The framing that distinguishes Mary Greeley Medical Center from most organizations using improvement methodologies emerged early in the session and held throughout the hour. Karen Kiel-Rosser put it directly: Mary Greeley does not call out Baldrige and Lean as new projects that the organization will do to get to excellence. Baldrige is the work. Lean supports the framework. Daily improvement is how the work gets done. None of it is an initiative layered on top of the operation. It is the operation.
That distinction matters because the most common failure mode in healthcare improvement is initiative overload — a hospital running a Lean program, a Baldrige effort, a high-reliability push, and a strategy deployment process as four separate initiatives competing for the same leadership attention. Mary Greeley's answer was to make Baldrige the operating framework and Lean the practical method that supports daily execution, so leaders stay focused on what matters most — quality, safety, and patient outcomes — without being pulled in four directions.
The session, presented by Karen and Ron, walked through three things: how Mary Greeley engages leaders for genuine buy-in, how it engages the people closest to the work, and how it sustains improvement over time through project management and documentation. The hospital is a KaiNexus customer, and the platform shows up throughout the story as the infrastructure that made the leadership engagement and the daily improvement program operationally workable. This was a returning-presenter session — Karen and Ron had presented for KaiNexus before — and Mark Graban had visited Mary Greeley several times, so the session had the texture of an update from an organization he knew well rather than a first introduction.
Karen Kiel-Rosser is Vice President of Quality at Mary Greeley Medical Center. She leads quality and performance improvement at the hospital and has been central to integrating the Baldrige Framework with Lean and daily improvement practices. She joined Mary Greeley in 2010, at a point when the organization's journey toward excellence was already underway, and has focused since then on building the spread — engaging leaders and staff across the organization rather than concentrating improvement capability in a small central team. She brings deep experience in leadership engagement, high reliability, and building systems that support sustainable excellence, and has served as a Baldrige examiner at both the state and national levels.
Ron Smith is Process Improvement Coordinator at Mary Greeley Medical Center. He supports organization-wide improvement initiatives, including daily improvement, Lean training, and project execution. He works closely with leaders and frontline staff to build problem-solving capability, encourage learning by doing, and ensure improvement efforts translate into real results. Ron described himself in the session as a student of Mark Graban's work on managing for daily improvement, and his portion of the session leaned heavily on that approach.
Mary Greeley Medical Center is an acute care hospital in Ames, Iowa, with roughly 220 beds and about 1,300 employees. It has an unusual governance structure — it is a city-owned hospital, governed by an elected five-member board of trustees, which makes it different from most hospitals.
The hospital's strategic plan is drawn as a compass, and the design is deliberate. Everything centers on the patient. Quality and safety is the organization's true north — the explicit belief is that if the organization focuses on quality and safety, everything else follows. Operational performance, where most of the financial and engagement metrics sit, is treated as a downstream consequence of getting quality and safety right rather than as a competing priority.
Mary Greeley has four "big dot" organizational goals: safety and quality, operational performance, access to health, and external relationships. Two of the organization's values — being respectful and being innovative — were the ones Karen highlighted as driving the improvement work most directly.
Karen returned repeatedly to one word: discipline. Her analogy was the marathon. You cannot decide you want to run a marathon and then run 26 miles next week. You need a training plan, and you need to follow the plan with discipline every day. The marathon is hard work, and the discipline is what makes finishing it possible.
Mary Greeley's framework for excellence works the same way. The hospital is disciplined every day in its training — engaging leaders, staff, and the whole organization in the work that matters. Baldrige is the framework, and the discipline is the daily practice of working on the principles within that framework because those principles drive organizational excellence. The Baldrige process becomes part of the daily work rather than a periodic exercise.
The discipline framing connects to two of the session's recurring themes. The first is that excellence is never complete and never perfect — high reliability in particular is an ongoing process that is never finished. The second is the hospital's explicit philosophy of not waiting for perfect. As Karen put it, the organization will start with "goodness" rather than wait for perfect, because starting and iterating beats waiting. The two themes are complementary: discipline keeps the work going every day, and the willingness to start imperfectly keeps the work from stalling before it begins.
