Published on September 14, 2018

Our Lean Transformation

In 2012, Chatham Hospital was experiencing declining patient volumes amid local economic downturn resulting in unsustainable financial losses and high staff turnover. To address this challenge Chatham joined the Carolinas Lean Collaborative in the fall of 2012 to undergo a lean transformation. According to the Virginia Mason Institute, Lean Healthcare is “the practice of continuous improvement and waste elimination that increases the quality, safety, and efficiency of patient care” (Virginia Mason Institute, 2018).

In the first three years of our lean journey, we learned how to set the world of continuous improvement on fire through rapid paced RIE's (rapid improvement events). We made critical improvements in select areas, within defined departments, and on occasion across departments. However, our lean work was not focused on the organization as a whole and in 2015 we hit the wall. Chatham Hospital was experiencing difficulties in sustaining the initial improvements made during the first three years of its lean journey and delivering further improvements to meet breakthrough organizational goals. We recognized that we were not using lean principles and thinking to manage the business of the organization.

In early 2016, hospital leadership and key departments developed an experimental lean management system model based on sound organizational theory and documented success from other healthcare organizations and industries. The Value Management System (VMS) is designed to plan, manage and execute continuous improvement by capturing input from all parties touching the process of patient care. The VMS, from frontline to senior leadership, drives focus and alignment around the most important goals of the organization. The VMS connects these critical few goals to the actual work that delivers value to patients. As of August 2018, the VMS has been implemented in 14 departments across Chatham Hospital including hospital leadership.

Chatham Hospital is becoming a transformational organization rather than a transactional organization, as evidenced by a forward-looking view, continuous analysis of opportunities for improvement, transparency, and focus on systems improvement, not people improvement.

Since the beginning of the transformation, Chatham has seen:

  • Improvement in employee engagement from the 13th percentile in 2012 to 85th in 2018
  • A decrease in median ED length of stay (for discharged patients) from 181 minutes in 2014 to 144 minutes in 2018
  • Improvement in ED patient satisfaction from the 45th percentile in FY14 to 72nd in FY18 (Press Ganey)
  • Chatham has received a 5-star rating from the Centers for Medicare and Medicaid (CMS) for patient experience for 14 straight quarters
  • Zero Catheter-related UTI and central line-associated bloodstream infections in over two years
  • Staff have implemented more than 500 improvement ideas since the implementation of VMS

Through lean, Chatham will continue to improve the care offered to the patients and communities of Chatham County and beyond as we continue to lead the way within the UNC Health Care System. 


Virginia Mason Institute. (2018). Lean Health Care Improvement. Retrieved September 3, 2018, from



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