How Akron Children’s Hospital saved millions on construction and improved outcomes with Lean principles

In May, Akron Children’s Hospital unveiled its $180 million patient care facility, which was supposed to be its $240 million facility.

Among the features of the seven-story, 368,735-square-foot Kay Jewelers Pavilion are a new emergency department, a 75-bed neonatal intensive care unit, an expanded outpatient surgery center, and a labor and delivery center for high-risk births.

William Considine, the hospital’s president and CEO, says the decision to improve its facilities was made to support its clinicians and its expanding services.

Behind the scenes of the redesigned campus and state-of-the-art facility is the process the hospital used to build them. The process not only shaved money and time off the project, but has been a conduit for meaningful internal changes well before construction began.

Breaking out of silos

Lean principles were applied to the design of the facility to improve the delivery of services and squeeze more out of less space. It involved getting input from hospital staff, parents and even children. Sharing information, however, wasn’t always the hospital’s strong suit.

“I think what happens when you have silos is that certain good ideas don’t get shared,” Considine says. “People were hesitant to bring up something that might be viewed as them pointing the finger of blame.”

That, he says, made it hard to foster a culture of trust. With the aim of having transparency around discussions of quality, the hospital looked for ways to improve collaboration.

In 2007, Considine says Akron Children’s joined Solutions for Patient Safety Network, through which Ohio children’s hospitals could work together to improve pediatric health care across the state.

Sharing information led to real changes. For example, it reduced codes outside the ICU by 86 percent by simply empowering parents to ask for a medical response team if they saw that their child had taken a turn for the worse.

“So we had a lot of success with that,” Considine says. “Then we said, ‘OK, what else can we do?’ Let’s talk about adverse drug events. Let’s talk about surgical site infections. Let’s talk about central line infections. And we got our clinical teams together, and we started talking about those kinds of things, set some metrics, then we started sharing.”

The statewide initiative was so successful that Ohio received a grant from the Center for Medicare & Medicaid Innovation to take that model and expand it nationwide.

Accountability, transparency

Changes were also made within the hospital to improve communication and share information. In 2008, the hospital established its Mark A. Watson Center for Operations Excellence, which uses Lean Six Sigma principles to develop staff and improve quality of care and organizational processes.

Considine says Kaizens, hyper-focused deep dives to explore specific areas of improvement, and huddles, very brief group meetings, have become commonplace — 95 percent of all departments huddle daily to talk about the work ahead and issues that occurred the day before.

“When you’re trying to be responsive and when you’re trying to be transparent, these are things you got to do,” he says. “It’s not one thing, it’s the package, and it’s got to be part of the culture.”

The hospital has sent some of its staff to Johns Hopkins University to get their Lean green and black belts, visited colleagues at Seattle Children’s Hospital to see how they incorporated the Toyota way and Lean Six Sigma to their work.

Back in Akron, front-line employees were finding ways to be more efficient in their day-to-day work and departments were brought up to Lean standards. According to the hospital, the initiative has generated savings of nearly $13.4 million and reduced patient wait times by more than 48,000 days.

The solutions, dollars saved and the patient convenience that came from these practices convinced the hospital and its staff that Lean made sense. So when it came time to approach planning for the new building, Children’s turned to Integrated Project Delivery, a Lean approach to construction.

“People are, and should be, demanding accountability from health care,” Considine says. “There’s a lot of talk about how expensive health care is and we wanted to be able to look people straight in the eye and tell them that we’re doing everything we can to be as efficient as we possibly can be, and we’re not stuck in the mud relative to past practice. And with what has been shown in research and literature, Lean provides benefit.”

The Lean lens

Early on, Considine and his team estimated that the new facility might cost $240 million.

“We knew that through the traditional approach, we could probably do some value engineering, you know, cut out some things that probably were over the top,” he says. “But I know in the old days I probably would have been willing to sign a guaranteed maximum price not to exceed, oh, $205 (million) to $210 million.”

Then he looked at it through a Lean lens.

“Without taking anything out of the project, they got that target price down to $180 million,” he says.

At the beginning of the project, Considine says there was a time when it seemed as if they’d never build anything. Prior to the start of construction, hospital staffers and patient families began meeting with architects to discuss their ideas on building spaces that made sense for those who’d spend much of their time within them. The focus was on creating efficiency and flexibility. Small models were initially used to design the layout. Then full-scale cardboard mock-ups were built in a warehouse so staffers could test out the spaces. There, staffers hauled stretchers and other equipment through the cardboard mock-up, testing different scenarios to find design flaws. That helped eliminate mistakes that later would have been costly to fix.

