Designing a Management System to Align and Transform

Introduction

WellSpan Health has successfully expanded, often through acquisitions, to approximately 20,000 employees and more than 2,600 physicians and advanced practice providers (APPs), enabling it to serve an increasing number of communities in south central Pennsylvania and northern Maryland. As it grew, leadership at WellSpan recognized that the positive growth of the non-profit healthcare provider also came with organizational consequences. 

“Because of the rapid growth at WellSpan, there was not time to create and spread system-wide improvement processes as we grew, which resulted in some disconnections,” says Dr. Roxanna Gapstur, RN, PhD, President and CEO of WellSpan Health. “As a result, our organization was not functioning as a true system. In order to function well as a system, you have to have a common language, a common way of tackling processes, a common way of standardizing; we didn’t have those in place.” 

WellSpan also had developed variations in how it solved problems and improved processes. Many units sought improvements independently, relying on various consultancies. “We all had different approaches to quality and safety and different versions of lean management,” Dr. Michael Seim, WellSpan Senior Vice President and Chief Quality Officer, told a healthcare summit in June 2022. “We went through seven different experts in lean before we merged into one health system. What that did was create everyone thinking they owned a fiefdom. Everyone thought their way was right. We did not have standard operating processes.” 

The varied process improvement methods that had been deployed throughout the organization often focused on location-specific objectives and relied on tools tied to those issues. Without a clear line of sight to organization objectives and direct leadership visibility and support, some improvements that had been made were difficult to sustain and there was little certainty that once-solved problems would not reappear. 

Dr. Gapstur wanted to improve WellSpan across all locations and design a culture for the future that standardized highly reliable care and achieved operational excellence. “As good as our culture was, I think every culture has room for improvement. Sometimes we were putting a Band-Aid on problems vs. really solving problems to root... We have a goal of achieving excellence, not just to achieve excellence but for our patients, for our families, for our communities, and for our team members.” 

“We always talk about WellSpan having 20,000 problem solvers, being all of our team members. And yet we really didn’t have a consistent framework to surface issues or new ideas. We needed a methodology for problem solving and innovation,” says Victoria Diamond, WellSpan Senior Vice President, Central Region. “Our lean management system provided that framework and facilitated having all team members become problem solvers. Prior to this, we were in firefighting mode too often where issues were elevated to leadership to be solved. Lean put problem solving and continuous improvement in the hands of the front-line teams.” 

“Those who are doing the work are often, if not always, the best to see the opportunities, how the work is done, and how we can improve that work,” says Dr. Geoff Nicholson, Senior Vice President of Population Health and Chief Clinical Officer. “The ability to leverage the strength and the entirety of the organization to help advance WellSpan’s organizational mission, vision, and goals is a tremendous, as is the alignment — the ability to get those people not only engaged in performance improvement and engaged in problem solving but rowing in the same direction.” 

White Paper Sections:

• Designing a Single, Holistic System
• Lean Management System Deployed
• Improvement at WellSpan Health