Ideas Transformed the Culture at Baylor Scott & White Health

Last month, an important book titled The Power of Ideas to Transform Healthcare: Engaging Staff by Building Daily Lean Management Systems, authored by Steve Hoeft and Bob Pryor, MD, was published. It details Baylor Scott & White Health’s journey from just one-of-many to one-of-the-best idea generating, staff engaging, Lean Management System building healthcare organizations in the world. I had the chance to speak with Steve about his book, and one of the main questions I asked was: "Why haven’t more healthcare organizations seen successes from choosing Lean as a methodology to transform and improve their culture?" Here is his complete response: 

Let’s start with an even more basic question. If you are a healthcare leader at any level, ask yourself, “Do we have good employees working in our organizations? And, do we think they have ideas for improvement?” If so, how many ideas have your staff brought forward and implemented this week? How about this month? Does anyone even ask them? And, if they did, have leaders helped build quick-feedback systems so they can Check if their ideas worked (Plan, Do, Check, Act)? Next, ask yourself the only Lean question – “Why?” 

From those questions, Dr. Bob Pryor, then CEO of Scott & White Health (before merging as equals with Baylor Health Care System in 2013) and I accelerated our previous project-based continuous improvement journey by teaching all leaders to build systems for daily improvements.

 At last count, we see over 2,000 ideas implemented every week! When we just did improvement “projects,” we didn’t see that many ideas tried out in a year! Our culture is changing. We are building a culture of continuous safety, quality, morale, service, finance, respect, and... everything improvement! You asked a good question. Now that a dozen or more healthcare systems have seen sustainable successes applying the Toyota Production System (TPS) aka Lean principles in healthcare, why haven’t more organizations seen successes?

There are many reasons, but we would say the main reason is still denial. Throughout the history of healthcare, leaders were able to use heuristic rules that reinforced their thinking, which was, “What has worked in the past, will work again now.” Coin in, gumball out. But, as healthcare environments change even faster, what worked in the past will not work in the future. Think of how quickly healthcare finance and reimbursements have already “reformed.” The need to change may not appear bigger (yet) than the pain of changing for some. For many, it will be too late. 

Another important reason is that we have relied way too much on low-level, leader-absent improvement projects by small teams. Maybe consultants have added to this myopic focus because projects are easy chunks to schedule and “sell.” But, consultants leave, improvement teams disband, and the changes often slide right back to where they started. 

There is a better way! And, it can engage more staff, while aligning them around common North Star goals. At Baylor Scott & White Health, we still do great continuous improvement training and projects. But, we also use hoshin kanri to align all staff’s North Star goals (CEO Joel Allison’s Vision 2020), and build Lean Management Systems to bring forward their full brainpower daily and close the gaps! 

Our leaders teach all employees that they wear two hats. They are to do their jobs well (follow their standard work), and they are to improve their jobs every day (make it easier, get rid of waste). We also promise to give them the tools to do this, and that their leaders will help build systems to allow them to try out their ideas. Something changes inside a staff member when they bring forward an idea in a pre-shift huddle, their team tries it out, they see that it worked, and then a leader thanks them. It changes in a very positive way when they see a meaningful measure move toward their goal and get recognized. The staff member goes home that night, gathers his or her family around, and says: “Kids, if I wasn’t working at Baylor Scott & White, that place would be going to heck in a hand basket. I am helping achieve all our goals with my ideas. You should have seen how happy the team was today when my idea worked! I knew it would. I think I’ll bring up another idea next week.” 

Organizations often ask for ideas from staff on teams but few have done so to the extent and with as much success as we have thus far. In the book, Bob and I share our experiences building a wide culture of continuous improvement over the past eight years at Scott & White, now Baylor Scott & White -- including our successes and failures. We weren’t smarter than other health systems. Maybe we were just more desperate, given the challenges we wrote about. 

Our new book offers insight on how to engage staff and garner ideas through projects, goal alignment and creative use of huddles. It also presents ways that your good staff members can try out their ideas without spending time away from their work. It works.

What do you think of Steve's thoughts on the power of ideas to transform healthcare? I'd particularity like to see comments from healthcare leaders and practitioners who are currently on a Lean or continuous improvement journey.