by Shannon Stewart
Project Lead, Lean Strategies, New Hanover Regional Medical Center

Going Lean can be a challenge. After all, it’s a leadership and performance improvement style that may not easily fit within every organization’s management philosophy. Across the country, 75% of all health care providers have tried the Lean method and struggled with it. But there are success stories, most recently by leadership at New Hanover Regional Medical Center (NHRMC) in Wilmington, N.C.

Prior to NHRMC’s CEO John Gizdic, strategy was deployed in a top-down fashion, controlled and dictated by the senior team members. This style of leadership was successful—NHMRC had become financially stable, known for its quality delivery of health services and business was going well. However, organizational achievements began to plateau, looming regulatory changes were mounting and patients began to shop around for health care services. It became apparent that without change in management style, NHRMC would not be responsive or nimble enough to handle the coming changes.

In response, NHRMC created a strategic plan to support its new mission statement of “leading our community to outstanding health.” To ensure the successful deployment of this new direction, Gizdic understood as the CEO that “... we needed to deploy our strategic plan in a new way – a way that would embrace our Lean principles and be more consistent with the culture we are trying to create. By engaging more leaders throughout the organization … having them create teams representing our entire health system, I believe we will generate more and better ideas and create a sense of ownership around the strategic plan like never before.” 

On the Lean journey for more than seven years, NHRMC has used those principles to move from a traditional top-down style of strategic deployment to one that involves all levels of leaders and frontline team members.

By applying the Lean approach, NHRMC senior team members were able to make major strides on the strategic initiatives they developed for process improvement. In just three short months, NHMRC had more than 400 leaders working on and managing the deployment of the organization’s five-year strategic plan. More than 2,000 hours of vice president time was reallocated to the operations of NHRMC. The organizational strategy became “everybody’s strategy,” from frontline staff to patients and customers.

Plan Do Study Act

Applying the Lean principles of Plan Do Study Act (PDSA), senior team members began creating problem-solving approaches for each of the strategic pillars: access, health equity and value, to decide what initiatives would be needed to successfully bring the organization forward into the next decade.

The next step was one of the hardest. Senior team members realized that they needed to assume the role of coach, stepping back to delegate strategic thinking to the mid-level leaders. To do this, the senior team selected several candidates, identified as a possible strategic process owner. Senior team members then vetted all candidates, and owners were assigned to each initiative. This “process owner” would be the single point of truth on the implementation, progress and performance of the initiative. The deployment of the strategic plan was now in the hands of 39 knowledgeable owners but far from “experts” in the strategic process.

The next step in the strategic deployment process was how to communicate.Building the structure for communication flow

With so many leaders now involved in the strategic deployment, it was essential to build consistent, reliable and transparent information flow to guide and support the work that was to come. Using visual cues with a structured discussion platform and layered accountability, we set out to accomplish our strategic objectives. Hands-on innovative thinking was encouraged and supported, and predetermined visual cues were quick to identify progress, barriers and looming deadlines.

Using the flow chart above, the team members developed the following communications schedule:

Monthly – senior executives review the strategic Mother A3’s (a problem-solving process used in PDSA) to validate their continued relevance to the strategic plan. They forecast out over a six-12-18-month time frame looking for future events or trends which may adversely affect the current initiatives and coach the process owners to that information.

Weekly – the senior team strategic Mother A3 owners report on the status, health and expected progress to date of their areas.

Monthly – strategic initiative owners update and post their status A3 in the war room.

Monthly – the strategic initiative owners report their team’s progress, efforts and barriers, if any, during an open-to-all-comers tactical meeting.

Quarterly – the initiative owners present a detailed status update which includes:

  • the health of the initiative
  • what the team has learned during the process,
  • next steps to be taken and any future capital or support requests, to the senior team

During this presentation update, senior team members give solutions to barriers, help prioritize capital needs and learn of new or additional deadlines.

Implementing Lean practices can be tough, but by working through each aspect of this managerial style, executives can come up with solutions that will be beneficial for the organization overall. Through our Lean principles of engaging, empowering and supporting our leaders to have an active role in the deployment of our strategic plan, NHMRC has accelerated the pace of change and created a new level of visibility and transparency in our organization.

Our venture into becoming Lean while engaging our staff through organizing huddles and the use of huddle boards was covered in a previous blog. Read more about how the Lean method played a role in our improvement process. If you want to dive deeper into the Lean method, take a look at the Vizient four-part Leading Lean series.

About the author and NHRMC. Shannon Stewart has more than 25 years of health care experience and currently serves as a project lead for the Lean strategies department at NHRMC. On their Lean journey for more than seven years, the Lean strategies department is currently working to ensure that there is understanding and alignment of the organization’s strategic goals from the board of director level to the frontline staff personnel.

Published: November 1, 2018