Rethinking Lean: Delivering Value with Purpose

Podcast Transcript

Beyond Leadership Podcast Series

Release Date: June 25, 2026

Expiration Date: June 24, 2029

Estimated Time of Completion: 40 minutes

Rethinking Lean: Delivering Value with Purpose

Jeffrey Chapman, MD
James Gutierrez, MD
Lisa Yerian, MD

Description

Welcome to L.E.A.D., a special series by Beyond Leadership. L.E.A.D. is an innovative, action-oriented framework built on four human-centered behaviors: Listening, Empathizing, Adapting, and Developing. In this series, we explore how top leaders apply these behaviors to build trust, foster collaboration, promote growth, and connect authentically every day.

In the episode, Dr. Lisa Yerian, Dr. James Gutierrez, and Dr. Jeffrey Chapman explore how Lean goes beyond cost-cutting to become a purpose-driven approach that empowers caregivers, improves processes, reduces burnout, and enhances patient outcomes. Through real examples—from redesigning workflows to improving access, teamwork, and caregiver wellbeing—the conversation highlights how Lean creates sustainable value and transforms the culture of care.

Learning Objectives

• Explain the core principles of Lean in healthcare
• Identify effective strategies for engaging frontline healthcare workers in Lean improvement efforts
• Evaluate how Lean practices can reduce burnout and support sustainable quality improvements

Target Audience

This program is designed for healthcare professionals interested in advancing their leadership skills.

Accreditation

In support of improving patient care, Cleveland Clinic Center for Continuing Education is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), the American Nurses Credentialing Center (ANCC), and Interprofessional Continuing Education (IPCE) Credit to provide continuing education for the healthcare team.

Credit Designation

• American Medical Association (AMA)

Cleveland Clinic Center for Continuing Education designates this internet enduring material for a maximum of 0.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Participants claiming CME credit from this activity may submit the credit hours to the American Osteopathic Association for Category 2 credit.

• American Nurses Credentialing Center (ANCC)

Cleveland Clinic Center for Continuing Education designates this internet enduring material for a maximum of 0.75 ANCC contact hours.

• American Academy of PAs (AAPA)

Cleveland Clinic Center for Continuing Education has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 0.75 AAPA Category 1 CME credits. PAs should only claim credit commensurate with the extent of their participation.

• Accreditation Council of Pharmacy Education (ACPE)

Cleveland Clinic Center for Continuing Education designates this knowledge-based activity for a maximum of 0.75 hours. Credit will be provided to NABP CPE Monitor within 60 days after the activity completion. Universal Activity Number List:

- Pharmacist UAN: JA0000192-0000-26-040-H99-P

• Interprofessional Continuing Education (IPCE) Credit

This activity was planned by and for the healthcare team, and learners will receive 0.75 Interprofessional Continuing Education (IPCE) credit for learning and change.

• Certificate of Participation

A certificate of participation will be provided to other health care professionals for requesting credits in accordance with their professional boards and/or associations.

Cleveland Clinic Planning Committee

James Stoller, MD, MS
Co-Activity Director
Chair, Education

Cecile Foshee, PhD
Co-Activity Director
Director, Office of Interprofessional Learning

Sawsan Abdel Razig, MD
Chief Academic Officer, Cleveland Clinic Abu Dhabi

Lindsey Amerine, PharmD
Sr. VP, Chief Pharmacy Officer

Lisa Baszynski, DNP
Executive Director, Associate Chief Nursing Officer

Colleen Carroll, MS
Sr. Director of Leadership and Learning

Matthew Donnelly, MBBS (Hons)
VP, Professional Staff Affairs

Mark Hamilton, MD
Cleveland Clinic London

Jospeh Iannotti, MD
Chief of Staff, Cleveland Clinic Florida

Debra Kangisser, PA-C
Office of Interprofessional Learning

Aanchal Kapoor, MD, MEd
Founder and Director of the Medical Intensive Liver Unit

Suchetha Kshettry, MD
Enterprise & Ohio Women’s Professional Staff Association President, (2025-2026)

Christopher Nagel, BA, MA
VP, Leadership and Learning

Silvia Perez Protto, MD
Immediate Women’s Professional Staff Association Past President, (2025)

