One of These Docs Is Doing Her Own Thing

And it’s working. Dr. Patricia Gabow’s remarkable turnaround of Denver Health has made it a national model for public hospitals. And it just may be a blueprint for health care in the United States.

There were no bombs. Gabow’s idea of detonation was to hire an industrial engineer who’d never been in health care. She had him study and map hospital operations, everything from food service to trauma residents. (While on the floor, a trauma resident walked eight-and-a-half miles a day.) Every time the engineer brought Gabow a map, she couldn’t believe how the hospital did business. There were so many lines on the page it looked like spilled spaghetti. The hospital had been in the black every year since she’d taken over in full in 1994, but what those squiggly lines told her was that efficiency, and thereby profitability and patient care, could be improved.

Gabow brought together a group of advisers: executives from companies like FedEx, the Ritz-Carlton, and Global Health. Looking at FedEx, she was inspired by the efficiency; she came to believe that if Denver Health could track its patients as well as FedEx tracks its packages, well, that would be brilliant. From the management theories in general, Gabow extracted and promoted a philosophy she called “getting it right.” When it came to the “patient experience,” the five rights were: achieving the right physical environment (built for safety and quality, supporting the patients, their families, and hospital employees); the right people in the right jobs; the right communication and culture; the right rewards; and the right process. Yet she struggled with communicating to her staff that these were all interconnected, like pieces of a puzzle. From her discussions with the group of executive advisers, Gabow heard about the “Lean” production principles of Toyota, the Japanese automobile company. She researched the concept and thought this could be the unifying philosophy she’d been looking for.

The cornerstone of the “Lean” Toyota way is getting rid of waste from the customer perspective. In the Toyota world, waste is disrespectful to humanity because it squanders scarce resources, and waste is disrespectful to the individual because it adds work. Gabow added her own twist: Waste is disrespectful to her patients, she said, because it asks them to endure processes with no value. Gabow loved the Lean idea but had to figure out how to take something that had been a manufacturing tool and apply it to health care. And that’s when things got really interesting.

Gabow hired trainers to educate her senior staff on Lean principles. Senior staffers got about four hours, and select mid-level managers got two hours. In those sessions, the managers learned, among other things, that a “Value Stream” is any process required to deliver services or goods to the customer. They learned that, on average, some 60 to 95 percent of a Value Stream is waste. Incorporating training terminology, Gabow dubbed the folks who completed these sessions Black Belts. She then sent the Black Belts forth into the hospital with the mandate to rid waste from the Value Streams.

Gabow didn’t merely send the managers back into the hospital, their heads filled with corporate speak—so treat patients like packages?—and weighed down by a mandate to cut waste. Senior managers picked processes in Value Streams that could be improved—and apparently they could all be improved. Black Belts then led groups of eight to 10 employees, each group a mix of the lowest- to highest-ranking employees from various departments. And each group was expected to improve the process in the Value Stream—find the waste, cut the waste, and implement a new, refined process. These group tasks were dubbed Rapid Improvement Events (RIE). Why rapid? Because each of these projects was supposed to take place in five days.