Learner-in-Chief

PROFILE – Another month, another inspiring profile of a lean practitioner. We were impressed by Dr Billi’s deep conviction in the idea that, first of all, leaders must be learners. You will be too.

Words: Roberto Priolo, Managing editor, Planet Lean

Profile on: Jack Billi, Chief Engineer, Michigan Quality System

It often happens that our lean epiphanies occur because of someone we meet who is already on the journey and who inspires us to embark on a transformation ourselves. It is exactly how Dr Jack Billi got his a-ha moment, in 2003, when he attended a talk by Gary Kaplan, MD, CEO of pioneering lean healthcare organization Virginia Mason.

Gary was a graduate of University of Michigan Medical School where Jack works. He had returned to Michigan to give a talk on the early results of Virginia Mason’s lean journey. That night Jack, Gary, and then Dean of the Medical School Allen Lichter talked for hours over dinner about applying lean in healthcare. They walked to the original Borders Book Store – located in Ann Arbor – and Jack bought a copy of Lean Thinking by Womack and Jones. That began Jack’s journey into how to transform an academic medical center using lean thinking.

“I had always been a natural problem solver, but had done it intuitively using my own skills and wits. What attracted me about lean thinking was the idea of a holistic and systematic model of problem solving,” Jack admitted to me during a recent phone interview. Once he realized there was a formal science to solving problems, he wanted to learn more. His aim was to bring the lean philosophy to the University of Michigan Health System, the clinical enterprise of Michigan Medicine.

Jack was aware that if he wanted to see his organization develop these capabilities, he’d have to be the one doing it. He realized that he would have to divest himself of some of the management responsibilities that were part of this job at the time, so that he could pursue lean thinking at UMHS. He started to speak to other practitioners around the United States who were making inroads in introducing the methodology in their healthcare organizations.

The initial breakthrough for lean thinking in the organization came when, during a meeting of healthcare leaders in Detroit, Jack chatted about it with a colleague from General Motors, Jan Whitehouse, who described GM’s journey introducing lean and said the company would be happy to help.

Shortly after, GM allowed UMHS to send several dozen managers to their basic lean training class. Then GM loaned lean coaches to UMHS to facilitate the first six lean projects the healthcare organization worked on. Although most of the initial projects ran into the usual problems, these early experiences (both successes and setbacks) inspired people in the organization and created the momentum for scientific problem solving that Jack was hoping for. Jack also told me about how UMHS received “invaluable guidance” from John Shook, Jim Womack, John Toussaint, and many other lean practitioners over the years: “We have benefitted greatly from a decade-long affiliation with the Lean Enterprise Institute, and with the Healthcare Value Network (Catalysis) since its beginning.”

The actual journey started with a collaboration among the Quality Department, the Operations Engineering group and the HR organizational effectiveness team – all of them rallying around the same goal. Jack commented: “For the past decade, the leaders of those three groups, along with an organizational psychologist, my administrative partner, and I have met for two hours a week, trying to plot out what experiments would make sense for our complex organization. We have about 26,000 employees and it has become our goal to create 26,000 problem solvers, who take the initiative every day to find and fix root causes of the most important problems, and to teach their leaders how to truly help them.”

THE RESPONSIBILITY OF A LEADER

Jack was trained as a general internist and has practiced internal medicine for his entire time at the University of Michigan – almost 40 years. Over the past four decades, he has held a variety of management jobs in the medical school and in the healthcare system, often with a focus on quality and safety. He’s also worked with community quality collaboratives and insurance companies to improve quality, efficiency and costs, and with population health, patient-centered medical home and disease management for chronically ill patients. His current informal title, which he created to describe his role 13 years ag