Ronna Romano, MBA
Office of Interprofessional Learning

Stormy Sweitzer, PhD
Office of Interprofessional Learning

Faculty

Jeffrey Chapman, MD
Chief Quality Officer
Cleveland Clinic Abu Dhabi

James Gutierrez, MD
Chief, Primary Care Institute
Cleveland Clinic

Lisa Yerian, MD
Executive Vice President and Chief Improvement Officer
Cleveland Clinic

Host

Elizabeth Pugel
Global Leadership and Learning Institute

Cleveland Clinic

Disclosures

The Cleveland Clinic Center for Continuing Education has implemented a policy to comply with the Accreditation Council for Continuing Medical Education Standards for Integrity and Independence. This activity includes non-clinical content only. In accordance with the Standards for Integrity and Independence, identification, mitigation and disclosure of financial relationships does not apply.

CME Disclaimer

The information in this educational activity is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition. The viewpoints expressed in this CME activity are those of the authors/faculty. They do not represent an endorsement by The Cleveland Clinic Foundation. In no event will The Cleveland Clinic Foundation be liable for any decision made or action taken in reliance upon the information provided through this CME activity.

HOW TO OBTAIN AMA PRA Category 1 Credits™, ANCC, AAPA, ACPE, IPCE Contact Hours, OR CERTIFICATE OF PARTICIPATION:

Go to:

http://cce.ccf.org/ccecme/process?site_code=main&activity_session_code=EKCE02705

to log into myCME and begin the activity evaluation and print your certificate. If you need assistance, contact the CME office at myCME@ccf.org

Copyright © 2026 The Cleveland Clinic Foundation. All Rights Reserved.

Podcast Transcript

Kelly Hancock, DNP, RN, NE-BC, FAAN:

Hello and welcome to Beyond Leadership, a Cleveland Clinic podcast where we explore the many dimensions of leadership. I'm Kelly Hancock, executive vice president, chief caregiver, and administrative officer here at Cleveland Clinic, and I'm thrilled to have you join us. In this podcast series, we’ll feature conversations with remarkable thinkers, and uncover how their insights and experiences are shaping the future of leadership in healthcare. Now let's turn it over to our host who will guide us through today's enlightening conversation.

Elizabeth Pugel:

Often Lean gets a bad rap. Too many people hear the word Lean and think cost cutting or doing more with less. But in healthcare, true Lean is the opposite. It is about doing what matters most better. It is a powerful tool for creating real value, supporting our incredible caregivers, and ultimately transforming patient care. Hello everyone and welcome to today's episode. I am your host, Elizabeth Pugel, and this is Beyond Leadership. I am joined today by Dr. Lisa Yerian, Chief Improvement Officer. Good morning, Lisa.

Lisa Yerian, MD:

Good morning, Elizabeth.

Elizabeth Pugel:

We have Dr. Gutierrez, Enterprise Chief Primary Care Institute. Good morning, Jim.

James Gutierrez, MD:

Good morning, Elizabeth. Great to be here.

Elizabeth Pugel:

Thank you. And we have Dr. Jeff Chapman, Chief Quality Officer of Cleveland Clinic, Abu Dhabi.

Jeffrey Chapman, MD:

Good morning, Elizabeth, and good afternoon.

Elizabeth Pugel:

And we are excited to talk about Lean today. Together we will improve how Lean can be purpose-driven, how it engages caregivers in improvement, and how it supports both wellbeing and sustainable impact. Lean is not just about cost reduction; it is about creating value. At its best, Lean helps organizations focus on what matters most, creating processes that improve outcomes and minimize waste. Lisa, let's start with you. What is Lean? How do you explain it to a team that might not be familiar with the term?

Lisa Yerian, MD:

Yeah, it's a great question, Elizabeth, and I think it's a good place to start this discussion. Primarily, Lean starts with purpose. Every organization, team has a purpose. There's some value that we are creating. There's a reason that we're together doing this work.

For the Cleveland Clinic, it's about patients, it's about our communities, and it's about our people—our caregivers. So, we look at our purpose and say: “What is the value that we deliver? Why do we fundamentally exist?”

As we seek to create that value—to take good care of our patients or to make our communities healthier—we encounter problems and we encounter challenges. There are processes that we implement to create that value, and we can improve those. Lean is about figuring out: how do we constantly solve the problems and improve the processes to enable us to give more and more value to our customer (in our cases, that's the patient)?

