Five Indiana Critical Access Hospitals demonstrate competency to receive top lean designation from Purdue

Purdue Healthcare Advisors (PHA) at Purdue University awarded Lean Office certifications to a handful of Indiana Critical Access Hospitals (CAHs) this year, designating the organizations as capable of facilitating and sustaining process improvement for increased efficiency and improved patient care. Based on the Toyota production system’s standardized, systematic approach to process improvement in manufacturing, lean now is being used in healthcare settings across the country.

Cameron Memorial Community Hospital in Angola, Ind., Franciscan Health Rensselaer in Rensselaer, Ind., and Harrison County Hospital in Corydon, Ind., were awarded a Lean Office-Advanced Level certification. Putnam County Hospital in Greencastle, Ind., and Rush Memorial Hospital in Rushville, Ind., were awarded a Lean Office-Basic Level certification. They received the honor upon successful completion of the multi-year Lean Healthcare Transformation Initiative, which was funded by Indiana State Office of Rural Health (INSORH) Program through the Medicare Rural Hospital Flex Grant Program to develop lean thinking in rural hospitals and behavioral health organizations. The initiative aims to help hospitals identify areas of “waste” or inefficiencies, and to eliminate anything that does not add value for patients. Awards were announced at the initiative’s annual conference in August.

Lean certification differentiates organizations by recognizing a minimum level of competency in complex lean problem solving using PHA’s Lean First methodology. “For rural health, this organizational capability produces new flexibility that is required by small  organizations to sustain day-to-day operations while making improvements in care delivery to customers” said Paul Griffin, Ph.D., director of the Regenstrief Center for Healthcare Engineering that oversees PHA. “A Lean Office acts as a catalyst to help organizations achieve an unprecedented level of excellence in customer value.”

To be certified as a Lean Office at the basic level, the organization has demonstrated competency of team members to execute in Lean Daily Improvement, a method for making daily improvements while you work, and Rapid Improvement Events, a tool requiring a team to assemble for several days to solve more complex challenges. Certification at the advanced level denotes demonstrated competency at all levels of the Lean First methodology including the capability to deliver and execute the most complex tool a Value Stream Analysis which produces a 12-to-18-month plan to re-engineer a process from start to finish.   

“The state extended the initiative an additional year to allow participating hospitals to operationalize their commitment to lean process improvement, and they made the most of it with the five lean office certifications,” said Ann Alley, Director, Chronic Disease, Primary Care & Rural Health Division at the Indiana State Department of Health. “For a relatively small investment of federal dollars and a four-year commitment, the state and Purdue have given these rural hospitals a way to continuously improve the patient experience.”

Since the initiative began in 2015, each hospital’s core team has worked to integrate lean thinking into their respective organization. First, they learned how to use lean tools to make and sustain process-improvement changes. Then they worked with coaches to develop an agile approach to align their lean work with their organization's top strategic priorities. They also established a core set of institutional metrics to measure outputs through data and to interpret the information in a transparent way. As the teams matured by learning from mistakes and celebrating successes, they gained trust from fellow employees and were better able move horizontally and vertically within their organizations to influence change. Once they began to view lean as a strategy necessary for organizational transformation, they established offices to operationalize it and ensure their ability to grow and incubate lean talent.

“As trust and capability grow, the tipping point in lean engagement occurs when enough staff have experienced it and start to look to it to solve problems — big and small,” said PHA Senior Advisor and LHTI Project Lead Melanie Cline, RN, MSN, LPC. “Sustained measurable improvements come when leadership not only supports lean but hardwires it into the organization. Success hinges on hands-on, executive-level support accompanied by executive willingness to make a multi-year investment in their team’s skills.”

Cline said the lean journeys of Harrison County Hospital and Rush Memorial Hospital demonstrate how a very small place can make a big change rapidly through executive leadership. Harrison County Hospital’s core team sustained executive-level engagement and coordination of the lean effort over the past two years, which led to an explosion of improvement work across inpatient and outpatient services, and support services. Value stream improvement work in outpatient physical therapy produced multiple improvement events and projects. Rush Memorial Hospital’s core team aligned leadership support with a top-down Lean daily Improvement (LDI) execution plan. Members of the executive team themselves completed successful LDI projects in each of their departments. Leading by example, they galvanized the organization to embrace lean, busting through layers of resistance that had stymied their ability to drive lean transformation.

The state also is funding an additional year of staff lean training to help them maintain certified skills. A second cohort of healthcare organizations is participating in the initiative with the goal of establishing Lean Offices by the summer of 2020.

About Regenstrief Center for Healthcare Engineering

The Regenstrief Center for Healthcare Engineering is part of Discovery Park at Purdue University and serves as a national nucleus for driving high-impact improvement in healthcare delivery by mobilizing the intellectual strengths of Purdue faculty and partners. Its applied arm Purdue Healthcare Advisors (PHA) is a not-for-profit outreach initiative created in 2005 to serve the training, project facilitation, and assessment needs of thousands of independent practices as well as hundreds of hospitals/healthcare systems striving to increase cost savings as they better the patient-care environment.