When Karen arrived in 2010, she understood that for the organization to not only reach a point of excelling but to sustain it, she could not be the person who held the framework. She had to create the spread.
The spread happened by engaging a substantial number of people in the work. Mary Greeley has trained examiners — leaders and staff who serve as Baldrige examiners for the state program and at the national level. By the time of the session, the hospital had 65 combined years of examiner experience among its leaders and staff. The Baldrige framework and criteria are used throughout the organization, and the depth of trained capability is what allows the framework to function as the organization's operating system rather than as something a small quality department administers.
The spread principle showed up again in the high reliability work. Early in the journey, Mary Greeley adopted a culture of high reliability — a daily focus on preventing harm and ensuring patient safety. The hospital took a systems approach, learned from the Baldrige framework, and identified its top work systems: admit, assess, treat, discharge, and continue, with patient care as a key work process. It then identified 49 support systems that support those systems of care.
The point of identifying the 49 support systems was not abstract architecture. It was to make sure all 1,300 employees understood how they personally support the systems of care. That understanding is what the work system maps were built to create.
The work system maps are one of the session's most distinctive practices, and the detail of how they get built is what makes them worth attention.
Each map starts at the top with the organization's four big-dot goals. Below that sits one of the support systems — for the first map the hospital built, that was the Human Resources and education system. The leaders and supervisors of the HR department identified the high-level work of the department, organizing it into categories: workforce capability and capacity management, workforce engagement, and a third category for the department's other work. That structure became a diagram of orange and blue boxes.
Then the staff came in. Every member of the HR staff participated in a session — led by the CEO — that worked like a sticky-note brainstorming exercise. The CEO walked the staff through a conversation about the work they actually do to support each category. The staff described their work in their own words and placed it on the map.
The initial purpose of the work system maps was to understand how the work was actually being done across the organization. What emerged from the exercise was something the hospital had not fully anticipated. The staff became deeply engaged in the discussion. They felt their work was valued. They saw that the CEO was personally leading these sessions and genuinely wanted to know about the work they did. The benefit turned out to be twofold — the organization understood its work better, and the staff felt engaged by the process of describing it.
Karen was honest about the state of the effort. The work system maps started in the fall before the session, and the hospital had not finished all 49 systems. The intention was to get through all of them. The early results were strong enough that the process was continuing. The HR map itself was not perfect — Mary Greeley had built better maps since — and the willingness to start with an imperfect first map, learn from it, and improve was part of the point. The hospital learned the practice from another Baldrige organization it visited on-site, brought it back, and tried it.
The detail worth holding onto: the CEO personally led these sessions. A CEO spending the time to walk department staff through a structured conversation about their work, one department at a time across 49 systems, is a substantial commitment of executive attention. That commitment is what the session later identified as the origin of Mary Greeley's unusual level of leadership engagement.
Karen connected the decision to use Lean inside the Baldrige framework to specific Baldrige criteria. The hospital needed to proactively plan for its future, which aligns with Baldrige category 1.1 — how the organization creates a focus on action. A Lean environment helps the organization focus where the work matters most.
The work system maps tie directly into this. When staff describe the work they actually do, the description starts to surface where waste might exist — not so the organization can eliminate jobs, but so it can spot duplication, find opportunities to streamline, and identify where two people in the same department are doing something similar that could be consolidated. Lean inside the Baldrige framework is about creating a focus on action and doing the right thing, and only the right thing — which Karen again tied to category 1.1, identifying needed actions and where to focus the work.
Engaging the people closest to the work to design and redesign their own work is respect for the workforce — Baldrige category 1.5.1 on workforce accomplishment and category 6.1 on designing work. Learning from each other is knowledge management, category 4.2 on best practices and organizational learning. The point of the criteria mapping was not bureaucratic. It was to show that Lean is not a separate program bolted onto Baldrige — the Lean practices are how specific Baldrige criteria get satisfied in daily work.
