The MNS Lean Journey

by Brent Wahba, Transformation Coach, Faculty, Lean Enterprise Institute

Every lean coach has a favorite example―that one organization that best embodies core principles, a unique, “situational approach” that makes them even more successful, and obviously, they must achieve impressive operational results. In this league, 2X output, 95% lead time reduction, and 10X quality performance improvements are barely enough to get noticed. Toyota, Wiremold, and ThedaCare are all common representations, but far and away, my preferred example is Management and Network Services (MNS), and I refer to them a lot.

If you are not familiar with MNS, they operate behind the scenes to, as their value proposition states, “make managed care manageable.” To the healthcare consumer, it means that MNS manages the placement of post-acute care patients into a national network of credentialed skilled nursing facilities, confirms that each patient is treated to applicable standards while there, and then processes billing and facility payments through payors like Medicare Advantage, Medicaid HMOs, and multiple commercial insurance organizations. To the nursing facilities, MNS provides revenue cycle management, utilization management, and quality- / value-based contracting oversight services that they could not easily perform on their own. And to the payors, MNS creates a comprehensive credentialed network of facilities to place covered patients while ensuring that treatment and billing are correct and timely. Combined, this results in better patient outcomes while lowering total healthcare costs―the holy grail of healthcare improvement.

I first visited MNS in 2006 as they were just starting their lean journey. At that time, most organizations were wrongly chasing lean as a quick fix, cost savings program; but MNS was different. They were growing rapidly and needed to maintain (or, ideally, improve) their already excellent customer service while managing a complex business model inside an increasingly complex healthcare world. This marked the first critical step in becoming a great lean company―understanding and internalizing lean’s true objective of “delivering the most customer value while consuming the fewest resources.” Lean perfectly complemented MNS’ core values and strategic direction.

The next critical step in approaching lean is answering a series of detailed “hows?” because the path is never the same nor very clear for any company. It is no secret that the vast majority of organizations that pursue lean fail and give up. As expected, MNS struggled initially too, but this became just another problem to solve in a life of problem-solving. They had always leveraged a data-driven approach to their business so applying the same methods to lean was a natural progression. To them, it meant understanding their enterprise-wide bottlenecks to prioritize which problems to fix first, and then digging deeper and deeper to uncover what their customers, and their customers’ customers, valued most. This led to an ongoing series of improvements ranging from simple process step changes to complex business process reengineering. And during each stage, MNS not only measured their improvements, but shared data and collaborated with their customers to make sure the larger system was operating as efficiently and effectively as possible.

Creating a “lean culture” is another necessary step in any transformation, but one that most organizations approach backward and therefore never achieve. First of all, because lean is situational and therefore unique to every organization, there cannot be a universal model or targets for creating a lean culture. Toyota or ThedaCare may have many admirable traits, but neither should, nor can, be copied. Secondly, culture is a resultant of consistent behaviors generated over a long period of solving (or not solving) problems. Advancing organizations are not only great problem solvers, but also choose which existing behaviors to reinforce and build upon. This is another area where MNS has demonstrated a deep understanding of lean application principles.

Easily observed is MNS’ focus on all people―customers, vendors, and their own employees. But what separates MNS from other people-centric organizations is the ability to have open, and sometimes very tough, discussions about what problems need to be solved while not letting it become personal. “Focus on the process, not the individual” is a commonly heard phrase in their meetings and improvement workshops.

MNS’ culture also has a natural rhythm, which is reinforced with cycles of hourly Plan-Do-Check-Adjust in Care Coordination, a daily organization-wide management system, weekly A3 sharing, and longer-term Network Development/Business Development planning and implementation (as just a few examples). These cycles not only keep the organization on track, but also help identify and solve problems as they arise, or often times before.

The last step in an outstanding lean transformation is applying lean to lean itself. Many organizations try to follow everything they see and hear by implementing as many tools and techniques as possible. Ironically, this creates a lot of waste and distraction. MNS’ approach, however, has always been one of only solving important problems while engaging those involved in creating their own custom solutions. As a result, you won’t see every office covered with out-of-date A3s, underused 5S systems, or overly detailed value stream maps―each of these would be waste. Instead, they create and constantly update only the tools they need, while placing them where they can best be leveraged in both physical and virtual workspaces. The offices of MNS may look surprisingly stark, but rest assured, there are years of improvements and several levels of deep lean thinking behind making one of the most complex businesses I have ever studied run and continuously improve itself so well.

This past year, I had the opportunity to spend more time observing what MNS had recently improved during their ongoing lean journey, plus learning what they have identified as their future focus. They did not disappoint! Most organizations are happy to optimize a single value stream, yet MNS was designing ways to coordinate across multiple processes while level-loading the entire enterprise. Very few organizations even attempt to apply lean in sales and marketing, yet MNS was using lean principles to not only develop a new sales management system but also create new business models that were lean from day one. And finally, when I spoke with a group of employees that had been there for just 2 or fewer years, I could tell that their culture was continuing to develop the next generation of lean thinkers and leaders based on how they described their combined daily and improvement work. To them, lean was just the way they did things at MNS, and to me, an organization could not ask for any better implementation.