St. Joseph Health System (SJHS) is a Catholic health system and a ministry of the Sisters of St. Joseph of Orange, consisting of 14 hospitals in Northern California, Southern California and Texas. Annually, their health system treats close to 865,000 patients, with over 2 million visits. SJHS began its transformational journey in Continuous Improvement in 2007. It began with a 2-day executive meeting to develop their Transformational Plan, where two Value Streams were selected to begin work. These two Value Streams have been particularly successful in achieving transformational results. The Information Value System has achieved $5M hard cost savings and improved integration of processes and work-flow. The Value Stream in Emergency Services has applied 6S, Kamishibai cards, Pull Systems, Visual Management and 2P that has resulted in the ability to care for and treat 20,000 more Emergency Department patients annually. Hear how each Value Stream is supported by a dedicated facilitator, executive sponsor and process owner. Find out how SJHS developed two 4-day workshops in basic and advanced Lean concepts. Learn why these workshops included exposure in participating and leading RIEs, as well as project completion. Hear how St. Joseph focuses on the development of a community of problem solvers engaged in daily Continuous Improvement.
Click to listen to the interview: Alternative content
Taking it to the next level.
Mary Kingston, Vice President for Performance Improvement at St. Joseph’s Hospital
Ms. Kingston, in her own words:
We’ve done facilitator training over the last two years and we wanted to step up our understanding of lean and how it applies to different industries and see what we could learn to bring it back to the healthcare system. So that was our main thing, is really to provide a facilitator experience that was a step above. We’re at year three and our facilitators are really familiar with some of the tools and the language and all that. We wanted to see if we could learn how to apply it in a more advanced way.
Lean is the Engine
It provided me with a more wide angle lens - that there are things we can learn from different industries. We've been working with Demming models but as the gentleman pointed out at the lunch time lecture, they don't give you real great models for actually how to put it in place and how to utilize it. And I think lean kind of provides this engine for how to do that.
Critical Lessons
What we've learned along our journey is the discipline. The tools combined with the discipline and the accountability, and obviously, the leadership engagement and the visibility to the process is critical. So, that's what we've learned, I think, in our first three years. Where we've been missing some steps or had some mis-steps is because one of those elements has been missing.
Bringing a Large Team Takes it to a New Level
I think it worked really great for our group. We went out to dinner last night I each of our 10 different hospitals, we had different people, different tables. The dialogue was really at a whole different level. Tonight we're meeting and ordering pizza and our whole group is going to sit and debrief as to what we learned and what we want to make sure we want to take back and just share amongst one another. Innovative lean development is the tool.
Sharing Knowledge Across Industries
I learned that we are on track. We also found out that we are having some of the same problems that manufacturing is having, like with standard work, and understanding how you stay true to standard work and teach to it and make sure people are doing it. We also have some issues the same as manufacturing: leadership and walking the Gemba and really holding people accountable. So I found that there was a lot more commonalities than I thought there would be.
New Insights: A Deeper Dialogue
One of the things I thought was really intriguing was the whole idea of capturing knowledge which I really hadn't thought about. We use A3 Thinking and our last box is called insights. What I've learned through this conference is that we've been very superficial about looking at those insights and we really want to look a level deeper: Like where are we failing? Why did we fail? How can we understand how to prevent that from happening again? And I think sometimes we look at the insights a little too superficially. So that deeper dialogue is what I'm taking away.
In-depth Learning from the Conference
The one other thing I would say that I took away from here is the executives need coaching too. And sometimes they don't know what to do on the Gemba. So it's a critical part of our facilitator's role to help coach them and help them feel comfortable on the Gemba and know what to look for. And then they'll take off with it in no time.
We were practicing. I think we bring our leaders to the Gemba and then they don't know quite exactly what to do so they're kind of looking around. People are a little nervous about having the CEO or the COO in their work area. It's an adjustment, but working with them to really give them some meaningful questions so they can feel comfortable. We can coach them a little bit before they go in as what they're going to see and what kinds of things they're going to want to ask so that we start off with a really good, comfortable relationship. So leadership and standard work was something I'll take away.
New Perspectives
I think it confirmed that we are on the right journey so that was a big confirmation for me. But I also think that we're farther along than I thought we were to begin with. This conference will even help accelerate us even more because you're always improving; you're always striving for some different level of performance to meet our patient's needs, our family's needs and our community needs. So we'll be able to accelerate that journey and hopefully be able to meet their needs in an unexpected and different way from what we've seen in healthcare before.
Taking it to the Next Level
Right now we're experimenting with our executive leadership team doing strategic planning using some of the Hoshin Kanri tools and we're very much novices on that and I did go to two, one workshop and one hour presentation on that. So for me that is something that I'm going to be able to take back and help our executives across the health system with regards to strategic planning and how we take that down from level 0 to level 4 in our organization.
Back in 2010 for Baltimore!
We're planning on bringing some more healthcare lessons and learning more healthcare lessons from both healthcare and manufacturing.
Raphael Rojas, Lead Facilitator, Mission Hospital
Mr Rojas, in his own words:
We as facilitators improve processes every day .... I was glad to hear that most of the workshops are really related to what we do when we try to improve a process. I learned a lot. From all the workshops that I've attended I think this has shown me there is actually value when you go to a workshop. You get good examples of what others are doing and other examples that tell us what hospitals, other companies have done to sustain or create a culture of lean. Most of the workshops I attended were related to sustainment and engagement of management and executives to our efforts and so those were the areas I was more interested in.
Executive Engagement
Before I came here I knew that there were a few areas we needed to work on but now I think I have a little bit more of a better idea of how to go about that. How to engage my executives. So we'll try it. We'll do some rapid experiments of that.