As the head of a hospital, Steven Moreau preaches the power of preventative medicine.
Just not to patients.
Moreau isn’t a clinician, so he doesn’t directly dabble in the medical responsibility of prescribing healthy lifestyle choices for those who come through the doors of St. Joseph Hospital of Orange seeking treatment.
The president and CEO of the hospital since last December, Moreau concerns himself with preventive medicine for the hospital itself — a 3,000-employee network of staff members that is a living, breathing organism in its own right. It needs constant care and maintenance to remain healthy and functional and able to conduct its mission of providing the best possible health care to its patients.
When Moreau took over the top post a year ago, he quickly identified strengths and weaknesses, and set about addressing the areas of concern at the hospital, which generated $627 million in revenue during fiscal year 2010.
“The one thing I knew coming aboard was that St. Joseph Orange is a high-performing organization with outstanding results in many areas that matter the most, such as clinical quality and patient satisfaction,” Moreau says. “We were also very strong in nursing and financial operations. But I also learned very quickly that our biggest challenges were around reducing costs, partnering with our physicians and growth. We had to find ways to grow in a business that is challenged and in an economy that is shrinking.”
To address the challenges of growth, Moreau needed to build a strategic plan with the help of his leadership team. The plan centered on improving processes, and increasing employee and physician engagement. To make it all happen, Moreau needed to increase the organizational efficiency of the hospital and plug the entire staff, at all levels of the organization, into the processes that would help shape the hospital’s future.
In a word, St. Joseph of Orange needed to get lean.
Earn your black belt
To increase efficiency in his organization, Moreau looked outside the hospital field, and even the medical industry in general, to the automotive industry. The performance improvement model that Moreau chose to implement was centered on lean methodology, made famous by Toyota.
St. Joseph of Orange had a lean-based plan in place for several years prior to Moreau’s arrival, but Moreau wanted the hospital’s staff to develop an even tighter focus on the principles of lean methodology, which include constant improvement of processes and the elimination of unnecessary redundancies.
“We use all of the tools of lean methodology in looking at our processes and how we can provide care,” Moreau says. “That is one way, on kind of a micro level, that we use lean methodology, and we have had significant success in improving operational metrics.”
The focus on lean processes has reached into all areas of the hospital’s operations, including medical care. Moreau says lean thinking has had a very tangible effect on patient care, even helping prevent the spread of disease.
“Patients that are brought into a hospital and put on a ventilator are prone to getting pneumonia,” Moreau says. “After all of our lean work, we put in a process, and (as of August had gone) 51 months without a ventilator-associated pneumonia case. Our process has won us national awards, and it includes steps such as raising the head of the bed and ensuring that someone is checking on the patient regularly. There are also numerous evidence-based steps about the way people are treated, the kinds of medications they’re given and ensuring that the steps are followed 100 percent of the time for every single patient. We write a checklist for every patient to make sure those practices are done consistently, no matter which doctor is providing the care. It’s fundamental that everybody does the process the same way.”
Moreau considers any process that solely involves St. Joseph of Orange to occur on the “micro” level. On the macro level — involving the St. Joseph Health System in general — Moreau also works with the heads of the other hospitals and facilities in the system to reduce the cost structure across the board.
“That means looking at something we call ‘value imperatives,’” Moreau says. “We’re looking at items we have identified in a number of areas where we can use best practices — from not only the health care industry but from business in general. We look at how we can centralize, consolidate or apply best practices to get fundamental costs out of our infrastructure.”
Developing a strategy built around lean methodology takes vision on the part of management and engagement on the part of the work force in general. Everyone in the organization needs a set of common goals, and the resources to reach those goals.
“You really need to have two things to implement lean methodology,” Moreau says. “One, you need a culture that embraces performance improvement. That’s fundamental, that you have to create a culture of people that want to be the best. That takes a lot of education and awareness that the status quo is not acceptable. You have to get the organization to the point where they’re saying ‘If anybody can do it, we can do it.’”
The second ingredient is the commitment from leadership to provide resources and support that will enable your people to make the necessary changes.
“That involves committing peoples’ time, as well as resources support, for them to accomplish the goal,” Moreau says. “For us, part of those resources is that we have a professional staff that supports them. We have a quality department that includes trained facilitators. In fact, the director of our lean methodology comes from Ford. So we brought in someone from an industry that had applied these concepts, someone who was able to bring many of the insights to us and help us implement the lean methodology in a hospital setting.
“Fortunately, we have a pretty strong infrastructure for lean with the facilitators, and then my role as the CEO is to actively support our teams, acknowledge the great work they’re doing and make sure they have the direction and support they need.”
