Monday, December 12, 2011

Lean progress at the University of Michigan

I just listened to an extraordinarily well done webinar from MIT, presented by Dr. John E. Billi, associate dean for clinical affairs at the University of Michigan Medical School and associate vice president for medical affairs at the University of Michigan. John leads the Michigan Quality System, the University of Michigan Health System’s business strategy to transform clinical, academic, and administrative functions through development and deployment of a uniform quality improvement philosophy.

As noted in the webinar summary, the University of Michigan Health System (UMHS) has been on the lean journey for the past six years, creating the Michigan Quality System. UMHS has 20,000 faculty, staff, and trainees. The goal is to create 20,000 problem solvers who are finding and fixing root causes of problems they face daily. Dr. Billi described UMHS’ initial approach, results of early experiments, what leaders learned, and how they adjusted. The discussion covered the transition from scattered projects led by coaches to an integrated approach that incorporates people development and process improvement.

John's presentation was one of the best I have heard on this topic.  His slides, too, were clear and descriptive.  I'd like to show you all of them, but let me pick a few.  The thing I liked best was the modesty and transparency demonstrated.  Even after years of doing this work, John felt comfortable starting with this slide, showing where is system still needs work:

That he would feel the need to do so is even more striking when you look at some of the successes.  Here are some results from cardiac surgery:

I liked the story about increasing mobility of ICU patients.  Here's the summary chart:

But even better than the substantive results was the fact the Lean approach resulted in pull-based authority.  Having achieved a broad consensus on objectives and experiments, the front-line team was able to exercise their discretion in how to carry out the improvement.  You see them here accompanied by the grandson of a patient, another key participant.

John summarized other key lessons.  The first is about how authority must devolve to make Lean work.  "Leaders have to show respect, which means trusting people to solve their own problems if they are given the tools."

Finally, to reach the goal of having 20,000 problem solvers, you need to design brilliant processes, based on creating standard work.

I have some more observations in the post above.


Mark Graban said...

Dr. Bill is one of the most passionate and committed Lean healthcare leaders I know.The University of Michigan is fortunate to have him as a key leader and influencer in both the health system and the medical school there.

I love their humility and the learning that has taken place. Their lean journey seems to be one big PDSA cycle. I appreciate how they have moved beyond Lean being just projects that are driven by key experts. Having everybody engaged in improvement is definitely the way to work toward a "lean culture."

Gary Wolfe said...


One of the best Webinars I have ever listen to. Thanks for posting about it on your blog. I would love to see the A3s they have developed posted online.

Unknown said...

Thanks for sharing this. I agree with Dr Bill, we are all learning. My learning has made me wonder if lean is enough. So, for example, the focus on standardisation may not, from what I have seen, produce the results that we might have predicted for it. I would go so far as to suggest that it may actually cause more problems than it solves. My thoughts are here, but the more general point is that there might need to be a broader perspective brought to the debate about how health systems globally address the problems they seem to have. I am not sure lean helps in that regard. Would be interested to hear the views of others.