Karen laid out the hospital's working definition of a good Lean leader. A Lean leader makes Lean part of their strategy and part of the work they are already doing, aligned with the organization — Mary Greeley does not run one-off projects disconnected from organizational strategy. A Lean leader accepts continuous improvement and rejects the status quo. Leaders across the organization are given the latitude to question whether something is being done a particular way only because it has always been done that way, and to treat that as a waste-elimination opportunity.
The customer sits at the beginning and the end of every improvement — at the beginning to make sure the work addresses what the customer needs, and at the end as a double check that the customer's needs were actually addressed. Lean leaders simplify their work and identify waste. And they always involve the people closest to the work, on a principle drawn from the Toyota Way: leaders know how the work should be done, and staff know how the work is being done. Bringing staff in and respecting their knowledge of how the work actually happens is what makes redesign accurate.
Mary Greeley's framing of the role of management, which Karen said the organization has genuinely adopted: the role of management is to enable employees to do their work well. Much of what the session presented is the hospital's approach to training managers to enable employees rather than direct them.
The 100-day workout concept is the engine of Mary Greeley's leadership engagement, and it is not original to the hospital — Mary Greeley borrowed it from GE Healthcare, and Mark Graban came on-site to help roll it out.
The concept is straightforward. A 100-day workout engages leaders to identify an improvement project in their own scope of work that can be completed in 100 days, with the project managed in KaiNexus.
The first 100-day workout, in 2014, had a specific primary purpose that the session was emphatic about: it was a learning-by-doing exercise to get the hospital's roughly 75 leaders into KaiNexus and comfortable using it. The hospital had a daily improvement program on its radar, and that program would require leaders to be efficient in the platform. The 100-day workout was the mechanism to get them in, working a project, and understanding how the system worked before the larger daily improvement rollout.
The ground rules for the 2014 workout: all leaders had to participate. Each project had to be within the leader's scope, the leader had to understand the project and any barriers, the project had to focus on improving revenue or saving costs — without negatively impacting quality, safety, or service — and it had to be completed in 100 days. The qualifier about not harming quality or safety was something the hospital did not really expect leaders to violate, but it stated the constraint explicitly anyway.
The timeline: kickoff in January 2014, senior leaders reviewing and approving every submitted project, leaders meeting with KaiNexus consultants to finalize their 100-day plans, 30-day follow-up meetings to review projects and metrics, finalization in April 2014 with results validated by the finance department, and a celebration to recognize the work.
The results from 2014 surprised the hospital. The primary purpose had been training, but the workout produced 54 completed opportunities for improvement that resulted in change. The common themes were cost savings — contract renewals leaders arguably should have been doing anyway but that the workout brought into focus, savings on medications and supplies, easy wins — plus some revenue-generating ideas including selling unused equipment on eBay, and charge accuracy reviews that captured volumes and services the hospital had not been capturing before.
The collateral benefit was financial and unexpected. The hospital had not been looking for cost savings as the goal — the goal was training — but the workout produced $691,000 in validated hard cost savings and another $116,000 classified as soft savings from roughly 5,300 hours of labor removed. Karen made a point about the soft savings that connects to the respect-for-people theme: the 5,300 hours were not dollars that left the organization, but they were hours of work taken off employees' plates — work that was not beneficial to the organization, the kind of work employees do not like doing. Removing it was a genuine staff satisfier.
Ron's portion of the session returned to a slide that he and Karen both identified as the single most important one. The slide established two fundamental principles: respect for the work, and learning by doing.
The learning-by-doing principle was the reason the 100-day workout existed in the form it did. If Mary Greeley had simply asked leaders to start using KaiNexus to manage improvement work, the result would have been wide variation — some leaders using it, some not, some never logging in at all. The hospital knew this because when the system first went live, there were leaders who were not logging in. The 100-day workout gave leaders a structured reason to get into the platform, work a project, and build the habit before the daily improvement program made platform fluency a requirement.
Ron's framing of the broader lesson: the hospital did not wait for something to be perfect. It started, learned by doing, and built up from there. The $691,000 in savings from the 2014 workout was a surprise precisely because the hospital had not designed the workout to produce savings — it had designed it to produce learning, and the savings came along.
