of quality really was in the United States – and it appeared to be quite shockingly low. The institute of medicine reports (To Error Is Human, and then The Quality Chasm), revealed the components of quality (safety, timeliness, effectiveness, efficiency, equity and patient-centeredness) to be not just a little off, but substantially off the mark. Compared to where we could and should be our quality was quite low. As costs had increased over time, our quality was either stable (at a low level) or decreasing, and therefore “value” in healthcare was decreasing over time. During this time, healthcare spending was now at 14.5%. Our value level appeared to be decreasing over time.
During this time period, I started to hear about the term “lean”. I read The Machine That Changed the World by Womack and Jones, and came to understand that while U.S. industry had been chasing various short-term fixes (primarily tools focused) over the years, companies like Toyota had listened to and taken action on the advice from Dr. Deming and others by creating and embedding a management philosophy that was steadily, over time, producing better value for the customer.
From my brief experience with Dr. Deming and studying his career, I knew this to be true. He and other quality leaders could not find a receptive audience in the United States, so they had to look elsewhere. And they did.
In 2003 I received a call from a colleague with who I had worked in the mid 1990s regarding an opportunity that might just be a part of an effort that would be different than what I had experienced in the past. Perhaps this would be an opportunity to truly break free of the gravity of the prevailing style of management and lead to true, sustained improvement in value?
While my time at ASQ had laid the foundation for this organization to make some impact in the healthcare improvement arena, I felt that perhaps my time and effort would produced greater results working “closer to the action” (where the value is actually created). Perhaps this would be the “rocket” that would actually “lift off”? Perhaps this was not another squirrel. Healthcare spending was now at 15.5%
7 years later, in 2009 healthcare spending was now at 17.6%.
Although I could look back at the positive impact I was making in a few organizations I was working with and in a few instances, sustainment was still at risk and I was concerned about how the prevailing style of management continued to dominate the day and the agenda.
I found some helpful perspective for what I was experiencing in the writings of Bob Emiliani, the author of a number books, including the series Real Lean. I came to realize that I had (unknowingly) become what Bob calls a “Bedaux” consultant – falling into the trap of the narrow focus of saving money.
I was particularly struck by this quote from Emiliani realizing that the challenge goes back for decades: “Most top management since the 1890s seem quite content to face a crisis, fix it, face another crisis, fix it, and so on. This implies there is virtually no interest among executives for fundamental changes in management practice”. End of quote.
Well . This was depressing.
Realizing I probably had one more chance to make an impact in healthcare; I reconnected with Dr. John Toussaint whom I had met in the early 2000s while at ASQ.
As CEO at Thedacare in Appleton, Wisconsin, John led the effort to introduce the serious application of lean thinking. This story is well described in his book, On The Mend. Dr. Toussaint told me he was interested in working with the top 1% of the organizations in North America. He was forming a new organization in collaboration with the Lean Enterprise Institute and I am fortunate to now be working as the Director of Network Operations at the Thedacare Center for Healthcare Value.
The Center has three primary and interrelated goals as listed on this slide:
1) first, we are working to make healthcare results (cost and quality) more transparent,
2) second, we are working to support the redesign of the care delivery system to produce less waste and fewer errors,
and 3) thirdly, we are working to change the payment systems to reward providing value (rather than volume).
The 3 goals are interdependent, and achieving all three goals will be necessary, as I will explain in the next few slides.
To support the collaborative learning and sharing regarding redesign of healthcare delivery using lean methods, a series of peer-to-peer learning networks has been established. This slide shows the locations of the current membership in the Healthcare Value Network. This is less than 1% of the total possible healthcare providers in the United States and Canada. Dr. Toussaint’s estimate was about right.
Here’s another view of those same organizations. As you can see, our network represents community hospitals, academic medical centers, multi-specialty clinics, systems and independent health care providers.
Does lean work in healthcare? The answer is “yes”. We have multiple examples of the simultaneous improvement of quality and reduction of cost.
This slide shows just a few of these examples. So, yes … lean (real lean) does work in healthcare. In my mind, there is no debate about that.
You may notice that I make the distinction of “real lean” as described by Bob Emiliani. There are many organizations that have applied the tools of lean – “fake lean”.
Applying tools alone is not what I’m talking about. Real Lean is the non-zero-sum (win-win) management philosophy that includes both respect for people and continuous improvement. It is (in my opinion) the same philosophy espoused by Dr. Deming and others, and it is (unfortunately) rare.
This slide and the next slide provide evidence that Improved quality and reduced cost has been achieved from the Collaborative Care efforts at Thedacare in Appleton, Wisconsin. This innovative model of care is well-explained in the book “On the Mend” as previously cited.
As you can see, there has been a substantial improvement in quality (defect-free admission reconciliation), improved customer satisfaction (68% to 95% very satisfied), reduced length of stay, 30-day readmission and lower total cost.
But here’s the “kicker”. This slide (below) shows that (under the current reimbursement method), Thedacare loses money by improving patient care and lower the cost of care. In other words, Thedacare(and other providers) makes a better margin by providing lower quality and higher cost care. This can be a significant disincentive to continue to apply lean thinking and can also deter other healthcare organizations (the other 99%) from adopting lean thinking and methods.
