1. 1 The Group Health Lean Journey Laura McMillan – Vice President for Strategic Planning and Deployment WA State Lessons in Leadership Symposium - March 24, 2011

2. 22 Group Health  Consumer governed, not-for- profit financing & care delivery system  628,203 insured lives  9,599 staff  26 primary care centers  6 specialty care units  82 specialties & subspecialties  22 county service area in Washington & Idaho  Contract with 9,000 practitioners and 39 hospitals

3. 3 Why Lean?

4. 4 The Strategic Imperative

5. 5 Implementing Lean

6. 6 “I have my real job and now I have my Lean job too.” Sustainability Challenges

7. 7 Model Line: A Learning Lab

8. 8 Path to Success?

9. 9 Lean Management System MBO Management System Problems are the result of, or lack of accountability Decisions are influence and status driven Solving problems from a conference room or office Being a master of management Having all the answers Improve the results!...and send me an e-mail when it’s done Problems are the result of process breakdowns and accountability for addressing them is clear Decisions are data-driven Solving problems in the workplace Being a student of leadership Asking the questions and expecting others will develop the answers Improve your thinking to improve the results and I’ll “check” back to hear your thinking and see the results Choice Point

10. 10 The CEO Factor

11. 11 Standard Calendar for Senior Leaders

12. 12 From To Building Leadership Capability

13. 13 From Executive Gemba Thursdays To

14. 14 Visual Systems and Data Cost = Quality = Service =

15. 15 Our Customers Strategy Deployment Our Customers Cross – Functional Management People System Financial System Our People Plan Set standards From customer requirements Standardize key processes Do the work using: Visual Systems that drive action to meet targets Check Workplace Rounding Standards in place? Standard work? Adherence? Linked Checking Meeting targets? Act A3 Thinking Coach staff, to identify root cause Daily Management Continuous improvement in customer care & experience

16. 16 Phases of the Journey Phase Zero: Exploration Phase One: Building the foundation Phase Two: Expanding with tools & deeper thinking Phase Three: Integration and reinforcement Phase Four: Systematic superior performance We are here Initial exploration into benefits & challenges Awareness & general understanding Some use of tools Activity Level Beginning to understand tools Uneven application & not tied to management systems Education begins in earnest – learning, applying, reflecting Marked by intentional learning Initial establishment of systematic approach Broad education across enterprise Specialized resources developed & deployed Integrated into management processes that have feedback mechanisms to reinforce them Increased and deeper systematic work The way we do business and we are getting the results that reinforce that expectation

17. 17 Results n Staff engagement n Medical Home n Care Transitions n Administrative costs flat n Clinical cost trend far below national average n Care delivery improvements n Medicare Value Stream n Awards: JD Power, Consumer Reports, Puget Sound Health Alliance, NCQA etc.

18. 18 What are we working on now? Stability of system – both what and why (Principles) More front line driven continuous improvement Use of lean principles in design (products, services, buildings) Broader value streams across organizations Implementation of large systems

19. 19 Our Lean Journey…

20. 20 Mental Models of Leadership As leaders, what has made us successful in the past, may not serve us as well into the future…

21. Reflections