Ron walked through Mary Greeley's improvement pyramid. At the top sit rapid improvement events — three-day focused deep dives on a process. They produce real results, but they have limited spread and limited capacity, because they pull staff away from their work. In the middle sit projects, which is where the 100-day workouts live. At the foundation sits managing for daily improvement.
Ron's framing of the pyramid is that when the hospital moved into daily improvement, it effectively flipped the pyramid upside down. The real benefit — the spread — comes from the foundation layer, the daily improvement work, even though the dramatic-looking results often come from the events at the top.
The hospital's Lean journey traced through several stages. In 2010, yellow belt training for leaders, starting immediately with a learning-by-doing project — a 5S effort (Mary Greeley calls it 6S, adding safety) in a warehouse. Every leader rotated through in four-hour shifts over two days. The team learned a red-tag process, learned to decide what was trash, what still had value, and what to keep. The effort removed eight commercial-size dumpsters of material, and the warehouses involved no longer exist today — the hospital trimmed its resources there substantially.
In 2011 and 2012, the focus moved to standard work, including leader standard work, and documenting processes to make them more reliable. A standard work steering committee was formed and facilitated through a project charter and purpose, and that committee helped decide the hospital's first rapid improvement event. In 2013, the hospital ran 13 rapid improvement events, did value stream mapping events, and introduced A3 thinking into its preventable harm work — running an A3 root cause analysis after any fall or pressure ulcer. The need to manage all those rapid improvements is what led the hospital into its relationship with KaiNexus.
The 100-day workout came in 2014. The daily improvement program began in 2015. Since then, the hospital has added an innovation and improvement council, run subsequent 100-day workouts, continued rapid improvement events, and continued the Baldrige journey — getting better at getting better.
Ron's section on daily improvement leaned explicitly on Mark Graban's work on managing for daily improvement, and Ron noted that anyone who follows Mark would recognize the approach.
The program starts with supervisors trying to engage their employees — making every effort to help staff bring ideas forward, no matter how small, and helping them focus on improving their own job. The challenge is that employees tend to surface big ideas they have no control over. Ron's running example: an employee suggests Mary Greeley needs a helicopter pad. There is very little that the employee and their leader can do to implement that. It can be sent up the chain to the senior team, but the employee is unlikely to be satisfied with that outcome and unlikely to hear back quickly. The employee would be far better engaged finding something they can actually improve within their own scope.
The hospital's framing for that scope is the three-foot radius. Staff are told to look at a three-foot radius from wherever they are — the bedside, the desk, the hallway they walk. Something in that radius that bugs them, frustrates them, or gets in the way of patient care is the right size of problem for the daily improvement program.
The program has stages. The first stage is getting staff to bring ideas forward at all. The second stage — where Ron placed Mary Greeley at the time of the session — adds coaching staff on problem-solving skills and PDCA. Since 2015, the hospital had received thousands of submissions to the daily improvement program. The third stage gets into tracking ROI on the improvements, which KaiNexus has the tools to support the same way it does for the 100-day workouts. Ron emphasized, again, that the hospital did not wait for perfect — it started at stage one and built up.
The principles Ron drew from Mark Graban's work:
People do not resist change — they resist being changed. When an improvement is the employee's own idea, or a version of it that they had input into, they are generally on board and speak favorably about the change. When change comes from the top with "do this because I said so," there is more resistance and the team has to work through the storming and norming phases. It can still be done that way, but it is harder.
Empower the worker to act and to change. That is the central principle of the daily improvement program.
No idea is too small. If a change saves three seconds of a nurse's time, and the hospital has 300 nurses doing that thing 10 times a day, the cumulative benefit is well worth the effort to make the change.
All ideas are addressed in some way. Employees are the customer of the daily improvement process, and the hospital wants them to have a good experience and come back with more ideas. Leaders are expected to respond to and engage with any idea — even one they do not want to act on, or that is too big, or not appropriate — within a week of submission.
Never blame the employee. If you want to stop employees from submitting ideas, the surest way is to let them submit an idea and then get in trouble for the problem they identified. Ideas are process opportunities. No employee should ever get in trouble for surfacing a problem.
