Process Excellence

Bonnie Tsang, Director

Process Excellence: Empowering innovation in every person, every day  

Stanford Medicine Process Excellence advances the School of Medicine’s transition to a continuous improvement organization by working with teams to discover how to improve the quality and value of our administrative operations.

Our mission is to empower innovation in every person, every day. 

Why Lean?

At Stanford Medicine, we are committed to the principles of Safety, Quality and Value. As part of the Integrated Strategic Planning effort, the School of Medicine is working with our partners at Stanford Health Care and Stanford Children’s Health to bring each of these to the highest levels of pre-eminence.

This applies not only to patient care, but also to our research and education missions, and the administrative and financial infrastructure that support these missions. That means that the processes involved in administrative and financial support for research and education should also be improved by articulating clear goals, eliminating waste, standardizing processes where possible and measuring results.

This continuous improvement expectation is the essence of what we call Lean management practices. Lean is one of the core elements of the Process Excellence Program, which is now in its third year. Lean is essentially a culture in which staff members in every department and at every level are empowered to take ownership for improving processes in their daily work. It includes documenting current practices, identifying pain points and waste, and developing, testing and tracking new approaches to change, that lead to more efficient delivery of service.

This involves an incremental approach to streamline tasks, reduce resource needs, and control costs.  It is a methodology that ultimately empowers workers to contribute ideas on how to make their work more effective and efficient. One of the central tenants of the approach is respect for people, and in this approach staff are given a “safe” environment in which to express themselves, their ideas, and to work as teams to own their impact on the customer. The idea is to practice bottom-up management, giving the front-line employees, who are closest to every-day challenges, the support they need to solve problems quickly. 

The Lean process of improvement is simple, yet powerful. Employees identify and report opportunities for improvement, and that begins a cycle of improvement known as PDSA – Plan, Do, Study and Adjust. The team agrees on a theory of what to do to achieve a specific improvement (Plan), the new idea is implemented (Do), the results are analyzed (Study), adjustments are made if necessary and a new standard is deployed for the process (Adjust). Once complete, a new cycle of improvement can begin, creating a continuous flow of small gains. 

But applying Lean techniques is not enough. Achieving better efficiency and process flow also requires a receptive organizational climate, active management support and engagement, sufficient financial and other resources and clear communication channels within the organization. Truly transformative change takes time and requires a shift in organizational behavior in accepting change and integrating it into the organization’s operations and expectations.  The “softer side” of organizational behavior is important for the Lean culture to succeed, with these key components critical to change:

Leadership – Although Lean is a bottom-up concept, strong leadership is essential for success. Leaders set the tone and provide support and resources. The best results with Lean come from deep commitment, which starts at the top.

Culture – Lean is a team sport that should impact the way every employee, from staff to students to faculty, approaches problems. Employees should be rewarded and recognized for engagement, and everyone should seek continuous improvement as part of their job responsibilities.

Training – The Lean approach has been around for a long time and has been broadly used. There are tons of valuable lessons that have already been learned. With the right training, Lean leaders build on what’s happened in manufacturing, healthcare, and technology companies rather than reinventing the wheel.

Our hospital partners have applied the Lean philosophy for many years, and continue to do so, in improving patient care. In education, we have similar opportunities; for instance, we can measure student achievement that can be monitored and improved over time. In our research administration, we can work for improved efficiencies in proposal development and award management to achieve more competitive proposals and improved financial compliance once awards are made. The same principles can be applied in laboratory settings, where the need for statistical precision and quality control and measurement are of paramount importance.

The Lean philosophy is part of our broader Process Excellence Program, which we are implementing across all administrative and finance functions at the school. The program is being implemented in phases, with an initial pilot program with a core group of passionate employees. We have now extended support and training to all staff in Finance and Administration, the Office of Academic Affairs and the Academic Department DFA Leadership.

Our FY18 shared strategic goals include:

People – 100% in Professional Development Activities

Environment – Deploy the four foundational elements of Lean (Strategy Deployment, Visual Management, Daily/Weekly Improvement, and Standard Follow-Up)

Operations – Discover customer expectations and apply to a core service for 25% improvement

Value – Increase capacity by 10% without increasing costs

The Process Excellence Program includes a series of training events that we call “Launches.” These are three-day events where a team of individuals dedicated to improving customer service come together to map out a process, identify pain points and opportunities to remove waste and add value for the customer.  They map out their own ideas and report results every 30 days. To date we have completed more than 20 launches with many stories of documented improvement by highly functioning teams that continue to work on positive change.

In addition, we have established a long-term relationship with our consultant Mike Martyn of the SISU Consulting Group, who has successfully launched this type of program at University of Washington in Seattle.  He has been working with Bonnie Tsang, our Director of Process Improvement, and Sam Zelch and Kathleen Thompson, who are co-sponsors of the program.  We have completed two cohorts of 6 months of Lean Leader Training, the first at UW Seattle, and the second group at Stanford, with a third to begin in Feb 2018.  We have successfully developed and deployed the strategy and goals outlined above. 

We now regularly engage units and have launched teams in coaching and mentoring resulting in dramatically improving the quality and effectiveness of viz boards and huddles, particularly those at 3172 Porter Drive. We have collaborated with SHC and SCH on the Safety, Quality and Value committee to adopt integrated and shared principles for process excellence programs that acknowledge the unique approaches of each entity while remaining in alignment overall.  We have rolled out a Process Excellence website and now post regular stories of process improvement efforts and successes.  We now publish a regular email Process Excellence Newsletter.   And we have established quarterly cross-unit board walks to share best practices across the SoM Operations Leadership.

It is naive to believe that long term and continuous efficiencies or effectiveness in healthcare, research, education, and administrative finance operations practices can be achieved without systematic tools and conceptual models to plan, understand, analyze and implement the diverse processes needed for effective improvements. That is exactly the potential role that Lean is intended to serve and that our SoM Process Excellence Program is working to deliver. The program is considered a key component of the Integrated Strategic Plan, and we encourage you to become an active part of this process.

Coming up

Jan 22 - Budget and Financial Planning Launch 90-Day Report Out 

Jan 23 - FY17 Lean Leadership Cohort- Final Session 

Feb 8 - FY18 Lean Leadership Cohort - First Session 

Feb 21 - Quarterly Wall Walk with Marcia Cohen 


Interested in a Launch?

I’m interested in using the launch process to help my team solve a problem.

Step 1: Are you a member of the Stanford School of Medicine?

Step 2: Start with a problem facing your team. Typically, this would be an area in where there is a gap between expectations and results.

Step 3: Discuss with your manager or leader, and contact us to determine if this would be a fit for a launch—usually a three-day event that focuses your team and customers on targeted improvements.

Step 4: We will work with your Team Leads/Managers to produce a scope document that sets goals aimed at significantly reducing your gap. The launch would then be scheduled, team members would be named, and facilitators and resources would be secured.

Step 5: The launch itself is attended by your team and a team leader; all participants collaboratively map the current and desired/future processes, along with issues and ideas for improvement. The final day includes a report out to your sponsors.

Step 6: After the launch, there are 30, 60, and 90-day report outs.