So, when we talk about Lean, what we're really talking about are the methods, the tools, and the capabilities that we need to identify and solve those problems—to improve those processes, to ensure we can create more and more value for our customer. And what we see in healthcare, repeatedly, is that people like being able to take better care of patients and to be able to do it with fewer problems and less effort. And that becomes a virtuous cycle: people enjoy it and want to do more and more.

Elizabeth Pugel:

Great. Thank you. Jeff, do you have a powerful example where a Lean initiative created value that went far beyond the bottom line? Something that truly transformed a process a patient's experience, or improved how caregivers deliver care?

Jeffrey Chapman, MD:

Yeah, I do. I have a great one—and echoing what Lisa said, this started from the primary care team who had a purpose because they knew with our data, that we weren't providing mammography, breast cancer screening to all the patients that could benefit from it. And they knew it was important; they wanted to improve. And we got a team together with that purpose to guide us along.

And this is where Lean gets a little fat, because although we had a drive, we often found a first barrier: Did we have the right access to the data in the EMR, so the physicians knew who needed a mammogram? And that was just a first step, and this is where Lean gets fat—is that it's usually not just one simple drive to the truth. That's a straight line; you have to go through the cycle several times.

And each time we went through it, we found other barriers because our patients are complex and our processes are also complex. So, what we uncovered through the whole hospital was we weren't able to accurately know who needed a mammogram. We weren't able to easily order it by the physicians. And then scheduling it and paying for it was also difficult for our patient —and rescheduling if they missed it.

So, every iteration, every month, people were concerned: yet another barrier. But I thought, this is great. This is another turn of the cycle. And that's where the people need to have the passion on the frontline—and they do have it—to improve. And when they see those small steps adding up—because rarely is it just one obvious fix and you and everyone's happy —usually at those multiple little, little turns that really by the end of it, then you're, everyone's really proud and they're, they're proud of caring for those patients so well,

Elizabeth Pugel:

Jim, beyond the numbers, how do you measure the true success of a Lean project for patients, for caregivers, and for the overall care team?

James Gutierrez, MD:

Beyond the numbers, I suspect you mean beyond the dollars and cents or the FTEs—because I think it is important with any Lean effort that we have measures and metrics that we can follow to really determine. Are we being successful? I would get back to what Lisa said at the beginning, which is thinking about, number one: What is our purpose? And really focus on how can we measure the impact on that purpose? And that starts with our patients. For Lean to be successful, we want to see patient experience improve. And that is something we measure and we get feedback on. One of the things we ask our patients is: What is their perception of the teamwork in the care setting, whether it's the inpatient ward or the outpatient clinic? So, are we seeing our patients feel that the caregiver team is actually humming more smoothly over time? How easy is it for them to get their needs met or to schedule an appointment? That's also something we measure.

And we look at how likely our patients are to recommend our practices. Are they satisfied enough that they would actually recommend to their friends, to their family, to their neighbors, whatever Cleveland Clinic practice or situation that they've been in. I would argue that satisfied patients translate ultimately to better outcomes. So, I think looking ultimately at: Are you driving better outcomes for your patients? And that could be better in primary care, preventive care screening rates like mammography or chronic disease control for things like diabetes and hypertension.

I think Lean also impacts our caregivers and we measure caregiver engagement on an annual basis. But that's something as a leader or a manager, I think we try to have our pulse on throughout the year.

I think when you're in a situation and working with a team, when they're engaged, when they're happy, when they're at their best and when they're not. You can look at retention—turnover has been a huge problem in healthcare for many years. And are we moving the needle on people staying in their positions and growing and developing in place and even absenteeism—just feeling that day-to-day burnout because of inefficient processes or wasteful processes and ineffective teamwork and feeling like `I've had enough, I just can't take it today, I'm gonna call off.’ So, these are some ways that we can really say: Are we having the impact beyond just looking at what our expenses are, what our revenues are, what our volumes are, what our volumes are? on a daily basis.

Elizabeth Pugel:

And Jim, you mentioned that Lean starts with a clear purpose. What mindset shifts are needed for leaders and staff to see Lean as an opportunity and not as a threat?

