WEST LAFAYETTE ― Purdue Healthcare Advisors at Purdue University awarded Lean Office certifications to a handful of Indiana Critical Access Hospitals this year, including Cameron Memorial Community Hospital — designating the organizations as capable of facilitating and sustaining process improvement for increased efficiency and improved patient care.

Based on the Toyota production system’s standardized, systematic approach to process improvement in manufacturing, Lean now is being used in health care settings across the country.

Cameron Hospital in Angola, Franciscan Health Rensselaer and Harrison County Hospital in Corydon were awarded a Lean Office-Advanced Level certification. Putnam County Hospital in Greencastle and Rush Memorial Hospital in Rushville were awarded a Lean Office-Basic Level certification.

They received the honor upon successful completion of the multiyear Lean Healthcare Transformation Initiative, which was funded by Indiana State Office of Rural Health Program through the Medicare Rural Hospital Flex Grant Program to develop lean thinking in rural hospitals and behavioral health organizations.

The initiative aims to help build lean process improvement capacity in rural hospitals that provides ongoing improvements to operational, financial, and clinical metrics by removing “waste” and eliminating anything that does not add value for patients. Awards were announced at the initiative’s annual conference in August.

“This is a very important honor and distinction for Cameron, as we have been working on this journey toward LEAN Office Certification since at least 2012; if not longer,” said Andrew Alred, Cameron’s executive director of ancillary services. “With the help of grants from various government organizations, and the assistance from Purdue Healthcare Advisors, Cameron has attained this certification through work completed by many people in the organization focusing on operational excellence and patient safety. The end result of our efforts is a safer, more patient-centered, healthcare delivery experience.”

Lean certification differentiates organizations by recognizing a minimum level of competency in complex lean problem solving using PHA’s lean first methodology along with executive strategic alignment.

“For rural health, this organizational capability produces new flexibility that is required by small organizations to sustain day-to-day operations while making improvements in care delivery to customers,” said Paul Griffin, director of the Regenstrief Center for Healthcare Engineering, which oversees Purdue Healthcare Advisors. “A Lean Office acts as a catalyst to help organizations achieve an unprecedented level of excellence in customer value.”

To be certified as a Lean Office at the basic level, the organization has demonstrated competency of team members to execute Lean Daily Improvement, a method for making daily improvements while working, and Rapid Improvement Events, a tool requiring a team to assemble for several days to solve more complex challenges. Certification at the advanced level denotes demonstrated competency at all levels of the Lean First methodology, including the capability to deliver and execute the most complex tool, a Value Stream Analysis, which produces a 12-to-18-month plan to re-engineer a process from start to finish.

“The state extended the initiative an additional year to allow participating hospitals to operationalize their commitment to lean process improvement, and they made the most of it with the five lean office certifications along with all of the significant changes they made within their organizations,” said Ann Alley, director, Chronic Disease, Primary Care and Rural Health Division at the Indiana Department of Health. “For a relatively small investment of federal dollars and a four-year commitment, the state and Purdue have given these rural hospitals a way to continuously improve the patient experience while making significant improvements along the way.”

Since the initiative began in 2015, each hospital’s core team has worked to integrate lean thinking into their respective organization. First, they learned how to use lean tools to make and sustain process-improvement changes. Then they worked with coaches to develop an agile approach to align their lean work with their organization’s top strategic priorities. They also established a core set of institutional metrics to measure outputs through data and to interpret the information in a transparent way. As the teams matured by learning from mistakes and celebrating successes, they gained trust from fellow employees and were better able to move horizontally and vertically within their organizations to influence change. Once they began to view lean as a strategy necessary for organizational transformation, they established offices to operationalize it and ensure their ability to grow and incubate lean talent.

“As trust and capability grow, the tipping point in lean engagement occurs when enough staff have experienced it and start to look to it to solve problems — big and small,” said Melanie Cline, who is Purdue Healthcare Advisors’ senior advisor and Lean Healthcare Transformation Initiative project lead. “Sustained measurable improvements come when leadership not only supports lean but hardwires it into the organization. Success hinges on hands-on, executive-level support accompanied by executive willingness to make a multiyear investment in their team’s skills.”

The state also is funding an additional year of lean training for participating hospitals to help staff maintain certified skills. In addition, a second cohort of healthcare organizations is participating in the initiative with the goal of establishing Lean Offices by the summer of 2020.

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