The questions leaders ask are deliberately framed. Leaders ask what bugs or frustrates the employee about their job — not what tools and equipment the employee needs. Asking about frustrations surfaces the problem. Asking about needed tools asks employees to jump to the solution, which is harder for them and skips past the problem the hospital wants to understand and solve in the most cost-efficient way.
Ron acknowledged that the daily improvement program might sound like an electronic suggestion box. The difference is the process around it. A traditional suggestion box is locked, ideas go in and disappear, and nobody hears back. The daily improvement program has a methodology, a leadership component, and a technology component wrapped around every idea. The four steps of the idea life cycle — capture, implement, measure, share — each have a leadership role and a technology role. Leadership engages and encourages through rounding, huddles, and meetings. Technology supports the flow — the user submits an opportunity for improvement, the leader gets a notification, and the work moves along without sitting in a locked box waiting for someone to check it.
PDCA lives specifically in the implement step. The leader's job at that point is to coach the employee through the cycle and make sure that when something is implemented, the employee checks whether it actually got better — a step that is commonly forgotten. The measure step documents the outcome — categorized as revenue generation, cost savings, patient satisfaction, or patient safety. The share step demonstrates the value, recognizes the employee so other employees can follow the example, and uses the technology to spread the improvement.
One of Ron's points about scope cuts to the heart of the program design. When employees said they had put something into KaiNexus and nothing happened, the hospital's framing was that there is "no somebody who works here." If an idea says "somebody needs to do this," it is out of scope. The program wants employees to surface things they can control, that they and their leader can work on together.
Ron told one story that he described as the epitome of the employee engagement the hospital is after.
The hospital's grounds crew used a tractor to clear snow from the sidewalks, then had to go back over the same route with a separate salt spreader. An employee, Dan Vaughn, submitted an idea: put the salt spreader on the back of the tractor so the two passes become one. John Randall assigned the idea to Dan to work on.
About three months in, Ron ran into Dan in the hallway. Dan said he was never doing another one of these again — he described how much work it had been to figure out what kind of equipment could go on the back of the tractor, and how much effort he had been putting in. Ron encouraged him to keep going.
About three months after that, Dan sent Ron a picture of the finished result — the salt spreader mounted on the back of the tractor. Dan was proud of it. Every time it snows, Dan and his co-workers use it, and they see the result of his idea every day. Ron's framing: the story is a good example of what employee engagement looks like — a frontline employee identifying a real problem in their own three-foot radius, doing the hard work of solving it through real difficulty, and ending up with visible, durable pride in the result.
The third objective of the session was sustainability. When the hospital asked itself what the best thing it had done was, the answer kept coming back to the 2014 100-day workout. So the hospital decided to keep that mechanism alive and keep running it.
The reasons the 100-day workout works as a sustainability mechanism: it is a simple, straightforward concept for solving organizational problems. It engages teams of employees. Managers are engaged. Senior leaders are engaged through their reviews and approvals. Everybody knows what is going on through the use of KaiNexus. Project owners carry out the recommendations. All the work is documented and fully transparent. The savings and revenue generation can be validated and rolled up into a total.
The 2016 workout used the same ground rules but added a competition with three categories — most collaborative, most significant impact, and lowest hanging fruit — and required leaders to put their projects into a storyboard format. The hospital also addressed a question leaders raised — what if I cannot find an idea — by pointing leaders to places they could look or trigger ideas: rapid improvement event ideas that had not been pursued, the 2014 workout's ideas, and the thousands of daily improvement submissions in KaiNexus. Searching KaiNexus to find or trigger ideas became the standard guidance.
The 2016 results were similar in total — roughly $700,000 — but with a shift from cost savings toward more revenue generation, which the hospital read as leaders finding new ways to deploy the workout. There were 42 projects, 37 completed with change. The storyboards were displayed and leaders voted with dots. The prizes had a sense of humor — a watermelon for the lowest hanging fruit, trail mix for the most collaborative effort, a Dollar bar for the greatest impact on the margin.