James Gutierrez, MD:

Yeah, I can think of at least two. I think it needs to start with simply being open-minded, or having what is sometimes referred to as a growth mindset. I think it's important that people, when they undertake an improvement process using a Lean framework—or really any framework—they need to be willing to look with fresh eyes at what they're doing every day. They need to look at themselves, not as much as cogs in the wheel, but as someone who actually is enabled to look at how can we make those wheels turn better and more smoothly. I think more for leaders, it's also important to understand that there has to be an investment in this. I think you have to give people the space, the time and the support to actually step back a bit, get together and work on this. And that doesn't need to take massive amounts of time and day-long retreats. That could be very short meetings, huddles, any opportunities during the day where you can get the right people together from across the different functions of the team to really share their thoughts, bring ideas to the table, and then think about which ones should we implement and move forward? And then when we do that, how can we continue to iterate and continue to cycle and get better?

Lisa Yerian, MD:

Yeah, I appreciate Jim's comments. I'd like to share a few other things that are a bit sensitive, but I think are real barriers to us. Sometimes as leaders, if there are problems in our processes that people point out, we feel vulnerable. As a leader, we feel like we should be able to solve the problems, or that we're not doing a good job as a leader. So, we might feel defensive if somebody says, `Hey, this isn't working as well as it should,’ or, to use Jeff's example, `We're not getting our patients in for mammograms as often as we should.’ So, I think that's one. I think there's uncertainty when your team begins to use tools or techniques that you're not as familiar with. I think you could feel insecure or uncertain because you're not as familiar or confident.

I think it can question the leader's role. I've seen some managers and leaders become really inspired by how Lean helps them transform their team, improves engagement, reduces turnover, all the things that Jim mentioned. But there are other instances where people begin to question their own role because Lean really emphasizes empowering the worker; `respect for the workers’ is one of the key tenets. And so if your worker or your team member is now fully empowered to solve problems, your role shifts from you solving the problem to you really fostering an environment and capability for them to solve problems. That might be good in the end, but at the beginning it can feel very vulnerable because you're no longer the one who the team comes to, to solve problems. And that might be uncomfortable for folks.

The last one I'll hit on—and I think it's really important for creating a true culture of improvement, as we say, a Lean culture where everybody's fully engaged in identifying and solving problems every day—and that is around our fundamental beliefs. Do we fundamentally believe in the value of every caregiver and every caregiver's ability to effectively identify problems, understand root cause, do that analysis and go through those cycles that Jeff referred to of iteration progress, learning, hit the next challenge, iterate, figure it out. Do we believe that people are capable of improving value to our patient in that way? And we've seen a lot of reactions. Those are some of the reactions that create challenge.

Elizabeth Pugel:

As Lisa has mentioned, Lean is most effective when frontline caregivers are part of the process. Their insights drive innovation; they boost morale and lead to sustainable improvements. Jeff, what are some of the most effective ways you've seen leaders meaningfully engage caregivers in these initiatives?

Jeffrey Chapman, MD:

And it's really the caregivers also engaging the leader, because they will often bring up an event or a problem and say, `This is an issue where we don't think we are doing as well as we can for our patients, either giving them the optimum care or the optimum experience.’ And then the leader with that sensitivity to operations needs to then take that. And usually there's a barrier somewhere. It may not be in that team, but as Dr. Mihaljevic mentions, we're all a team of teams—but it may be that first team having an interaction with another group, and that's where as a leader, you've gotta facilitate those merging of the teams. Because often both groups are frustrated; both groups want to do better, and that's where you can sit down and achieve a common purpose. As we started, it's all with the purpose.

Get a common goal of what you want to improve. And occasionally I'll say this as a leader—sometimes I'll say, `This is something that we're not going to be able to solve. This is inherent to the complexity of this patient and it's hard work.’ But sometimes you can bring them together and you can say, `We can simplify. Let's improve what we can.’ And that gets to that defining part of once you have your purpose to define—and as the leader, bringing those teams together, eliminating those barriers. And then sometimes also saying, `I don't think that is possible right now.’ And that may be a tough conversation, but you have to have it because then they will get frustrated. And that's where the process breaks down when people don't see improvement: a futile goal.

Elizabeth Pugel:

Lisa, will you walk us through an example of a workflow redesign where caregivers were truly involved? What did the process look like and how did it affect patients and team dynamics?

Lisa Yerian, MD:

Yeah, so actually just recently saw a team share a really exciting one. And it was around reducing the risk of patients falling and getting hurt. Our teams have actually hit our enterprise target this year. And the way they did it was really to combine a few different Lean practices. So, we introduced daily visual management boards. That's a great place to bring the team together in a huddle and talk about how things are going. Are we succeeding in our goal or not? If we didn't, what's getting in the way?

