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Although Lean Sigma puts quality improvement tools in the hands of frontline providers, successful efforts also depend on having an infrastructure that gives teams the resources they need. Failure to provide this infrastructure is anecdotally cited as the top reason why past implementation efforts have failed.
The Johns Hopkins Model
At Johns Hopkins, the Lean Sigma infrastructure includes a mix of full-time, permanent change agents—Lean Sigma Master Black Belts and Black Belts —as well as trained clinical and administrative staff—many of whom are Green Belts—whose full-time jobs are in the pharmacy, operating rooms, clinics or other areas of the hospital. Johns Hopkins has trained more than 150 clinical and administrative staff who are armed with the tools and techniques for improving their departments, with the support of the full-time Lean Sigma team.
Introducing Lean Sigma to Your Organization
Lean Sigma may be one of several improvement methodologies offered by your organization (as is the case at Johns Hopkins), or it may be deployed across the organization. The following steps are suggestions for introducing and gaining buy-in for the methodology. They may be performed in any order, or simultaneously.
Build Organizational Will
Introduce several short-duration performance improvement events in small but important areas, such as the pharmacy, lab or procedure areas. Examples include:
- Lean Kaizen. Requiring just two or three days, these improvement projects focus on highly visible improvements that can be implemented and tested almost immediately by a multidisciplinary team. At Hopkins, for example, Kaizen has been used to reorganize the workspace of an outpatient pharmacy and reengineer work processes, resulting in shorter medication preparation times.
- 5-S Session. This one-day event introduces a team to the basics of Lean health care. A team evaluates and scores their workplace and workflow with the five S’s in mind—sort, straighten, sweep, schedule and sustain—to better understand waste in their environment. See 5S Evaluation form.
These events have a very low training time, and participants can see virtually immediately that their involvement helped to produce results. This can help overcome inertia associated with more sophisticated methods and yet still introduce the organization to the benefits of Lean.
Identify an area or two with possible high impact, leadership who will support a new approach, and the presence of an interested clinical champion (if it is a clinical area). A manager and a frontline clinic staff person should get training and complete a project that meets an organizational goal that has a quantifiable impact on the bottom line and quality of care. Ensure that these staff have support from a Master Black Belt—either externally to start, or internally if resources allow.
Create Executive Leadership Awareness
Have the team report to executive leaders at kick-off and at project completion. Ensure that leaders in these areas involved meet regularly with the team in order to champion the project and remove barriers. Successful efforts will justify the organization doing more projects and training more staff.
Expand Lean Sigma Infrastructure
Develop organizational competency for innovation by training a dedicated force of Lean Sigma program leaders and Black Belts/Green Belts to support the work of clinical and administrative staff projects. This infrastructure can develop a focused deployment strategy and develop a portfolio of projects to meet organizational quality and efficiency goals.