The hospital reached a point where it held an all-employee meeting with the winning storyboards on big posters at the back of an auditorium and all the leaders' project storyboards along the sides, so employees walking through could see what their leaders and teams had been working on.
The hospital decided not to run the workout in consecutive years — every year was judged too much for the cycle. The next workout actually started in November and finished in 2018. The 2018 results showed the hospital getting better at getting better: 61 total projects, 48 completed with change, over $1 million in validated savings and over $1 million in validated revenue. One project tipped the scales at $700,000 in revenue, another at $200,000 in savings. Where the hospital had been excited about a $50,000 project in 2014, the 2018 workout had roughly half a dozen projects in the $50,000 range. The change rate climbed too — of 53 submitted projects, 91% were completed with a change, up from 83% in 2014. The soft savings from time reduction were actually going down, which the hospital read as leaders learning to find cost savings and revenue rather than just time savings.
Karen's framing of what the workouts represent in the Baldrige sense: the learning. The Baldrige framework is about creating systemic, fact-based approaches that are deployed, and the workouts are exactly that. The dollars saved or revenue generated are, as both presenters put it more than once, the cherry on top. The point is the learning and the engagement at both the leader and the staff level.
Karen closed the substantive content with the results the hospital cares about most — not the dollars, but the outcomes.
The preventable harm index, one of the hospital's big-dot goals, was going down — the hospital wants to reduce events that create or potentially create harm for patients. Patient engagement, another big-dot strategy, was going up. The bars between fiscal years on the hospital's tracking represented all the improvement work being done to engage leaders and staff in sustaining a culture of high performance and safety.
The improvement journey traced back to the 2010 training and forward into the years ahead — the hospital sees the work as continuing because patients expect it and the organization has a goal of zero harm. Karen's lessons learned were brief: engage everybody, make the work part of what is done every day, and do not cram for the test. The repeated point underneath all of it — helping leaders understand so they can help staff understand.
Mary Greeley is a KaiNexus customer, and unlike many of the webinar sessions where the platform's role has to be drawn out as a connection, this session described the platform's role directly because the presenters used it as part of their own story.
The first thing the platform did was make the leadership-engagement strategy possible. The 2014 100-day workout existed as a learning-by-doing exercise specifically because the hospital needed all 75 leaders into the system before the daily improvement program could launch. The hospital knew, from watching the system after it went live, that some leaders simply were not logging in. The 100-day workout was the mechanism that converted "we have a platform" into "our leaders actually use the platform." The platform was both the thing leaders needed to learn and the system that held the projects they learned on.
The second thing the platform did was make the daily improvement program operationally real rather than a suggestion box. Ron was explicit that the difference between the daily improvement program and a locked suggestion box is the process wrapped around every idea — capture, implement, measure, share — with a leadership role and a technology role at each step. The technology role is the documentation and the flow. An employee submits an opportunity for improvement, the leader gets a notification, and the work moves rather than sitting in a box waiting for someone to unlock it. Across thousands of submissions, the platform is what kept the ideas from disappearing — and disappearing ideas are exactly what teach employees not to bother submitting.
The third thing the platform did was make the management of the program possible. Ron described his own use of the system's queues in concrete detail. Newly submitted ideas not yet addressed by a leader can be set to surface in his queue after a defined interval — 24 hours, seven days, 30 days, whatever the hospital chooses. Employee-submitted resolutions waiting for a leader's approval surface when they have been sitting too long. Ideas with no activity for six months surface so he can manage them. The platform's reporting lets the hospital see submissions, completions, and completions-with-change by department, by location, and across the organization, top to bottom. That visibility is what lets Ron and his partner coach the specific leaders who need coaching rather than coaching in the abstract.
The fourth thing the platform did was make the sustainability story trackable. The 100-day workouts work as a sustainability mechanism partly because everybody can see what is going on through KaiNexus, project owners can carry out documented recommendations, the work is fully transparent, and the savings can be validated with finance and rolled up into a total. The hospital's own engagement metric — the percentage of opportunities for improvement completed with a change, tracked by department — is a platform report. That metric rose from 83% in 2014 to 91% in 2018, and the hospital can see exactly where it is rising and where it is not.