They paired that with another Lean tool that they call a K card. It stands for a Japanese word, but basically, it's a card that shows some standard process that we need to follow, how to check it. So, each unit has a box of cards and every day leaders pick a card from the box, and they go to the patient's bedside, and they talk to the patient, and they talk to the caregiver to see: Did we follow that standard? And the card shows how to check the standard.

And if we did great, that's fantastic. We'll mark it on the board as green; we'll celebrate it with the team; we'll use it as an opportunity to share and learn and remind everybody. If we didn't hit the standard, then the flip side of the card shows what it is that we need to do about it. We put the standard in place, we talk with the patient, we talk with the caregiver, we make sure that it's been applied correctly in all of those patients. We put it on the board in red, we talk about it with the team the next day.

So, the team together really worked through how do we not only create better processes—which I think we often emphasize the invent better processes—how do we actually engage our teams in making sure that we're following them every day? And I think that requires constant attention, focus, feedback, learning, cycles of improvement. Those are really many cycles of improvement that Jeff referred to occurring every day on the floor. So, the teams have seen great progress, and they really like the process. It's collaborative, it's transparent, it's relatively simple compared to many other ways we've tried to solve this really complex problem. And so now they're looking at: How do we start to use these cards for other important processes in our care to make sure that we are checking, following them, coaching them, following them on a consistent basis.

Elizabeth Pugel:

That's a great example with the cards. Jim, from your experience, how does authentic participation directly impact staff morale, psychological safety, and overall buy-in?

James Gutierrez, MD:

Yeah, Elizabeth, I think in answering that I'd like to reference some ongoing work that we're doing in our primary care practices to really improve the efficiency and standardization of how we're handling various types of messages and work that comes into our physicians and our advanced practice providers’ in-baskets. I don't think primary care is unique, but perhaps more than any other specialty. There's a huge burden of messages coming into the electronic in-basket every day. And that on top of the day-to-day, face-to-face patient care, is a key driver of burnout. And that's not only at Cleveland Clinic, that's documented across primary care in general. We see a lot of wasteful processes in how we handle messages—messages not being handled by the appropriate member of the care team, messages being bounced from one to another person—and that really multiplies things.

So, one by one in our practices we've undertaken what we call Project Joy, because we're looking at this to really bring some joy back to the practice of primary care. On a practice-by-practice basis, we're getting the key members of our care teams together. So, the physicians, the advanced practice providers, the nurses, and the medical assistants, and the clerical staff, and really getting them together to do what we've been discussing here. They're the closest to seeing these processes. They know where there is waste and they're in the best position to identify what are some better workflows. And then once we determine those, how do we hardwire those into our practices? And I can tell you one of the challenges with our new organizational structure or OP model at Cleveland Clinic is that at the practice level those various groups kind of sit in different areas of the organization in terms of how they report, but yet they're all working side by side in the practice.

 A lot of this work was getting them to together, giving them a little time offline, and then really getting them to get to know each other better, share their challenges, and together work on solutions and drive that buy-in. So, we saw a huge impact just by doing that. And I think more importantly, we really laid the ground for ongoing improvement and success by just really assuring that those teams get together and meet on a regular basis, which wasn't happening in all of our practices for the last few years. And that, again, that builds trust. And trust is a force multiplier. Trust really enables people to work together. And it also enables people to tap each other on the shoulder and say: `Hey, you're not following the process. I'm not criticizing you, but I want to make sure we're doing things the way we agreed is the best way to do them for us and for our patients.’

Elizabeth Pugel:

Appreciate hearing a little bit about Project Joy. Jim, what did you notice in terms of the quality of patient care when caregivers felt ownership of the improvement?

James Gutierrez, MD:

Well, I think what we've seen in the practices so far—and I will admit it's early—is that there is more efficiency. We've been looking more at how it's impacting that in-baskets work. So, we're looking to see: Is there a lower number of messages? More importantly, are the messages being touched by less people and, ideally, being closed by the first person who touches them. I have to imagine that because of that, as that improves, patients are going to see that their issues are addressed more quickly: Their refills are done, their messages are replied to, they're given appropriate appointments or care sooner to when they call. Ultimately, that's going to lead to a smoother and more satisfying care experience for these patients.

