Community mental health agency applies Lean processes to improve service to clients

Karen Goike, Michigan Manufacturing Technology Center, explains Lean processes to NCCMH Gaylord staff.

A concept that Toyota first applied to automobile manufacturing in the 1940s, Lean had become a buzzword in the manufacturing world by the 80s. In short, Lean works — and not just on the production line. In fact, a Michigan community mental health agency applies Lean processes throughout its operations with the result of improving care for its patients.
“One of the things I always like to tell everybody when we talk about Lean is there's a little bit of stigma around it that’s really not true,” says Joseph Balberde, chief information officer of North Country Community Mental Health (NCCMH). "Lean is not about doing more with less. It’s about making sure everything you do has value. Our guiding principle is ‘Does everything we're doing bring value to the client.’”
 Joseph Balberde, chief information officer of North Country Community Mental HealthBalberde leads the Lean training efforts at NCCMH, the community mental health agency serving Antrim, Charlevoix, Cheboygan, Emmet, Kalkaska, and Otsego counties. He describes Lean as a framework for improving the many processes involved in delivering mental health care to the counties NCCMH serves. One area where NCCMH applied Lean first was the help desk.
“We were looking at why people weren't using the help desk when they should,”  Balberde says. "We got a group together that included several end users. And we went through what's called a Lean A3 Problem Solving.”
A3 problem solving lists the problem, the analysis, possible corrective actions, and an action plan on a single sheet of large paper. This piece of paper is a roadmap to improving the management process based on dialogue about the problem.
“Lean is really, really great because anybody in the organization can propose a change. It doesn't matter what position you're in, frontline all the way up to in the executive team,”  Balberde says. “Then there's this formal process that we call Lean process improvement. Once an idea comes to us that we realize is big enough, if we have the capacity at the time, we put together a formal team with a project leader and a sponsor who is a member of the executive team. Their role is to make sure that the team gets access to all the information they need and all the resources they need.”
Balberde says that when problems are identified and lean processes are put into action, solutions are usually up and running within six months to a year.
“We've done this training in one of the offices that came to us," Balberde says. "They said, ‘You know, clients are very confused when they come in. It's a very difficult building with lots of hallways and everything looks the same.’ So they decided to work on a project that made sure that similar jobs were in the same areas and labeled the medical area, the psychiatric area, the therapies area, and case management.”
Lean A3 problem solving lists the problem, the analysis, possible corrective actions, and an action plan on a single sheet of large paper. Lean processes also help NCCMH deal with regulatory tasks that can eat up a lot of staff hours.

“Lean helps us become efficient at doing the bare minimum we need to meet those so that we can take our resources and really put them into the client. That's a really big thing for us,” Balberde says. “The other thing that's really powerful about this is it's change from the middle instead of change from the top. Anybody can propose an idea. And we are going to seriously look at it.”
Balberde notes that staff feel empowered when their voices are heard. In addition, he says that there's no way for the administration to know every single thing that's happening on the front line within a six-county organization. Being able to propose problems for Lean processing “puts a magnifying glass” on issues that otherwise might never have been brought to the administration’s attention. In addition, with workforce shortages impacting mental health agencies across the state, Lean processes leverage existing staff more efficiently so that clients’ needs can be better met.
Balberde concludes, “Ultimately, what it does is, during everything our clinicians do, they're thinking about, ‘Does this bring value to the client?’ If we're going to suggest a particular referral, what is the reason? Is it really bringing value to the client? We think those things through, and I think that's where Lean seeps into our everyday decisions.”

Estelle Slootmaker is project editor for the MI Mental Health Series. Contact her at

Photos courtesy North Country Community Mental Health.

The MI Mental Health series highlights the opportunities that Michigan's children, teens and adults of all ages have to find the mental health help they need, when and where they need it. It is made possible with funding from the Community Mental Health Association of MichiganCenter for Health and Research TransformationGenesee Health SystemMental Health Foundation of West MichiganNorth Country CMHNorthern Lakes CMH AuthorityOnPointSanilac County CMHSt. Clair County CMHSummit Pointe, and Washtenaw County CMH.

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