But take a look anyway, if you have an interest in process improvement in hospitals. This is a collection of my best posts on this topic.

Sunday, February 23, 2014

This is not my main blog

Hi and welcome!

You can find my main blog here.

I have gradually copied posts related to transparency and Lean process improvement to this blog to serve as an archive and resource to people in hospitals who might want to review the experience at Beth Israel Deaconess Medical Center and other hospitals and apply lessons to their own institutions.  (You can also search "Lean" and "transparency" on my main blog and find most of these, but the search engine is not always complete, so you might find this a more useful place to review those posts.)

I've also included stories from training programs I've conducted around the world on this topic.  What a pleasure it has been to meet thoughtful and well-intentioned people in other countries who are interested in enabling their hospitals to become learning organizations.

Our early version of Lean in the Boston hospital was called BIDMC SPIRIT, so you will see a number of blog posts that refer to that.  We came up with the concept of SPIRIT in November of 2007.  All of the stories during the "SPIRIT" era had the logo atop, to provide a touchpoint for our staff.  I've left some, but not all, of those logos on these reprints to give you a sense.  Eventually, by July of 2009, we let SPIRIT die away as a program "brand," but the lessons we drew from that stage in our institutional development were extraordinarily helpful as we rolled out a philosophy more directly based on Lean principles.

People often ask me how many staff members read my blog during the period covered by many of these posts.  It is impossible to tell exactly, but the likely range is between 1500 and 2000 each day, out of the 6000+ FTEs and 900 doctors on staff.  Some people regularly went to the blog link daily, others subscribed through Feedburner or another aggregator service, some read it on Facebook or Twitter, and others were referred to it by the clipping service published electronically each day by our media services department.  I know, also, that when a specific staff member was mentioned in a blog post, s/he would circulate it widely to family, friends, and co-workers.  This, in turn, led many people to send me story ideas about programmatic successes and setbacks, whether in clinical care or logistical or administrative arenas.  It is hard to overstate the importance of this medium as a leadership, team-building, and institutional communications tool; but a very important aspect of that was that I wrote the posts myself, keeping them current and in my own voice.

But blogging is really not the main point here.  What you see documented is a consistent and decided institutional commitment to transformational change.  It takes a long time and with constant reinforcement from the top folks to fight inertia and entropy and build sustained momentum for this kind of change.  While the senior management has to work really hard to make this work, my personal involvement and interest as CEO and that of the Chiefs was essential.

Another lesson is that personalizing the stories of success and setbacks is extremely important.  You cannot overdo the recognition of individuals, whether formally or informally.

Finally, this approach really works on many dimensions of quality and efficiency, as Steve Spear, John Toussaint, Gary Kaplan, Jim Conway, Bruce Hamilton, Jim Womack, John Shook, Peter Pronovost, Brent James, Mark Graban, Jeff Thompson and the others say.  If there is any path for a general hospital or academic medical center through what is coming down the pike in terms of government and private payer revenue restrictions, and demands by the public for more personalized medical care, this is it.  The attached scatter diagram from The Leapfrog Group is one indication of the kind of results that are possible.

(I have not transferred all the many thoughtful comments from these blog posts.  You will need to go back to the originals to read those.)

I have also transferred a blogroll here of useful resources in this field.  You will find some of the world's experts listed therein, but also real-life people reporting on the work in their hospitals.

Best of luck to you as you make health care safer, higher quality, and more efficient!


  1. Mazel tov!

    Where's the "subscribe by email" thingie??

  2. Thanks Paul. We're all learning to SAY "Value." ACHIEVING it is another thing. As I reviewed the prior posts, I thought what a great gift this is. Thanks again, Jim