Gary J. Passama, President and Chief Executive Officer of NorthBay Healthcare System since 1981, is a veteran of more than 40 years in Northern California health care. He has served as faculty and speaker for programs of the American Hospital Association, Hospital Council of Northern California and the Medical Group Management Association. He is a Fellow of the American College of Healthcare Executives.

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We got Lean at NorthBay last week during two one-day sessions for managers.

Our seminar leader, Mark Graban, a consultant, author, keynote speaker and blogger, is the author of "Lean Hospitals: Improving Quality, Patient Safety and Employee Engagement." The principles of Lean were presented to more than 60 NorthBay attendees.

His presence at NorthBay's Green Valley Conference Center was the result of a presentation earlier this year at a national meeting I blogged about earlier. Given the challenges healthcare providers face in the next five to 10 years, there is a growing interest in Lean.

What is Lean? Mr. Graban uses the definition of the Lean Enterprise Institute: "Lean is both a set of concepts, principles and tools used to create and deliver the most value from the customers' perspective while consuming the fewest resources and fully utilizing the knowledge and skills of the people performing the work."

At its best, Lean is a bottom-up process, not a top-down directive from suits like me.

Lean's roots are in processes used by Toyota that vaulted it to a brand known for value and quality. Lean adherents pepper their discussions with Japanese words and expressions like "kaizen" (literally, Kai or "idea" and Zen or "good"). It's used to denote a process whereby employees improve their workplace.

Then there's "gemba," used to denote the workplace itself (as in "going to the gemba" to discover new areas of improvement). Getting past the foreign jargon, you learn Lean means striving for continuous improvement and listening to the folks who do the actual work.

The presentations last week were a primer on Lean in health care. We heard some eye-opening examples of how applying Lean principles made significant improvements possible in hospitals and physician practices. These examples helped to open minds about how lean could make NorthBay Healthcare and how we can become an even better provider of health care.

One particularly vivid demonstration of the power of Lean was a short video of how not to make toast. Titled "Toast Kaizen," it was funny and very enlightening. You can get a sense of what we saw by going to to see a promotional video about "Toast Kaizen." I went home that night to see how I could adapt my kitchen to make toast better. My wife did not appreciate my tips.

The reaction from the NorthBayers in attendance was uniformly positive. We have several staff members at NorthBay who have experienced Lean in their past lives in other healthcare organizations and know the positive changes that can come from adopting these principles.

Lean is a journey, not a destination. It requires a long-term time horizon and long-term commitment. There is much education and communication required.

To the question why should NorthBay embark on the Lean journey, I say "kaizen"! It's a good idea.