None of this changes what Mary Greeley built. Baldrige is the framework. Lean is the method. Discipline, the spread, learning by doing, respect for the work, and the willingness to start before things are perfect are the principles. The CEO personally leading work system map sessions is the leadership commitment that makes the rest possible. What the platform does is preserve the integrity of the practice at the scale of a 1,300-employee hospital — holding thousands of daily improvement ideas, surfacing the ones that need attention, validating the savings, and making the whole portfolio of improvement work visible enough that leaders can be held to it and staff can see that their ideas went somewhere.
How does Mary Greeley combine Baldrige and Lean without creating initiative overload? Mary Greeley treats Baldrige as the operating framework and Lean as the practical method that supports daily execution. The hospital does not run Baldrige and Lean as separate programs with separate project lists. Baldrige is the work; Lean supports the framework; daily improvement is how the work gets done. Karen's framing: the hospital has not called out Baldrige and Lean as new projects to get to excellence — they are simply how the organization operates. The integration is what keeps leaders focused on quality, safety, and patient outcomes rather than being pulled in multiple directions by competing initiatives.
What is a 100-day workout? A structured improvement cycle where leaders identify a project within their own scope of work that can be completed in 100 days, managed in KaiNexus. Mary Greeley borrowed the concept from GE Healthcare, with Mark Graban helping roll it out. The ground rules for the first workout: every leader participates, the project is within the leader's scope, it focuses on improving revenue or saving costs without harming quality or safety, and it is completed in 100 days. The cycle includes senior leader review and approval of every project, 30-day follow-up check-ins, finance validation of results, and a celebration.
Why was the first 100-day workout really about training, not savings? Mary Greeley designed the 2014 workout primarily to get its roughly 75 leaders into KaiNexus and comfortable using it, ahead of a daily improvement program that would require platform fluency. The hospital knew some leaders were not logging into the system on their own. The workout gave every leader a structured reason to get in, work a project, and build the habit. The $691,000 in validated cost savings and $116,000 in soft savings were a collateral benefit the hospital did not design for — the goal was learning by doing, and the savings came along with it.
What are work system maps and why does Mary Greeley build them? Work system maps document how each department's work supports the organization's systems of care and its four big-dot goals. The department's leaders and supervisors lay out the high-level work in categories, and then the department's staff come in — in a session led by the CEO, working like a sticky-note brainstorm — and describe the work they actually do, in their own words. The initial purpose was for the organization to understand how the work was really being done. The unexpected benefit was engagement: staff felt their work was valued and saw that the CEO personally wanted to understand it. Mary Greeley identified 49 support systems and intends to map all of them.
Why does the CEO personally lead the work system map sessions? Because the CEO's direct involvement is what makes the sessions meaningful to staff and is, according to the presenters, the origin of Mary Greeley's unusual level of leadership engagement. A CEO spending the time to walk department staff through a structured conversation about their work, one department at a time, signals that the work matters and that leadership genuinely wants to understand it. The session's closing Q&A made the point explicit — the hospital attributes much of its success to senior leader engagement, and the CEO modeling that engagement personally is what makes it real rather than rhetorical.
What does "managing for daily improvement" look like at Mary Greeley? The program, drawn explicitly from Mark Graban's work, starts with supervisors engaging employees to bring ideas forward — no matter how small — and helping them focus on improving their own jobs. Staff are told to look within a "three-foot radius" of wherever they work for problems that bug them, frustrate them, or get in the way of patient care. The program has a methodology (a four-step capture-implement-measure-share life cycle), a leadership component (engagement through rounding, huddles, and meetings), and a technology component (KaiNexus, which handles the documentation and flow). Since 2015 the hospital has received thousands of submissions.
