Keys to Process Improvement

"Demand always exceeds capacity," she said. "These same challenges underscore how important it is for the safety net to make this operational improvement to continue to be here to serve that population."

Thus the urgency—and the need for transparency.

Every performance improvement project in progress is detailed on bulletin boards in the hospitals' most frequently used training room. Each has a clearly stated monetary goal, and progress toward that is charted regularly for all who care to see. That creates a sense of competition and a sense that the efforts truly matter and are recognized at the highest levels of the organization.

Denver Health now trains its own black belts, said Philip Goodman, director of Lean Systems Improvement. One of the interesting transformations that has occurred over time, he says, is that hospital workers, from physicians to housekeeping employees, recognize that Lean is not a separate project that takes away time from everyday activities, but rather, a part of their everyday work.

"This is about teaching them tools that will be useful and productive in their day-to-day work," he said.

The results are unambiguous. Despite a 35% increase in organizational square footage over the past six years, Lean has delivered $119 million in financial benefit to the organization.

"The ROI for Lean is pretty impressive," said Goodman. "We achieved those results with no reduction in patient services and no layoffs. It's simply from elimination of waste."