Based in Salem, Oregon, Salem Health is the premier health care provider for Oregon’s Willamette Valley serving patients in Marion, Polk, Benton, Lincoln and Yamhill counties. Salem Health facilities include the main campus in Salem, Salem Health West Valley in Dallas and seven Salem Health clinics. The not-for-profit organization has provided pioneering medicine since 1896. Salem Health Hospital operates the busiest emergency department in Oregon and is Salem's largest private employer, with approximately 3,900 employees.
Culture Change + Quality Improvements = Lean Transformation
Salem Health’s lean transformation began in 2010. The organization’s leadership team set off on a plan to improve quality.
“Our CEO at the time also knew that making quality changes would require a culture change within the organization,” said Debbie Goodwin, RN, BS, MSN and Kaizen Learning and Development Consultant at Salem Health. “He helped us understand that it’s not just a set of tools that we deploy and use, but a process that leads to culture change. He correctly told the board and leadership team that it would be a long journey.”
So in 2010, Salem Health began its journey using an event-based approach to lean transformation. Goodwin said this effort required a lot of resources in terms of people and time, but yielded small results. After an initial 12-18 month period, the team paused its lean initiative.
“We found a consultant who was able to provide the guidance we needed to ensure both culture change and transformation, then we re-launched our lean transformation effort in the spring of 2012,” said Goodwin.
Creating A Lean Process That Works
Every healthcare delivery system has its unique nuances. In order to create a successful lean transformation that included a culture shift, Salem Health decided to get the entire staff involved.
“Our focus is on quality and quality happens at every level,” said Goodwin. “To transform our culture and implement lean methods that would lead to better quality, we needed to involve everybody.”
Initially, unit leaders were trained so they could deploy and use the fundamentals of lean in their respective departments. Concepts including team huddles, visual management boards, four-step problem solving, and standard work were implemented throughout Salem Health. Goodwin said additional lean education is provided and leaders take part in a monthly two-hour lean cohort session for support and added training.
“Today our strategy is getting front-line employees to use lean methodologies,” said Goodwin. “We trained everyone and offer more in-depth training if individuals wish to take part. We also created a lean leader orientation series for new hires and individuals who are in our leadership development program to ensure lean thinking is used everywhere, by everyone.”
Goodwin said the organization also found it important to combine Salem Health’s Quality and Safety department with its kaizen staff – reporting to the same vice president. “This structure helps us stay focused on our lean transformation and on quality.”
Using lean problem solving methodology, Salem Health has improved hand hygiene compliance and decreased healthcare acquired infections at the organizational level. In departments, staff participate in problem solving and have enhanced processes such as how to manage patient financial requests or schedule patients for procedures. In addition, the team created a metrics tracker, used to convert lean improvements (waste removed from the system, time saved and inventory managed) into dollars. “It’s not ‘hard’ dollars in every instance, but it gives us a great way to look at improvements each month from a financial point of view,” said Goodwin.
“Now, whatever comes our way, including reimbursement declines or other changes to healthcare regulations, we know we can adapt using lean principles to meet each challenge.”
Four Keys to Success
Keep the board of directors engaged. Goodwin says the CEO and senior leadership team did a lot of work with board members to ensure the board’s commitment to the lean transformation plan. In addition, the CEO created a transition plan to ensure that when he resigned, the organization would continue moving forward on its lean transformation journey.
Conduct site visits. Leaders at Salem Health toured ThedaCare in Appleton Wisc., to experience first-hand how successful lean transformations work. “That became our model – we wanted to create a similar structure,” said Goodwin. The organization has subsequently sent key individuals to participate in training and education courses at Catalysis. The Catalysis resources that exist and the network of lean healthcare organizations that is in place is helpful and cost efficient. And site visits help reinforce what works and what needs further attention.
Involve the entire organization. “In 2010, when we started our first lean initiative, only a select group of people were trained and involved,” said Goodwin. “But our second effort included the entire organization. We have created a Kaizen department with staff who consult with leaders, staff, providers and support the lean work happening across the organization.”
Train. Train. Train. Salem Health invested time and resources in proper training of its people – including promoting lean training to the organization’s front-line staff. “This training helped to align everyone in both lean principle thinking and in terms of getting everyone to work toward the same objectives,” said Goodwin.
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