Those of us who spend time in the hospital have likely seen the addition of a feature from the
automobile manufacturing floor to a number of patient care and support areas. The lean production
process derived from the Toyota Production System has been adopted by a number of leading health
systems including ours.
The lean process is aimed at focusing co-worker time and energy on things that
add value to our patients and reducing everything else.
The “lean board” is a running scorecard for how we’re doing at fulfilling that principle and is updated
each day in a huddle with team members. This board is organized with the five areas of excellence our
organization is focused on: clinical, service, cultural, financial and community. Even if you’re not familiar
with that list, the first four probably seem fairly obvious and straightforward. One would hope that any
health system would aspire to have excellent clinical outcomes, an exceptional patient experience, an
engaged group of co-workers, and to fulfill their mission while achieving financial profits to sustain the
organization over the long term.
But what does an excellent community look like and how does a health system make it more excellent?
If you look closely at the lean boards, you’ll see the difficulty in answering that question. The
“community” portion of the board is often blank.
Here’s what we know: Communities with excellent health have low rates of poverty, heart disease,
cancer, stroke, hypertension, COPD, diabetes, obesity, asthma and low birth weight babies and a high
percentage of people with health insurance. Health insurance is a key driver of health status as lack of
insurance is a primary barrier to primary and specialty care and other health services. Greene County is
2 percent higher than the rest of Missouri’s adult uninsured rate and roughly 36,800 adults without
health care insurance.
Here’s what we don’t know: How does our organization make an impact on those metrics? By growing
the number of patients we care for, we’ll be able to create some new jobs but even the most optimistic
would find it unrealistic for us to make a meaningful impact on the region’s poverty. Similarly many of
the diseases listed above such as COPD, obesity and heart disease are the result of behavioral habits
made by individuals. Even with our most idealistic glasses on, it’s hard to envision a health system
capable of reaching into people’s lives to affect years’ worth of habits and decision-making.
Which leads to this. We can’t do everything, but can do something, and we shouldn’t let all that we
cannot do interfere with what we can. When we look at that blank community space on the lean boards,
what should we fill it with? What should we be doing for our community to make it more excellent?
I am interested in your thoughts. Email me at alan.scarrow@mercy.net.
