Maybe you've had this experience: You attend a workshop or conference to build your skill set, you pick up new strategies and tools, and you leave energized and excited to put them to use in your hospital or clinic.

Yet when you return to work, you find it hard to get the ball rolling. Colleagues may not speak the new lingo you've picked up, and there may be no clear structure or resources to build a team and carry out an improvement project. Feeling unsure how to proceed, you slowly return to the old routines that existed before training. Nothing changes, and your enthusiasm wanes.

This can happen in virtually any area of training in health care, even areas we are passionate about, such as patient safety and quality improvement.

Through our Lean Sigma training, participants develop the "lenses" to perceive the waste and defective processes in their environment. What happens when others don't see what you do? What if they lack your newfound enthusiasm for spaghetti diagrams and A3 charts?

Health care organizations need strategies to ensure that training pays off. Certainly, it's essential to have the backing and commitment of the leadership where you work, protected time to pursue an improvement project using your newly developed lens and skillset, and accountability for ultimate results. It's helpful to have an expert in performance improvement mentor you in your project and to team up with others who have been through the same training. At Johns Hopkins Medicine, we can help department heads, clinic leaders and others understand their "bench strength" by providing a list of those trained in their department so they can direct those resources toward meaningful improvement projects.

In recent years, we've also seen great results from a simple but powerful strategy called the management triad.

The concept was the brainchild of physician John Flynn, vice president of the Office of Johns Hopkins Physicians. A few years back, Flynn was designing the Ambulatory Management Program, a six-month experience for improving care and operations in our clinics, with Lean methods as its linchpin. He understood how critical it was to have all stakeholders, including physicians, on board for this work. So he designed the triad approach, in which a physician director, nurse manager and clinic manager from each clinic would attend training together, then select an improvement project to collaborate on. Representing the three main groups of employees in the clinic, with joint accountability for improvements, they take a two-day Lean course, and then meet for two hours every week over five months. Then, they serve as ambassadors for Lean with staff members in their ambulatory settings.

The results are testaments to the power of this simple strategy. For example, a neurosciences clinic reduced the time it took to administer Botox to migraine sufferers from nearly 42 minutes to less than 25 minutes. A Gyn/Ob practice reduced overtime through greater efficiency, while safety related-attitudes showed tremendous improvement in a survey. A vascular surgery clinic slashed the time patients spent in examination rooms alone by 40 percent and eliminated other bottlenecks in patient flow.

We have since applied the triad strategy in another program, called the Lean Leadership Cohort, which we launched this fall. We are working with "teams of teams" within Johns Hopkins Medicine over three months to improve care processes that cross units or departments. For instance, we are following the journey of surgical patients at The Johns Hopkins Hospital, from the time they arrive until they are either admitted to a unit or discharged after their procedure. Triads from prep areas, the operating room and the post-anesthesia care unit all engaged in the project.

Similarly, triads from Johns Hopkins Bayview Medical Center's Emergency Department and Department of Medicine are focusing on improving access to care for ED patients. These teams seek to reduce ED wait times and the boarding time for those admitted to an inpatient unit from the ED. This team-of-teams approach reinforces the common vision of delivering great patient care.

Many hospitals and health systems are seeking a Lean transformation. The goal: Reach a critical mass of trained staff members who have a common set of lenses for seeing their workplace and a shared toolbox for reducing waste and improving quality of care. While these organizations may tailor the approach to their unique circumstances and resources, adopting this triad approach can be an effective strategy for rolling out training one unit, clinic or clinical journey at a time.

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