1. Optimizing Our Human Capital Using Lean Theory

2. Roadmap of Our Discussion • Overview of Our Organization • Discussion of Our Previous State • Our Lean Journey • Path to New Structure • Premise & Goals of New Structure • Current Successes & Failures

3. WHC Overview • 5 Site CHC Offering Medicine, Dentistry, Pharmacy, Mental Health, Limited Radiology • Employ Approximately 175 Employees • Rapid Expansion in Past 10 Years • Added Staff to Existing Structure

4. Previous Structure

5. Weaknesses of Former Structure • Span of Control Too Large • Expected Clinic Manager to Be An Expert In All Areas (Dental, Medical, Billing, etc.) • Job Was Emotionally Exhausting Position with Little Pay • Systemic Weaknesses Due to Lack of Standardization • Hard to Hold Employees Accountable To Unknown Standard • Lack of Standardization Had Financial Impact to Organization

6. Our Lean Journey • Began 2 Years Ago After IHI Conference • Initially Conducted Process Mapping Exercise • Successful, Yet Only a Few Had Formal Training. • Recognized Need for Additional Training • Participated in KPCA Events • Lean Overview, Standardized Work, Problem Solving

7. Our Path to a New Structure • Core Lean Nerd Group Developed • Two Resignations During Maternity Leave • Reached Breaking Point • Proposed New Structure to Executive Team • Began Implementation by Reassigning Existing Management Staff • Interviewed Existing Staff for Team Leader Positions • Held Training Retreat

8. Premises of New Structure

9. Goals Of New Structure – Team Member Level • 1:3-5 Span of Control • Standardization of Processes by Team Members Completing the Job • Improve Job Security for Team Members by Providing a More Clearly Defined Set of Expectations • Create a Culture That Encourages Identification of Errors/Systems Needing Improvement • Create a Culture Where an Action Plan Doesn’t Mean You’re Getting Fired on Friday

10. Goals Of New Structure – Management Level • Improve Recruitment Process Through Seeking More Specific Type of Person • Increase Staff Retention by Increasing Salaries Associated with SLM Position (which replaced Clinic Manager job) & Focusing Knowledge Base • Increase Ability to Make Decisions Based on Data

11. Current Successes & Failures • Significant Productivity Increases • Resolutions to Problems Improved • IT Added to Operations Team • Training on Resolution Occurs in Timely Way • Focus on Service – Internally & Externally • Employees Appreciate When Standard Developed – Communication Weaknesses Highlighted • Ability to Make Business Case Improved Through Data • Morale Has Taken a Hit During Transition • “Someone Always Watching Us” • “What Was Wrong Before”

12. Conclusion • Renewal Such as This Is a Long Path • Expect Results to Come Over Long-Term If We Stay Invested

13. Questions? Contact Information Stephanie Courtright Moore, MPA, CMPE Chief Operating Officer White House Clinics stephanie.moore@whitehouseclinics.com 859.626.7700 x 1032