ThedaCare at Home learns from gemba

APPLETON, Wis. - It's called “going to gemba”—a Japanese word that's part of the Lean lexicon, meaning going to the heart of the work to study core processes.

It's a place ThedaCare at Home goes frequently, but not just for observation. This Appleton, Wis.-based provider uses the principles espoused by the Toyota Production Method to find and eradicate muda (waste), mura (unevenness) and muri (overburdening).

“It boils down to simple things,” says Randy Lutz, manager of HME operations and support services for ThedaCare at Home, a 370-employee division of a 6,800-employee integrated health system. “Ask your staff, 'What are the things that get in the way? What are the things that are wasteful in your day? What causes rework?'”

Not long ago, ThedaCare at Home was averaging $58 per delivery, including fuel, truck maintenance and salaries. After scouring for waste, Lutz and his team brought down that per-delivery cost to $36, while also improving driver safety.

Next, Lutz divided the volume into “skilled” and “non-skilled” deliveries, outsourcing non-skilled deliveries—which don't require any patient communication—at a cost of $18 each. In July alone, Lutz was able to divert nearly 500 of his 1,750 deliveries to a delivery partner.

A rarity in healthcare today, ThedaCare also holds to a no-layoff policy, so improvements in efficiency don't translate into workforce reductions.

As a result, employee satisfaction is up. Between 2011 and 2012, the number of staff reporting they are “engaged” rose from 14.3% to 37.5%, and the number of “ambivalent” staff decreased from 38.1% to 12.5%.

“There was a time when supervisors were supposedly the smartest guys in the room,” Lutz says. “We are an inverted organization. Staff are the ones seeing the improvements that need to be made, and they can go home knowing they've made a mark with the work they do.”