Eric Cecava | Lean Six Sigma in Healthcare: Still Working After All This Time

Eric-Cecava at work


The process improvement methodology built for factory floors turns out to be just as useful when the waste you are eliminating affects patient outcomes

Lean Six Sigma was developed in manufacturing. Its vocabulary comes from Toyota: value streams, waste, pull systems, standard work. Its statistical rigor comes from Motorola's Six Sigma program, designed to reduce defects in electronic components. It is not language that sounds natural in a clinical environment. Eric Cecava of Fort Gratiot, Michigan, who led Lean Six Sigma deployment at Adena Health System in Ohio and applied process improvement principles throughout his work at McLaren Port Huron in Michigan, is more interested in what the methodology produces than in how it sounds.

Waste in Healthcare Looks Different Than Waste in Manufacturing

In a manufacturing context, waste is visible and physical: inventory sitting in a warehouse, material being reworked, equipment waiting for a part. In healthcare, waste is often embedded in the system in ways that clinical staff have adapted to work around rather than eliminate. The patient who waits four hours in the ED because the discharge process upstream is inefficient. The medication administration that is late because the pharmacy workflow has a bottleneck that nobody has ever formally mapped.

Cecava's introduction to process improvement was in manufacturing, at Delphi Automotive, where lean implementation was the core of the work. When he moved to Adena Health System in 2010, the methodology translated because the underlying logic is the same: identify where work slows, where effort is duplicated, where the design of the process is creating problems that the people doing the work are absorbing without complaint because they have accepted those problems as normal.

The first step in any Lean implementation is making the current state visible. In manufacturing, that usually means a physical walk of the production floor. In healthcare, it means mapping clinical workflows with the people who actually perform them, not the ones who designed them on paper. The gap between those two versions is typically larger than any administrator expects.

Physician Engagement Determines Whether It Works

Lean Six Sigma implementations in healthcare fail for several identifiable reasons. The most common is insufficient physician engagement. When process improvement is treated as an administrative initiative that happens around clinical staff rather than with them, the resulting process designs tend to be optimized for the administrative view of the workflow rather than the clinical reality of it.

Cecava's work at Adena Health System included physician relations and contracting as part of his expanding operational portfolio. That background shaped how he approached process improvement in clinical environments: physicians who are involved in designing the process are invested in following it. Physicians who are handed a new process from an improvement team and told to comply with it will find workarounds, and the workarounds will undermine the improvement.

The investment in physician engagement upfront is not optional if the goal is sustained improvement. This is true whether the improvement project is a clinical workflow redesign, an EHR implementation, or a quality program initiative.

The Deployment Has to Become a Capability

The difference between a Lean Six Sigma project and a Lean Six Sigma deployment is the difference between solving a specific problem and building an organizational capability to solve problems. Projects produce results and then end. Deployments produce results and then produce more results, because the organization has learned how to apply the methodology rather than just experiencing one application of it.

Cecava's role at Adena was leading the deployment as a system-wide initiative, not managing individual projects. That required training clinical and operational staff in the methodology, building internal capacity for process improvement work, and creating the management systems to sustain the gains after the initial projects were complete. By the time he became COO at Adena, the Lean Six Sigma capability was an organizational asset, not an ongoing consulting relationship.

The Methodology Does Not Replace Clinical Judgment

One of the persistent misunderstandings about Lean Six Sigma in healthcare is that it attempts to reduce clinical work to a standardized process in ways that conflict with the individualized nature of patient care. Cecava's view is that this misunderstands what the methodology does. Lean and Six Sigma are tools for designing administrative and operational workflows, the supply chain, the scheduling system, the documentation process, the discharge planning sequence. They are not tools for standardizing clinical decision-making, which is a different activity that requires clinical judgment, not process optimization.

The organizations that use process improvement effectively in healthcare understand this distinction. The ones that create the most resistance are the ones that blur it, trying to apply process thinking to activities where clinical discretion is the point. Done correctly, process improvement gives clinicians better operational support so they can focus on the clinical judgment that actually requires their expertise.

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