“I mean, I know organizations that have spent considerably more money than we spent, they move into a brand new facility and right away they have to redo the emergency room because the doors aren’t wide enough for stretchers and things of that nature,” he says. “I mean, that stuff happens.”

Changing roles

Considine has been involved in six building programs. In many respects, he says he was less involved in this project than any other, adopting a support role that changed as construction went on. He says initially, it was important for him to show confidence that it could be done.

“You know, believing is so important,” he says. “If you believe in something, people know you believe in it. And I believed in it, I really did. So I became a champion at the front end — that this was what to do, and this is why we needed to do it, and we’re going to knock this out of the ballpark. You show that confidence, you show that belief, it works. So being a champion was important.”

He moved from champion to coach, sharing his experience in past builds and empowering people to believe their input was important. Then he became a storyteller, carefully choosing words that relayed a sense of partnership as he solicited donations and talked with the construction crews during the project.

“I mean, they’re investing back into something that touched their lives,” he says. “And you want to bring that emotion to the table. So the storyteller role was very important.”

As the project wound down, Considine says he was a cheerleader, raising their spirits when they hit an unexpected bump in the road and celebrating accomplishments.

“I’ve had the real privilege of being the CEO here at Children’s for 35 years, going on 36 now. I do believe that, through lessons learned along the way, I’ve become a better storyteller,” he says. “I think I know how to provide a vision that is exciting to folks. I think a leader has that responsibility to be a dreamer, to be a visionary.”

Telling stories

Continuous improvement has been a staple under Considine. He says Children’s has transformed itself many times, which has required doing some things that made people uncomfortable — destructive changes, as he calls them. It’s also required that he change as well.

There was a time, he says, when he knew what was going on in every room in the building. Now, with 90 locations, that’s not possible.

“I had to change my mentality about some of the things, but one thing I never have changed is how I want to stay connected to our people,” he says.

To stay connected to his more than 5,000 employees, Considine attends orientation with new employees every two weeks. He talks about the culture, the history of the hospital, the meaningful nature of the work, their role that they have in continuing the legacy and a little about himself.

“I mean, sure I’m the CEO and president of the hospital, but that’s a title. More importantly, I’m Bill Considine,” he says.

Takeaways:

  • Sharing information makes a big impact.
  • Leaders must adapt their roles.
  • Be diligent in finding ways to improve.

The Considine File

NAME: William Considine

TITLE: President and CEO

COMPANY: Akron Children’s Hospital

Born: Akron

Education: University of Akron for undergraduate, The Ohio State University for graduate school and a few honorary doctorates.

What advice do you find you give most often to young professionals who are looking for guidance as they develop in their careers? I talk about the importance of believing in your own capabilities, in yourselves — I think confidence is so important. I also tell people knowledge is a lot. You don’t know what you don’t know and don’t let it stop you from following your heart. Be courteous but also be proactive. Don’t be arrogant, but be in the game, get on the field, no sitting in the stands or on the sidelines. If you’re playing, get in the game. Be solution oriented, not problem focused.

If 1979 William Considine traveled forward in time and met 2015 William Considine, what would surprise him the most? What would surprise me the most? I still got hair. My dad had hair too, all my uncles don’t. My one brother doesn’t, but you probably think, well, you had the right gene.
I don’t know if I’d be surprised that I’m still here. I think it might be the one thing that would surprise me is that I wouldn’t be surprised — I still got the enthusiasm, that wouldn’t be a surprise. It would be a surprise that, you know, I stayed in the same job for 35 years.

For the past 35 years you’ve helped shape Akron Children’s Hospital strategically, culturally, physically. Your name is on the building, your wife’s name is on a building, you’ve seen it develop. When you move on from being CEO, what element of your legacy do you hope perseveres?
Well, I really hope my belief in our people is something that folks talk about and can point to specifics as to the kind of impact I had on carrying the phenomenal mission of this hospital forward. Quite honestly, what I’d really like to see is when I do leave, it’d be like taking a hand out of water: it fills in pretty quickly. This is not about an individual, this organization, it’s about this mission. I just want to make sure that when I leave people know it’s never been about me, it’s been about that mission, and those children.