Additional Thoughts Regarding our Roundtable with the Experts

In November 2008, four SHS members with more than 100 years of combined improvement experience attempted to summarize the challenges facing health care today. SHS News released that compilation last December. This article, with input from Karen Martin, is the first formal release of potential solutions to those challenges. The newsletter team invites members to read Karen’s thoughts, with plans to write your own. Responses should be sent to Enjoy!

Health care in the United States indeed faces many challenges as the December article stated, but none of them are entirely insurmountable.  Karen Martin would know; she has been involved with multiple facets of health care operations for more than 20 years. Her vast experience includes working as a clinical laboratory scientist, a preventative medicine educator, an operations leader within several health care payors, and her current role, as principal consultant for Karen Martin & Associates. As a performance improvement consultant, she specializes in applying lean enterprise principles in service, transactional, analytical and creative environments, with particular expertise in health care.

Currently, Karen spends 50 percent of her time working with health care organizations, and the other 50 percent in other industries, which provides her with valuable insights into the parallels between health care and industry. She feels that health care can learn much from the process improvement gains of other business realms. In her words:

"All industries have unique attributes, but the health care industry sometimes holds itself back by seeing itself as unique on all fronts. A process is a process is a process. All of the lean tools apply to health care. Instead of benchmarking within health care, go outside health care to other industries. Do "trades" with industrial engineers from other industries. Tour each other's facilities and discuss solutions to performance challenges. Lots of industries have 'high stakes' processes where life and death enter in -- not just health care. At their core, non-health care industries are more similar to health care than different. Spend more time focusing on the similarities and learning other industries than focusing on the differences, a mind-closing activity."

In learning from industry, she operates with a philosophy of “creativity before capital.” While many health care organizations have taken a “technology first” approach to reducing inefficiency, Karen doesn’t recommend that path. She believes that waste should be eliminated first, and operations should be optimized second through the use of human and technology solutions. 

Karen believes strongly that leadership in health care, from supervisors on up to top executives, will need to refine their improvement focus to include both clinical quality and process efficiency. When asked what advice she would give to health care leaders, Karen put it this way:

"I would say [to our leaders] that you need to have a balanced approach to your improvement efforts – 50 percent focused on clinical quality and 50 percent focused on process efficiency, cost reduction and quality of service. I would urge each and every one of them to teach their leadership teams – from supervisors up and especially their clinical staff – why cost reduction is a noble cause and doesn't have to conflict with delivering excellent clinical quality. So many hospitals are afraid to talk about cost reductions. It's getting in their way of becoming best-in-class operations. Cost reduction is absolutely necessary with today's reimbursement model and has been shown to, in many cases, actually IMPROVE clinical outcomes. Profit should be a large concern even to not-for-profit organizations because if your margins don't allow for reinvesting in people and improved technology and facilities, you will be left in the dust by your competition. It's time to view health care as the business enterprise that it is. Patients will actually BENEFIT."

In her view, cost reduction will be a necessary reality as patients become more like actual consumers. She believes that even though they are not directly paying for the bulk of their bill, patients are becoming more selective in who provides their care and how it is provided. Through this transformation to patient-directed health care, customer-defined value will take on more meaning.  Eliminating waste from the patient’s perspective will no longer be a nicety, but will become a necessity. In order to “stay ahead of this curve,” health care must try to eliminate as much waste as possible. 

How can we lead this necessary transformation?  How can management engineers and other members of SHS make an impact and combat the challenges that are faced?  Karen left us with her thoughts on this subject:

"Learn as much about lean as you can. Become a proficient value stream mapper for setting improvement strategic plans. Learn how to create metrics-based process maps for tactical improvement. Learn when to apply takt time and when not to. Learn how to apply all types of pull systems. Become a proficient facilitator -- learn how to shift from "doing" to "facilitating." Become a masterful teacher and coach. Learn how to measure your outcomes and "sell" them to leadership. Learn how to teach leadership what they need to help you help them. Partner with leadership so that you're intimately involved with both strategy and tactical execution. Become the eyes and ears that bring improvement needs to the table rather than being a resource that's "told what to do." This enables you to be an even more critical element of the organization. Establish lean steering committees that you oversee to create and maintain alignment across the entire organization re: improvement prioritization, execution, and results monitoring."

Karen Martin, principal consultant of Karen Martin & Associates, specializes in applying lean enterprise principles and tools in non-manufacturing environments, with particular expertise in health care. Karen’s broad understanding of the health care environment and history of producing rapid results stems from 20+ years working in both clinical and administrative areas within hospitals, physician practices, clinical laboratories, post-acute care, behavioral health organizations and payors.

Karen’s quality and process orientation evolved from her early career in diagnostic care and medical research (B.S. in microbiology, Pennsylvania State University) and her passion for the educational component of the change process led her to a graduate program in adult learning (M.A. in education, California State University, Bakersfield). She served as the director of quality improvement for a nationwide health care organization that managed health care services for 22 million Americans and the director of the Institute for Quality and Productivity at San Diego State University, where she oversaw the university’s sell-out lean enterprise and quality business practices programs.

Karen maintains her license as a clinical laboratory scientist, is an instructor for the University of California San Diego’s lean enterprise program, and is a frequent speaker at conferences across North America. She's the author of The Kaizen Event Planner and co-developer of Metrics-Based Process Mapping: An Excel-Based Tool, and is passionate about transforming health care through the application of lean enterprise principles and tools.