How to use lean in healthcare IT

Benefits grow as a result of experimenting and tweaking, says Sue Schade.

Recently, I had the opportunity to share lessons I’ve learned as a lean leader and champion—in particular around visual management. I was honored to give a presentation at the Lean Enterprise Institute (LEI), which holds an annual Lean Transformation Summit at which experts and practitioners come together from all industries to learn from one another.

My talk covered a multi-year journey that has involved learning from others—both in and out of healthcare, site visits, training classes, lots of reading and experiments with my leadership team. Most of my talk is based on my experience and lessons learned at the University of Michigan Health System.

I was delighted to see that University Hospitals, where I’m currently the interim CIO, has been on its own lean journey since 2011. At our hospitals, you will see huddles and visual boards throughout. Thousands of staff have been trained in lean concepts and methods. In contrast, there have been limited experiments with lean at the corporate office. I have a few allies in my IT leadership team who have experience with lean in other organizations.

I would have been making a mistake to arrive at UH as the interim CIO and start introducing lean methods the first week. I needed to see and hear the problems that need to be addressed. There are gaps, even though the internal processes are good and everyone is working on a long list of projects. Teams could coordinate better.

At our weekly Project Management Office (PMO) meeting, we review a long list of projects, focusing on those with a project health status of red or yellow. But with so many projects, it’s hard to see the forest for the trees. What are the top 20 projects that are most important? We should be focused like a laser on the most critical projects and initiatives.

I am beginning to socialize with my leadership team the idea of regular huddles and a visual board that covers the most critical projects. I’ve identified and shared with them my top focus areas for this interim engagement. I developed the list in my fifth week and validated it with my boss after a lot of listening to my team and UH executives.

The whiteboard in my office is my visual management canvas. My focus areas are listed. The proposed critical projects and initiatives are listed and refined as I bring my VPs in to see it and give their perspective. Each of them do a weekly “quad chart” and those are posted there. They are one page visuals that the former CIO introduced. The four sections are: “now/this week,” “later/immediate horizon,” “barriers/issues/roadblocks” and “immediate action required.” There is also a fifth section in the middle called “wins.” At a glance, I can see where they are focused and the issues they are dealing with that may need escalation. It’s a great tool that I plan to copy in future organizations.

Here are the key takeaways and lessons that I used to close my talk:

Leader as champion. The success of lean efforts in any organization depends on the top leader committing to it, driving it, supporting it and spreading the word. If I’m the top leader of IT within my organization, then I need to be the champion.

The need to be vocal and visible. The leader needs to talk and write about it so everyone can see you are committed to the journey and that it’s not the “program du jour.”

Limits of the “just do it” approach. I’m an impatient person, and I want things to happen quickly. I like to get through planning and design phases quickly and just do it. I’ve learned that it takes time to be successful with lean. You need everyone on the journey, so be patient and figure out how to bring them along.

The need for an overall program owner and driver to partner with. You can’t do it yourself. Find the person on your team who shares your passion and commitment, and partner with them to make it happen.

Letting go so others can develop and shape it. You have a partner, so you don’t have to do it all yourself. And that means it may not look the way you think it should.

Be willing to experiment, and don’t get stuck on perfection. In IT, we need to have everything well designed, built and tested before we implement. People depend on our systems. But with lean, you can experiment and tweak as you get some initial experience and learn what works. As you adjust it, ask yourself if that is what better looks like.

Ownership by the entire team. Like anything a team does, the leader can’t own it by themselves. It’s a team effort that takes buy-in and ownership from every member.

Plan, do, check, act. At the right intervals look at what’s working well and what’s not. Make adjustments and implement. Then repeat.

Be patient, but persistent. No further explanation is necessary.

Sue Schade's blog can be accessed at

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