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Lean in Healthcare: A Personal and Professional

JourneyElizabeth J. Warner, MD FACP CPE

Warner Well Being, L.L.C.

Internal Medicine Physician, Leader, Coach and Human Being

Objectives

Share my personal story about becoming a lean thinker, while serving as a healthcare leader and embattled clinician.

Reflect upon one’s personal journey in parallel to an organization’s lean transformation.

Emphasize some of the unique cultural conditions in healthcare, which influence its lean improvement journey.

Medical Training & Career Path Life Track

1994-1998 Medical School Single, then Partnered

Aug 1998 Birth of first son

1998-2001 Internal Medicine Residency Crisis of competing professional and personal demands

2001-2013 Internal Medicine New Primary Care Practice

Fertility workup & care

June 2004 Adoption of second son

2005 Reduced to part time clinical status

2007 First major episode of burnout First major episode of burnout

2010 Divorce

2012 Primary Care Medical Director Created

Burnout

Cynicism

Exhaustion

Lack of Efficacy

Pivotal Question which re-routed my career

“Why don’t problems stay fixed

around here?”

A Leadership Path opens before me

Survey Results for Primary Care Providers (2012)

• 63% response rate, from one email request

• Over 10 pages of free text responses

• Strong themes of:• Frustration with EHR

• Burden of paperwork and non patient care activities

• NO ONE is listening in leadership

• Helplessness, hopelessness and cynicism

• Exhaustion

Experimentation (“Willy Nilly” style)

Student of lean thinking

TrainingThedaCare Center for Healthcare Value (Now Catalysis), Gemba VisitsUniversity of Michigan Lean for Healthcare certification (2014)Managing to Learn, John Shook, LEI, Toyota Way,

Practicing the toolsA3s and eraser stubble EVERYWHEREAsking “Why?” during meetingsSIPOC and flow mapping in committee work

Flowing any and all resources to Primary Care clinical teams

Quickly, I could see the broken processes and system gaps.....

Leadership Opportunity

For the next three and a half years…

Shingo Principles

Shingo Principles for Operational Excellence

Align

• Constancy of purpose

• Provide value to the customer

• Think systemically

Enable

• Lead with humility

• Respect every individual

• Learn continuously

Improve• Focus on process• Provide quality at the source• Flow and pull value• Understand & manage variation• Embrace scientific thinking• Seek perfection

Lifelong Learning guides me to an off ramp!

And the Journey Continues...

Thank you for your time and attention!

What questions do you have?

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