Joan Wellman pioneered application of Toyota principles in healthcare; helps complex health systems facilitate large-scale change

Last June, healthcare leaders from around the country – Stanford’s Lucile Packard Children’s Hospital, Oregon Health & Science University, UCLA Health, the University of Michigan Health System, and Vancouver Coastal Health – converged on the campus of Nemours Children’s Hospital in Orlando to see lean healthcare transformation in action.

As usual, Joan Wellman, president of Seattle-based Joan Wellman & Associates (JWA Consulting), worked quietly and diligently behind the scenes, connecting hospital system administrators with companies in a strategic way to build a more reliable healthcare system using lean manufacturing principles.

“A lean transformation is excruciatingly patient-focused,” said Wellman, who pioneered the application of Toyota principles in healthcare and helps complex systems facilitate large-scale lean healthcare transformations. “Every activity in the organization is assessed, relative to whether it adds value for the patient. As waste is removed, more time and resources are paid to the patient. It’s a very smart move to use these principles in a highly competitive environment because if you can do more for your patients with the same resources, you obviously have competitive advantage.”

Wellman’s lean transformation journey began in the early 1990s, when she was consulting with Boeing on its lean manufacturing effort.

“We were taking executive teams from Boeing to Japan,” explained Wellman. “In the course of two weeks, we took them by Toyota, Honda, Fuji, Xerox and other prize-winning companies to see how their manufacturing processes work. They saw the same principles in action at all these companies.”

In 1994, Wellman recalls a Boeing executive, who served on the board of directors of a Seattle hospital, pondering whether lean principles could apply to healthcare.

“At that time, none of us were healthcare consultants, but we saw the appeal,” she recalled. “We took a group of clinicians to Boeing’s final assembly line in Everett, Washington, and trained them in lean principles alongside operators on the line. Then we went back to the hospital and scratched our heads, trying to figure out how to make it palatable to healthcare professionals so the same principles could be applied. We looked at the waste and problems in hospital processes as we would in a lean manufacturing line.”

Wellman spent a year at the hospital, better understanding the healthcare sector and the application of lean manufacturing principles to a healthcare setting. In 1996, Wellman became involved in delivering a series of lectures at Seattle Children’s Hospital about concurrently improving patient flow and quality while also reducing costs.

In 1998, “it was time to put our big toe in the water,” said Wellman, who established JWA Consulting in 2000. A few years later, her book, Leading the Lean Healthcare Journey: Driving Culture Change to Increase Value (CRC Press), was published with co-authors Pat Hagan and Howard Jeffries, MD. The book chronicles healthcare improvements at Seattle Children’s Hospital, Memorial Care, The Everett Clinic in Washington, and Children’s Hospitals and Clinics of Minnesota.

“I don’t see the lean principles movement slowing down at all because of the Affordable Care Act,” said Wellman, whose firm has grown to 22 associates. “I see an increased commitment and attention to building a more reliable system – with better quality, better safety, and better patient flow – at a lower cost. Applying the lean production system to healthcare is one of few models anywhere that simultaneously addresses all of those issues.”

A lack of time, attention, and leadership passion are the primary barriers to lean principle implementation in healthcare systems, said Wellman.

“Mainly, it’s the lack of time,” she said. “Money is not the issue because it’s rare for organizations to look back and say they aren’t getting financial gains from doing this work.”

The application of lean principles is also aggressively being used in another segment of the healthcare industry: the design of healthcare facilities around the world, said Wellman, whose firm is becoming well known for its work in what JWA Consulting refers to as Integrated Facility Design, applying lean principles to the design and construction process.

“We just finished up some work in the Netherlands, and helped design a healthcare facility in Saudi Arabia,” she said. “We’re also doing work in Canada and the U.S., whose clinical processes are fairly similar but social systems are quite different. All those factors have to be taken into account. One thing’s for sure: With the healthcare industry facing financial challenges and other market pressures, lean healthcare transformation is catching fire.”

Creating High-Powered Healthcare Improvement Engines

Chapter 3 of Leading the Lean Healthcare Journey: Driving Culture Change to Increase Value (CRC Press, 2010), written by Joan Wellman with co-authors Pat Hagan and Howard Jeffries, MD, begs the question: What additional value do consumers in the United States receive for the extraordinary financial commitment made to healthcare?

“A 2008 Commonwealth Fund Report ranked the United States last in quality of healthcare among 19 comparative, developed nations,” said Wellman, noting the United States spends twice as much per capita on healthcare than other developed nations. “Not a stellar track record for a society paying top dollar.”

The chapter, “Creating High-Powered Healthcare Improvement Engines,” provides a blueprint for change through:

Brutally honest leadership

Moving from ‘episodic’ project based improvement to continuous improvement;

Changing the mindset and the management system of the organization vs. just applying lean methods;

Developing lean leaders; and

Developing a long term plan that ensures that this is a pervasive effort.

“Although the quantitative evidence demonstrates undeniable success, some of the emotional aspects of staff and clinicians engaging in improving the healthcare system are even more exciting,” said Wellman, after helping an organization through the early years of its lean transformation. “The sense of accomplishment – ‘we can do this!’ – is palpable. Even during the very early days of this organization’s lean transformation, improvement team members frequently expressed their enthusiasm for being engaged in the work. Other team members saw this as one of the most rewarding times of their careers. Still others keep asking, ‘When are we going to do this again?’ Such comments are the reward for the lean leader.

 Joan Wellman & Associates: http://jwaconsulting.com