This brings me back to the point that the simultaneous achievement of all 3 goals: redesign of healthcare delivery, transparency of healthcare performance and aligned payment systems will be required.
This slide shows that everyone will have a role to play in the effort.
Providers will need to identify and remove waste from their systems and work toward improving value to their patients. Patients need to become critical consumers of healthcare and take responsibility for their own health. Insurers and Employers will need to develop and publically provide accurate quality and cost data, and reward providers for value – not volume.
Efforts are underway to make quality and cost data more transparent. The slide shows real data for real physicians who are overseeing the care for real patients with diabetes in Wisconsin. Quality data are on the x-axis (horizontal), cost data on the y-axis. The size of each dot represents the number of patients under the care of each physician. When you view the data in this manner, it can become clearer the variation in value that is being provided.
Making this data available to providers to show them where they are in providing value is the first step. Sharing the data with payers and patients is the 2nd step.
Why would a provider continue to provide high cost or low quality care? Why would a patient or payer continue to pay for high cost and low quality care? This slide codes the physician identity, the actual reports show the physician’s names.
I have heard some argue that there are two types of data: 1) data for improvement, and 2) data for judging. And we need to be careful about the misuse of this data. While that may be true, I believe this represents a 3rd category – data for consumption.
This kind of comparative data is already being use by some companies. We can learn a lot from CEOs such as John Torinus at Serigraph (also in Wisconsin) who wrote the book The Company That Solved Healthcare. In this book, Mr. Torinus describes how they have reversed the trend for healthcare costs, and involved their employees to make care decisions based on better value. Serigraph’s leadership works with employees to help them become better consumers by providing price and quality data on doctors, hospitals and prescription drugs so they can take responsibility for their own health, and by creating benefit incentives that encourage the right behaviors.
The results have been striking and significant. The increase in medical costs for Serigraph and it’s workers have been held to 2.8% per year, far below the national average of 7%.
Mr. Torinus’ book describes the three primary strategies that Serigraph used:
1) consumer responsibility – companies using “consumer-driven” health plans have enjoyed savings of 20-40% - employees have their own “skin in the game”
2) centers of value – help employees find the best providers – service, quality, cost
3) prime role for primary care – doctors, nurse practitioners, nurses on-site
So, there is reason for hope. This slide shows Part A & B expenditures per recipient. If we extrapolate this data to national numbers, it is conceivable that there would be an estimated savings of $57 billion per year in the United States if care were provided at the low-cost (and high quality) levels seen in La Crosse and Outagamie counties. As a side note, two of the founding members of the Healthcare Value Network – Gundersen Lutheran and Thedacare – are in these two counties.
If we use the Institute for Healthcare Improvement’s estimates that 30-50% of what is currently done in providing care is waste (providing no value to the patient), there is a potential of 750 billion dollars of savings. So, what’s at stake is substantial – between 57 and 750 billion dollars per year.
I believe that making the changes required to provide increased value in healthcare won’t be easy, and I think that everyone will not be up to the challenge. The level of transformation required is substantial. Healthcare leaders who choose to purse real lean will find themselves moving from the prevailing style of management (white coat style) as described in the left-hand column, to a radically different style in the right-hand column. Anyone who has heard Dr. Toussaint speak will be familiar with this viewpoint. He is the originator, and we use this in our discussion with members of the Healthcare Value Network.
This list is very similar to the current state and better practice list provided by Dr. Deming as previously shown.
Before I close, I’d like to provide you with an example of what (I think) this better practice looks like. I’d like to share a 6- minute section of a video clip from a visit to one of our Healthcare Value Network members in Apple Valley, California. This video shows Dr. David O’Brien, Chief Operating Officer at St. Mary Medical Center leading a morning huddle meeting with other leaders at St. Mary’s. This meeting occurs every morning at 9:30 am. It is the final is a “cascade” of huddle meetings at various parts in the organization. Prior to this meeting, each leader has had at least one huddle meeting with their staff and the information they gathered at that meeting is summarized for the 9:30 meeting. The purpose of the meeting is to understand what has happened in the last 24 hours, and what must be done in the next 24 hours. If I went back to St. Mary Medical Center tomorrow, I can guarantee you that I would see this huddle. Only it would be better. This leadership group believes in continual improvement.
There are 3 messages that I wanted to convey in this presentation: 1) why this is important for everyone (and everyone has a role to make things better), 2) my personal reflections on pursuit of healthcare improvement over time, and 3) why I still think there is “hope that there’s hope”. My hope level is high and I am optimistic that we’ll achieve all 3 of our goals. It’s an exciting effort to be connected with, and I am truly fortunate to be able to help people to learn, share and connect. I think we’ll see our 1% number grow over the next few years. If there is time, I’d be happy to answer any questions. You have my contact information should you wish to connect after the conference. Thanks again for the opportunity to speak with you today.
PLAY THE CLIP
