The Lean Journey

Greg Souza of Stanford Children’s Health is paving the way for the future of pediatric healthcare through a major organizational culture shift

Stanford Children’s Health is entering one of the most exciting phases of its nearly one hundred-year history as an organization as it prepares to celebrate an impressive milestone. In December 2017, Stanford Children’s Health completed its first major expansion since opening the Lucile Packard Children’s Hospital in 1991. The new hospital campus is the culmination of a $1 billion, multiyear journey that aims to transform the patient and family experience and make Stanford Children’s Health a leader in children’s healthcare for years to come. For Greg Souza, the organization’s chief human resources officer, the expansion is about more than a new state-of-the-art facility. It signifies a major cultural shift within the organization.

“We have been shifting or changing from just a hospital to a children’s health system, creating an enterprise approach to deliver pediatric care across a broad geographic expanse,” Souza says.

About three years after Souza joined Stanford Children’s Health in 2007, the organization started looking at adopting a lean management system. The journey started by researching Seattle Children’s Hospital, which had already adopted a lean management approach to children’s healthcare. Stanford’s leadership team even visited the hospital to get a better sense of the process.

Greg Souza, Stanford Children’s Health

“We came back and felt that, yes, there were some intriguing aspects in terms of what this management system could do in creating greater efficiency within the hospital and improving our abilities to deliver care,” Souza says. “That was really the beginning of it.”

So in 2010, Stanford Children’s Health officially began introducing the Packard Quality Management System (PQMS), which was its own take on the lean management system. According to Souza, PQMS is not just about efficiency and cost reduction. Rather, it’s about continuous improvement in every respect.

Souza points to patient flow as one example of where the organization has improved. As patients need admission into the hospital, Stanford Children’s Health now has staff that works specifically on looking at the number of surgical cases planned for the day, the number of available beds, the amount of discharges, and if the hospital has the proper rotation to create the acceptable flow of patients in and out of the facility.

When the organization began to introduce the program, the human resources department was instrumental in unrolling it throughout the organization. This happened with two programs.

First, HR introduced PQMS to the organization with the Stanford Children Health’s Leadership Academy. In this program, leadership development staff from Souza’s team worked closely with some leaders in the process improvement office.

“The approach we were taking was to recognize that as a lean system is introduced into an organization, it’s not just about the tools, if you will, but it’s also very much about the mind-set,” Souza explains. “You have to marry these two things together or you can’t really make any progress. That partnership started many years ago and has continued.”

After the Leadership Academy unrolled the tools and mind-set of a lean management system to leaders throughout the organization, human resources then progressed the roll out of the lean management system with the Coaches Academy. Similarly, the Coaches Academy trained leaders in the company on lean tools and the mind-set required to be a successful lean leader. The Coaches Academy, however, trains managers throughout the organization rather than only company leadership.

The three-day program was broken down into three focuses. The first day focuses on shifting the mentality to align with PQMS. The second and third day focus on the more tactical aspects and help managers learn what it takes to actually coach staff and to be coached.

“At a practical level, what we were trying to do was shift managers’ behavior from being an authority figure and addressing immediate needs to exploring issues with an individual and facilitating their development process,” Souza says. “There was a whole process around identifying or examining some underlying assumptions about what works and what doesn’t and about why people don’t perform effectively.”

Following the Coaches Academy, Souza and his team provided managers with a ninety-day virtual learning program called Coach the Coach. The program alerts participants via text message when topics that may interest them are available.

At the end of the program, Souza and his team felt as though it was a success, and they eventually had the data to back that up. “We did a survey about people’s willingness to coach and willingness to be coached before the program, and then we did it again after the program and saw significant improvement in both areas,” he says. “They were much more comfortable with the idea of acting as a coach, but most importantly, to being coached. That can affect either their relationship with their own leader or with each other as peers.”

The implementation of a lean system has not only affected leaders throughout the organization, but it’s also affected the way Souza leads the HR department, which is made up of about fifty people. Since adopting PQMS, HR has unrolled a daily management system to each subgroup within the department: compensation, talent, benefits, learning and development, and operations. In this system, each group has a daily huddle, and they also use a visual management system where they use a whiteboard to track major components of their work to track progress and ensure everything is aligned with the core values of the company. And they’ve used the visual management system to help solve issues as large as revamping the organization’s recruitment system to most recently unraveling some of the complexities of leaves of absence.

Now that Stanford Children’s Health is more than seven years into its lean journey, the organization is seeing major improvements and continual advancements across the board. It’s also spurring collaboration across departments and functions. One initiative in particular that’s a priority for the organization is the Optimal Human Experience.

This idea dates back to late 2013, when Stanford Children’s Health began working with Bridget Duffy who was, at the time, the CEO of ExperiaHealth and the former patient experience officer at Cleveland Clinic. The idea is that patient experience, employee experience, and physician engagement all feed into and affect one another.

“The dots started to really connect that you can’t really improve on one without the other,” Souza says. “It led us to this concept of looking at the optimal human experience and how could we actually achieve that.”

So Souza, along with the vice president of medical affairs and the chief operating officer, began looking at engagement and experience numbers from everyone throughout the organization. By working together, they believed they could create the Optimal Human Experience, a goal that they’re still working toward. And taking this theoretical concept to their teams, they found that there were many actionable items that could improve the experience for patients, staff, and physicians alike.

“We’re looking at how to take action within our work environment that will ultimately translate to the work we do caring for patients and families,” Souza says. “That includes looking at how we care for ourselves.”

Now, as the new hospital and Stanford Children’s Health continue to grow its footprint in the healthcare industry, Souza will continue to improve upon PQMS, focus the organization on the Optimal Human Experience, and positively affect employees through wellness programs, coaching, and positive cultural change.