Stop, look and listen
Sometimes, you don’t see the results of heightened efficiency. You hear it — or actually, you hear silence.
St. Joseph of Orange has a pneumatic-tube delivery system that carries prescription bottles from the hospital pharmacy to various points throughout the hospital. When a delivery arrived at its destination, it would slam into the end of the tube, creating a noise that would jar the eardrums of anyone within listening distance.
As part of a larger initiative aimed at reducing noise in the hospital environment, Moreau and his staff listened to the input of staff members, and installed soft bumpers in the pneumatic tubes, cushioning the impact when a package arrived at its destination and deadening the sound.
Moreau and his staff promote lean thinking throughout the hospital by getting team members to think in the first place. If you ask for input on how the work environment could improve, you’re asking for your employees to observe their surroundings and identify areas in which the status quo doesn’t align with the goals that you and your management team have stated. You’re asking them to become field scouts for your mission.
At St. Joseph of Orange, Moreau enlists the help of every constituency under the hospital’s roof, including patients. Moreau helped to assemble performance improvement teams comprised of employees from every department in the organization, and asked patients to serve as well.
“It is a combination of staff-level people who have expertise in their areas, who are supported by black-belt and green-belt facilitators who are experts in the lean process,” Moreau says. “We have doctors, nurses, pharmacists, maintenance workers, housekeepers — anybody who impacts the process we’re looking at right then. And then we invite patients to offer input, so they can participate in the solution. Patients offer additional insight as to whether the improvements we’re making are actually making a difference.”
Monthly, Moreau gets the idea juices flowing throughout his staff by hosting a breakfast forum. Many CEOs have a sit-down meal during which staff members can ask questions, but Moreau takes it a step further. The 100 or so people who attend are tasked with finding the questions that the people in their department want answered.
“That’s kind of their ticket to the breakfast,” Moreau says. “Find the issues and submit them to me via e-mail. At the breakfast, I answer all of the questions submitted and then we print the questions and answers so that everyone in the organization gets the benefit of it. You do something like this not only to address concerns, questions and rumors, but also to build a level of trust between the CEO and the staff.”
Without trust, it’s extremely difficult for anyone in a position of leadership to drive a common set of goals throughout a large organization. Without everyone on board, Moreau says he would have had a hard time implementing any type of lean methodology, because staff members wouldn’t have identified many of the efficiency problems that could have been solved by lean processes.
“The questions and answers are important, because if somebody has a question, what it’s doing is bringing it to the forefront,” he says. “If one person in the organization has a question or comment, undoubtedly others have it too. It could be as broad as ‘Where are we going as a company?’ or as narrowly-focused as ‘I don’t like the food in the cafeteria.’ But in the end, by having anyone able to ask any question they like, when you answer it, it’s giving everybody in the organization the ability to recognize the rationale for what you’re doing. That is what builds trust.”
Moreau also creates dialogue opportunities with management by sharing data on how the hospital is performing against its goals — both good and bad. Another key factor in building trust is the willingness on the part of management to give everyone in the organization a complete view of how the organization is performing and how initiatives are progressing. If you try to paint a rosy picture, and your team finds out the truth isn’t as positive, you will damage the trust factor.
“You have to be willing to shine a light on the areas where you’re not the best,” Moreau says. “If you shine a light on that, the competitive spirit of most people will win out. I think some leaders fall into the trap of sharing information that is only the good information. They only want to share what they’re doing well, and move away from highlighting what they’re not doing as well. But I think a high-performing organization focuses on the areas where they’re not doing as well, areas where they need to do better. Then, you use that as a burning platform for change.
“That is really leadership’s role, to define what success looks like and to engage the team. Then, to bring resources and focus, which will enable your team to overcome obstacles. I’ve had a lot of success in past organizations creating those burning platforms for change, and rallying people around those. It’s really that transparency and those platforms for change – and your commitment to give them support – that allow your people to step up and perform.”
How to reach: St. Joseph Hospital of Orange, (714) 633-9111 or www.sjo.org
The Moreau file
Born: Los Angeles
Education: B.S. in microbiology, San Diego State University; M.S. in medical technology, California State University, Dominguez Hills; MBA, University of Redlands
What is the best business lesson you’ve learned?
You have a lot of power in your position. The CEO has an incredible opportunity to impact the organization’s success, and the success of the people you work with. So show an interest in development of the organization and the people that work with you. You can make a huge difference in their development and performance.
What traits or skills are essential for a leader?
Fundamentally, you need experience and competence in your given field. But you also need strong interpersonal and communication skills. Confidence and a willingness to continuously learn are also key traits. In the health care field in particular, you need passion and a calling for helping others.
What is your definition of success?
Being your best, and that means helping an organization or individual real their optimum potential.