What is the "three-foot radius"? Mary Greeley's framing for the right size of problem for the daily improvement program. Staff are told to look at a three-foot radius from wherever they are — the bedside, their desk, the hallways they walk — for something that frustrates them or gets in the way. The framing keeps employees focused on problems they can actually control and improve, rather than on large organizational ideas (Ron's example: "the hospital needs a helicopter pad") that the employee and their leader have no power to implement and that lead to disengagement when nothing happens.
Why does Mary Greeley ask employees what frustrates them rather than what tools they need? Because asking what frustrates an employee surfaces the problem, while asking what tools or equipment they need asks the employee to jump straight to a solution. Surfacing the problem lets the hospital solve it in the best and most cost-efficient way. Asking for the solution skips past the problem the hospital actually wants to understand. The distinction is deliberate and built into the questions leaders are coached to ask.
Why is "never blame the employee" a core principle of the daily improvement program? Because blaming an employee for a problem they surfaced is the surest way to stop them from surfacing problems. Ron's framing: if you want to shut down idea submission, let an employee submit an idea and then get them in trouble for the problem it identifies. Ideas are process opportunities. No employee should ever get in trouble for calling out a problem. The principle, combined with the commitment to respond to every idea within a week, is what keeps employees willing to keep participating.
How does Mary Greeley measure improvement beyond cost savings? Improvements in the daily improvement program are documented in categories — revenue generation, cost savings, patient satisfaction, and patient safety. The hospital tracks soft savings (time reduction) separately from hard savings (validated dollars), with finance validating the financial results. Beyond the improvement-level metrics, the hospital tracks organizational outcomes that matter most — the preventable harm index (going down) and patient engagement (going up) — and treats those, not the dollars, as the real measure of whether the improvement work is succeeding. Both presenters repeatedly described the financial results as "the cherry on top."
How does Mary Greeley track whether leaders are engaged and coaching well? The hospital tracks the percentage of opportunities for improvement completed with a change, broken down by department. The logic: if an employee submits an idea and the leader does not respond, or nothing gets done with it, the employee disengages over time. The completion-with-change rate by department surfaces which leaders need coaching. Ron uses the platform's queues to see newly submitted ideas not yet addressed, employee resolutions waiting too long for leader approval, and ideas with no activity for six months — and reaches out to the relevant leaders. The annual employee engagement survey provides a second read on whether the daily improvement program and the workouts are moving morale.
Why did Mary Greeley start with Baldrige as a framework? Karen's reasons: Baldrige is fact-based, it asks how an organization does things rather than prescribing what it should do, it puts approaches through a PDCA cycle of evaluating whether they produce favorable results and learning, and it allows benchmarking against world-class organizations. A common misinterpretation, the presenters noted, is that Baldrige is only about process improvement. It is actually a holistic, overarching framework covering strategy, leadership, customers, workforce, measurement and analysis, knowledge management, and operations — with process improvement living inside it alongside everything else. The presenters pointed interested practitioners to the National Institute of Standards and Technology (NIST) website and noted that most states offer a Baldrige-based program organizations can participate in.
How does leadership engagement at this level get started? Karen was direct that it starts at the top. Mary Greeley's CEO is deeply engaged — a former CFO who, in Karen's description, has not forgotten what he knows about finance but focuses on patient safety, quality, and respect for the workforce. He spends time touring, working with staff, and personally leading the work system map sessions. The four vice presidents are equally engaged with directors on the 100-day workouts and with staff on daily improvement. Karen was candid that the hospital is fortunate — she has asked herself what the work would be like without that level of CEO engagement, and the honest answer is that the hospital could still succeed but the road would be considerably harder. The leadership engagement is the foundation everything else sits on.
How many healthcare organizations combine Lean and Baldrige this way? The presenters knew of roughly half a dozen in their own state and described Baldrige in healthcare as a growing field. Healthcare measures a great deal and works with multiple accrediting agencies (the Joint Commission, CMS), and those bodies support the Baldrige philosophy because the framework is grounded in PDCA, improving work, and using data to measure progress. Karen noted that in seven years as a Baldrige examiner she had not seen a healthcare application — or any application — that did not involve process improvement and some form of Lean approach. Her framing: if you are interested in Baldrige you will be interested in process improvement, and vice versa.
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