Elizabeth Pugel:

Jeff, what challenges come with engaging frontline staff and how do you overcome them while still keeping patient and caregiver needs at the forefront?

Jeffrey Chapman, MD:

Yeah, that's a great question because you've gotta have the frontline caregivers. You gotta have the caregivers buy in and start working on this. And as I often say, we all have a day job. We all have work we need to do and we know we need to get done. And then on top of it, we're asking them: `Well, we want you to improve your work and make it even better.’ And as Lisa said, you have to subtly approach that and not say you're doing it wrong or something is poor but focus on the: `We can do it better and we can make your life easier.’ And that's where you have to, as Jim said, give them the space. And it doesn't have to be a whole day-long retreat, as Jim says—a focus time of getting the right people together who can define the problem and go on and start that first turn of the wheel. And that's where I think you have to get the buy-in. They have to see the purpose and then give them a little bit of space and say: `I understand this is not your main job description, but at Cleveland Clinic, it actually is part of your main job description to do your job and then try to make it even better. Because in the end, when you go home, you'll feel better, your patients will be better, and your team will be happier.’

Elizabeth Pugel:

The key to lasting improvement isn't just engaging caregivers, it is also about supporting them. Let's explore a core benefit of Lean, how it can reduce burnout and improve wellbeing by simplifying work streamlined processes and less administrative burden. Don't just improve efficiency. They can be a lifeline for caregivers, this is all about retention, their wellbeing, and ultimately patient safety. Let's talk a little bit about how Lean can directly help reduce burnout.

Lisa, will you give us an example of a Lean project that was specifically designed to reduce an unnecessary workload for caregivers? What was the impact?

Lisa Yerian, MD:

Yeah, so very recent one—a few years ago, I was asked to take over responsibility for the contact center. We started by spending time in the place where the work is done, or the `Gemba,’ as we say in Lean. And what we saw was caregivers who were working hard trying to help patients but hitting roadblock after roadblock after roadblock. And it's pretty discouraging to try to be empathetic when you can't actually help patient after patient after patient. I saw one instance where a caregiver took 10 calls and was only actually able to schedule one of the patients because of delays, and problems, and barriers, and blocks, et cetera. That had been—overtime —had accrued in the system. So, we did a few different things. One is we started tiered daily huddles, so caregivers on a daily basis could bring forth challenges, problems, opportunities, ideas, and talk about them with the team.

The second thing we did was introduced Kaizen. So, our Kaizen system we actually developed in 2013. It's unique to the Cleveland Clinic and it is a way for people to bring forth problems that they face in their work. We built that system, applied it within the contact center, and many of the caregivers work remotely. So, we have a virtual card that team members fill out. Our CI team created 15-minute introduction sessions to Kaizen, Waste, and Problems. I consider it `Kaizen Express.’ I watched it and I've been studying Lean for a long time. It is a fast explanation of Kaizen. And so, the team members are really encouraged to—when they encounter a problem—to identify it, fill out a card, which is a short quick process. And then the team huddles every week on the cards that have been submitted and looks at each one to decide, as Jeff indicated: Which ones can we solve? Which ones are within our power? Which ones do we want to prioritize? Which ones do maybe we need to set aside, wait for later, give it to somebody else, engage a different team.

Through that process, the team has solved almost 300 problems that they face in their work. They've improved engagement and reduced retention. They consistently now achieve an 80% service level. So that means 80% of the calls into that team are answered within 30 seconds. Now, that's not all calls system wide—so it's not anywhere you call the Cleveland Clinic—but if you call the contact center, 80% of the time you're gonna get somebody picking up the phone in 30 seconds and they're much, much more likely to be able to actually help you, which of course is much more rewarding. So, we share that information back through the tiered huddle so the team can see: Not only did my card or my idea get looked at, considered, or solved, but look at the impact we're having collectively on our patients. And then we also feedback some of the other data points like Jim shared around patient experience. What are our patients telling us about how satisfied they are with how easy it is to schedule care? And what we've seen is year over year, we're improving about a decile every year, which is pretty remarkable improvement if we look across the country at how quickly people are able to change access.

Elizabeth Pugel:

I love the idea of the Kaizen Express <laugh>, Jeff, question for you. How do you balance simplification with the complex realities of healthcare where patient needs are constantly shifting?

