I have been part of the healthcare system for 27 years. I have unintentionally hurt patients, bowed my head in shame and embarrassment, and have had nowhere or no one to turn to for support, all the while dreading the Saturday morning morbidity and mortality conference massacre that I would soon have to endure. I have also been late to clinic, late to the operating room – I was busy and my time was precious. I have been stressed by a system with broken processes so I drew blood for patients because the phlebotomist was too busy, or I transported patients to radiology because the transporter was overworked.
I had an epiphany, many years into my tenure as a physician. It was a coalescing of many events, many observations. As a member of our hospital-wide peer review committee, I was struck by an audit that demonstrated that 90% of all adverse clinical outcomes were due to bad processes, not bad people. Our system was setting up our people – greatpeople – for failure. As I studied other industries during my time in business school, I realized how broken healthcare was and started to believe that it could be better. I began to dream of ways to make healthcare more efficient, more effective. Then, I heard a talk by John Toussaint, the former CEO of ThedaCare health system and present CEO of the Lean Enterprise Institute. I was enamored by the possibilities he discussed – how he believed we could extend Toyota production principles – proven principles for high quality, just-in-time, low cost service delivery in many industries – to the healthcare sector. He described what I had been dreaming about, but in “lean” terms. I quickly became a student of lean. I became convinced that devotion to rigorous, patient-focused performance improvement was a way to help healthcare and its devoted workers out of its present funk.
One of the key precepts of lean is to spend time identifying and studying what the customer values as an output or element of our processes. That awareness lets lean practitioners optimize processes around producing value-add for the customer.This relentless focus on the customer – in healthcare, the patient and family – while simultaneously finding and eliminating waste seemed the perfect way to disrupt the service recovery conundrum.
I am now the Vice President of Quality and Performance Improvement at Lucile Packard Children’s Hospital at Stanford (LPCH) where I am helping to lead the lean journey. We call lean at our institution the Packard Quality Management System. It’s the way we do business. We believe it is the system that will keep us “relevant” in the future—that patients and referring physicians and payers will see us as a high quality, safe, efficient, low cost, and patient-focused provider. Our aim is to fix the broken processes that lead to bad outcomes, rework, inefficiencies, and staff and patient dissatisfaction.
If I am correct that healthcare today is principally dependent upon service recovery, and that service recovery should largely be unneeded, then strict adherence to patient-focused performance improvement techniques (lean, at my hospital) can potentially get us to our desired future state. If we create better processes to support our teams, we should be able to decrease preventable harm (hospital acquired infections, pressure ulcers, medication errors, etc…), while at the same time protecting investments that allow us to connect with and care for our patients and families. This will drive down costs, increase staff satisfaction, and increase patient satisfaction. We should work to decrease the size of and potentially dissolve all waiting rooms. Why can’t we room a patient in clinic at 8 am, the time that they scheduled? And what about support for our staff? If we decrease all preventable harm, we will decrease the emotional agony that accompanies these adverse events. However, non-preventable bad outcomes will persist—that’s the industry we are in. This is where should be the sole focus of service recovery.
About Craig Albanese, MD, MBA
Craig T. Albanese, MD, MBA, is Vice President of Quality and Performance Improvement at Lucile Packard Children’s Hospital at Stanford University Medical Center. In this role, he is responsible for overseeing the children hospital’s Lean transformation. Under his leadership, Craig is approaching Lean transformation by developing a rigorous daily management system to support ongoing improvement efforts and the hospital’s core goals. In addition, he has recently overseen the implementation of a production control management system in the perioperative services department and is expanding this work to the rest of the hospital. Craig is also a pediatric general surgeon, Professor of surgery, and holds the John A. and Cynthia Fry Gunn Directorship of Surgical Services at Lucile Packard Children’s Hospital.
Craig obtained his BS in Natural Sciences and Mathematics from Washington and Lee University. He earned his MD at Downstate Medical Center, subsequently completing his general surgery training at The Mount Sinai Hospital in New York and his pediatric surgery fellowship at the Children’s Hospital of Pittsburgh. He was on the faculty at the University of Pittsburgh followed by the University of California, San Francisco before joining the faculty at Stanford in 2002. In 2008 he earned an MBA from Santa Clara University’s Leavey School of Business. Craig still practices pediatric general surgery. His 26 years as a surgeon in a broken healthcare system has shaped his passion for increasing value for our patients.