February 4, 2013
The Lean Virus has hit the Federal Government….Kaizen!!!

By Mindy Hangsleben (@MindyHangsleben), External Fellow for the Clinical Quality Measures Project

We just finished an amazing, exciting, empowering Kaizen (continuous improvement) Event focusing on leaning out the electronic clinical quality measurement development cycle.  Stakeholders gathered from all parts of the process to “map it like it’s hot” for a full 5 days…and believe me they mapped it like it was hot.  The event included folks all the way from federal employees to EHR Vendors.  With over 100 attendees, most of which had never participated in an event like this, we had 8 different scopes where we mapped out the current state of process, defined our ideal state, and then built our future state.  The current process timeline takes anywhere from 3-5 years and is filled with defects with our future state we hope to knock this down to 1 year and a large reduction in defects.  Throughout the process we were excited to uncover the horrors of our waste which included crazy amounts of re-work and multiple layers of sign-off causing significant wait time.  Not only did we uncover the horrors, we also learned about different roles throughout the process.  Many folks commented about how they didn’t realize that the other person had the same inefficiencies within their processes.  In Lean we always say bad systems beat good people, most of the time we don’t understand what others processes are and we tend to blame the people before looking at the system.

Throughout the event we shared our a’ha moments with our Senior Leaders.  It was a true reflection of how folks from different strokes can come together and really make things happen.  A couple that really resonated with me was when the HHS CTO joined us and a contractor stood up and shared how empowered she felt and the excitement around collaborating to enable the future state process.  Another external participant shared how for five years she has been dealing with enormous amounts of waste and frustrating processes and she finally felt like she was heard and now there is hope that it will be fixed.  Can you imagine working in an environment where change seems so impossible that you are always stuck banging your head against the wall?  Believe me, I have never worked in a place where I have felt so landlocked by restrictions and policy that even doing the smallest things like trying to hold a meeting with external stakeholders took me two months of very, very persistent follow-up and trying to  get approval even when the funding was ridiculously minimal.  Remember no free lunch with the government like the private sector. image

Personally, I could have never held this event without the support of Senior Management at CMS, ONC, the Secretary’s Office and the two Lean expert trainees.  Out of the senior leaders, two of them, who are very dedicated to this process, spent all week with us mapping and busting rocks.  That being said five days is a huge time commitment and this really shows how all parties involved are ready for change and are committed to making it happen.  In addition, the two lean experts were phenomenal and saved me quite a few 12 hour work days.  Last but not least the participants were amazing and so open to learning the process and working to remove waste. 

There was so excitement and energy from the group.  Usually these events are so draining that most people are dragging by the end of the day…not this bunch! 

On our final day of the Kaizen we held an optional networking lunch before folks flew back home.  It was crazy how many people showed up, I thought most would have been drained from the 5 days but they still had a ton of momentum and energy.  As I sat at lunch I observed how many relationships had been built over the week and could feel the empowerment.   I even had one group approach me with a picture of a mapping they had put together when they were out one night.  They were working on Leaning out one of the participants dating process.  How funny and touching at the same time…in the back of my mind I was asking myself is everyone was carrying around mapping supplies after hours, what have I done to these people???  There goes the virus spreading again, hopefully it moves as fast as the flu.  One by one folks continued to approach me and share their excitement and feelings of empowerment.  I believe this is the first time in the federal government that anyone has taken on such a task.  If any group can get er done I believe it is this one.  I can’t wait to implement all of the great work everyone did.  I will leave you with one final note never underestimate the power of the post-it!!!  Great job everyone!  If you attended please share any stories or reflections by selecting the comments below.

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