Jeffrey Chapman, MD:

Oh, good question. And, the caregivers know that they know how complicated our patients are. And I’ll use two HRO principles: One is deference to expertise. Ask an expert, What can we do here? Get some smart people to think about what our problem is—defining it and what our possible causes are —and then also sensitivity to operations. I've seen many times where leaders have tried to solve a problem just by telling their folks or their teams to not cause the problem anymore or just to fix it. And that sensitivity to operations to really walk in the shoes and do the Gemba walk and understand. And that gets the two-way buy-in of true understanding and then also know when to say, `Hey, sometimes you've gotta phone a friend and call it an expert to get some input to guide you forward.’

Elizabeth Pugel:

Jim, I'd love to get your insight on ensuring that Lean projects remain focused on people and not just the process. How can we ensure that that is happening and that both caregivers and patients experience meaningful improvements?

James Gutierrez, MD:

Yeah, I think it starts with something Lisa brought up earlier. To really be successful with Lean methodology, it has to start with truly valuing and truly respecting every caregiver and every member of the care team. Because if you don't have that, then it's really impossible to fully engage them and support that engagement. Beyond that, you really need to ensure that you're bringing the right people together from a range of backgrounds, really ensuring that all the stakeholders are involved. And we often forget patients in that. So, Cleveland Clinic has a very robust program of patient panels and patient enablement that really encourages the pulling in of patients into many different design and decision processes, leadership groups, etc. And that’s really important as well, because as we've said, it all starts with our patients as well as our caregivers.

I think you have to ensure that the people who live this situation, live this work every day, are listened to, that the ideas that they bring forward are fully vetted and respected. And then finally, in terms of patients, you need to look to link our patient outcomes, ultimately the results of the care we're providing to the processes that hopefully we've improved to ensure that we're ultimately driving to that purpose, that outcome that we're aiming to from the beginning.

Lisa Yerian, MD:

Jim, I have a question for you. I fully agree with you about the importance of having that foundation of the team: valuing each other, respecting each other. I'm curious: Have you seen cases here, where that's not the case and you need to start there first? And if so, how have you addressed that? Because I agree with you; I think it's going to be hard to make progress if you don't address that first.

James Gutierrez, MD:

Yeah. Lisa, that is not only something I've seen, but it's a frequent challenge in some of our practices. And I think a lot of that is because we’re obviously very busy at Cleveland Clinic because of that operating model—I mentioned sometimes people are receiving direction from various areas and there's not full alignment on that. And when you're busy and you're working hard and bordering on burnout, sometimes it's easy to point to someone who truly is on your team, but you can perceive as being on another team and say: `Well, it's all because of them.’ So, I think it really gets back to number one: just getting people in the same room and building that relationship and building that trust.

And as you can imagine, more often than not, you realize we’re all good people. We all want the same things, we're all driving toward the same purpose, and we can do this. Occasionally, there are circumstances where there are significant issues with interpersonal interactions and that's when we escalate; we escalate to leadership, whether that’s at the local level, the departmental level, human resources, whatever the case may be, and really look for opportunities to mediate the situation. And, fortunately, not that often, but occasionally, it takes changing some of the personnel to really get to a better place where everybody can lock hands and row in the same direction.

Elizabeth Pugel:

Simplifying work helps reduce burnout and the ultimate goal of Lean is to create sustainable value. When you get that right, you get lasting improvements in safety, quality and the caregiver experience. Effective Lean strategies prioritize safety, quality and caregiver experience. Cost reduction becomes a byproduct of value creation, not the main goal. Lisa, can you share the single most important thing leaders can do to sustain this momentum?

Lisa Yerian, MD:

Actually, I think the most important thing is to feedback to the caregivers the impact of their work. We learned early on in our journey that the most impactful thing we could do was show people their ability to make a difference: what the impact was of their work on their fellow caregivers, on our patients. Seeing that through data was powerful. It feeds the beast. People want to make a difference. They want to find meaning in their work. And so, the faster that we can get that in front of them, the better. And it's not always easy or obvious to know that we see the big picture data all the time, we're talking about it, but it doesn't always make it back to our teams. And so, taking the time to consistently make sure that your teams understand the difference they are driving is probably the most important thing that we can do.

Elizabeth Pugel:

Jeff, what advice would you give a leader starting a Lean journey who want to avoid any common pitfalls?

Jeffrey Chapman, MD:

Wow, that's a great question. There are so many common pitfalls, like we've all said: You've gotta start from the buy-in and the purpose as we began this discussion. And then, as Jim said earlier, you've gotta have everyone on the team. They all may be a little different and have different expertise, but they've all gotta respect each other, work together and be rowing in the right direction.

And I often say everyone wants to jump to the solution and solve the problem and move on. Let's spend a few more minutes trying to understand the cause before we jump to a solution first—understanding that will we just be generating more waste and be unlean if we go down a divergent pathway. So often those first steps of starting off slow or even not moving, and it's like when we all take care of patients. Sometimes just watching the patient listening to them gives you the most insight. So, understanding the problem, but then also realizing that the first problem you see is just the first problem you see. You're often, as Lisa mentioned, you're going to turn that cycle many times. And then once you've succeeded, like Jim said, that's where it brings in the pride and that's where it's infectious. When you've gone through those multiple turns and then have achieved something.

Elizabeth Pugel:

We've explored Lean as a purpose-driven approach, engaging caregivers, reducing burnout, and creating value. Let's close with each of your reflections on the future of Lean and healthcare. Jim, if there's one single misconception about Lean that you could clear up for our listeners, what would it be?

James Gutierrez, MD:

Yeah, I think that brings us back, Elizabeth, to where we started, which is Lean is not fundamentally about doing more with less. And I think there's something about the word Lean that immediately gets people who aren't familiar with what it means to go there. In fact, I'll call out my wife when I told her last night that I was going to be doing this podcast about Lean, she said: `Oh, what's Lean? And that just sounds like doing more with less.’ And sorry honey—to if you're listening to this —but really framing it to: Lean is about number one, having the right amount of resources to take care of whatever you need to take care of—to do the job and to have the right processes that do the job with the right amount of resources, and avoiding waste.

And I think if you could help frame it that way, everybody can understand what waste is because we could look at our day-to-day work and identify a dozen things off the top of our heads that are wasteful: unnecessary movement, unnecessary mouse clicks, whatever the case may be. If you really frame Lean as a way to reduce that, and do the job more effectively and efficiently, and get to where we want to go with that purpose in mind, that makes it a much easier thing to sell.

Elizabeth Pugel:

Lisa, for leaders listening who want to act now, what is one small Lean inspired change they could make tomorrow that would have a big impact?

Lisa Yerian, MD:

I'd say spend time in the place where the work is done. Spend time in the `Gemba.’ Time and time again, we have an impression of what's occurring, or how it's occurring and it's different from what actually is. I'll share a quick story. Many years ago, we were working with the sleep center here, and the team was looking at trying to serve more patients—and of course it started with probably a volume target. And they saw that one of their labs had the highest no-show rate and they couldn't figure out why. So, the manager of the area took it upon herself to drive out and visit. She couldn't find it.

Suddenly she had a really good impression of why maybe we had a high no-show right there. And of course, then very quickly started to implement steps to make it easier for patients to find that lab. It's just so incredibly powerful. It shows respect for the work for the worker. It helps us understand how values created, where problems exist or waste exists, that's getting in the way of value, and it's a really good way to build empathy and to understand what's getting in the way for our caregivers.

Elizabeth Pugel:

Jeff, same question. What is one small Lean, inspire change that could have a big impact?

Jeffrey Chapman, MD:

As Lisa said, going to where the work is and walking the `Gemba’ and listening and when someone has a, an issue or an event or a complaint or brings up a: `Gosh, I hate it when this happens’—to take the time and say, ‘Can we remove this barrier? Can we solve it? And, then get the frontline involved. Cause they know the barriers are right there. And sometimes they are just aspects of the business, but many times we can help, and we can remove them and that will get them inspired.

Elizabeth Pugel:

Thank you all. Your insights were absolutely brilliant.

Thanks for joining me today on Beyond Leadership. I hope this conversation sparked new ideas on the topic of Lean and how we can put patients at the center of everyday process. If today's episode gave you something to think about, please share it with your colleagues and follow the podcast so you don't miss what's coming next. I'm Elizabeth Pugel, and together we'll keep building a better, safer, and more efficient healthcare system. One improvement at a time. Stay curious.

This concludes another episode of Beyond Leadership. You can find additional podcast episodes on our website, clevelandclinic.org/beyondleadership. Or subscribe to the podcast on iTunes, Google Play, Spotify, or wherever you get your podcasts.