Lean Transformation - 3 Clues You're Not There Yet

Any major transformation is going to take time, resources, working together, and a whole lot of hard work. But a Lean transformation requires a change in the way people think, and that is why only 2% of Lean adopters prevail.  As noted in the previous post, companies typically focus on the culture or the tools, and usually not on both together. This can lead to confusion, dis-engagement, and the belief that "Lean has failed." Don't give up just yet, but if you think your company is headed there, look for these 3 clues:

Lean is referred to as "lean" (quotations included) and/or LEAN
Lean is not an acronym nor is it some magical potion that will solve all your problems in a 2 hour meeting, so please don't refer to it that way. Lean is a business practice and a way of thinking across all levels of the organization. There is no "lean team" - we are all working together to improve what we do, everyday. In fact, some of the best organizations don't even call it Lean because it has become something every employee does in their everyday work. The Virginia Mason Production System is one of the more famous examples.

Goals are not SMART. Actually, they're not even goals.
The core fundamental of PDSA (continuous improvement) is being able to measure your test of change to see if there was indeed an improvement. In order to do so, goals must be SMART (Specific, Measurable, Attainable, Realistic, and Timely). Most organizations don't have SMART goals at their highest levels. Come to think of it, most companies don't even have goals, they have "initiatives."  For example, if your initiative is to "provide efficient, high quality care to all patients," how could you possibly know you've done so? Now, what if it said, "By the end of FY11, we will provide efficient, high quality care to all patients by decreasing ED to inpatient-care flow time by 30% and reducing the number of re-admits by 50%. That type of goal infuses accountability into each and every staff member in the hospital, creating that "clear line of sight."

Human Resources is not involved
People are not the cause of problems, bad processes are. But most people need help seeing that, they need to learn about value and waste and how a problem is an opportunity. People. Development. Isn't there a department that deals with that... oh yea, Human Resources. A lot of organizations somehow don't see that connection, and can sometimes lead to stepping on others' toes.  By including HR up front, details about Lean thinking can be integrated into employee orientation, training can be more efficient, and the culture change from "firefighting" to "waste surfacing" can be a bit smoother when the department whose major responsibility is people, is involved.

Creating Capable Problem Solvers - Tools or Culture?

It seems self-evident that having capable problem solvers on the front line (care-givers) almost always trumps one lean/six sigma/Harvard Business School guru at the top. However, what may not be so clear is, how do we get there? Where do you start? And what do you focus on? In my opinion it comes down to two paths, "tools" and "culture."

Tools
Flow, Pull, and Visual Management. Its knowing how to apply them, but more importantly,when to apply them. You can hammer a nail in with a wrench. But is it the right tool? A lean or problem solving tool set and way of thinking can help get to the best solution, quicker. In addition, improvements made are typically easily spreadable to other areas of the hospital dealing with similar issues.

Culture
Everybody improving, everywhere, and everyday (Masaaki Imai).  A culture where the identification of problems or errors is not seen as a blame game. A problem is an opportunity, and a problem solving culture fosters the when-it-happens, on-site brainstorming necessary to identify the right solutions. This type of culture creates accountability within ones own work, and helps to break down the silos that so often exist within interdepartmental care. Its 15,000 employees all rowing the boat in the same direction, at the same speed.

But which is best? Or better yet, which is first? Do you teach the tools and then foster the environment? Or do you create the culture first, then give employees the skill set with which to work with. I personally believe it's the latter. Get alignment and  gain consensus. Make sure the entire organization knows, its OK to surface problems, and this is how to do so. You don't need to understand pull to come up with a solution to multiple queuing areas in a clinic visit.  You just need to know that multiple queuing areasis a problem and feel confident saying so.

What People Think a Lean Healthcare Consultant Does - From the Inside

If you are familiar with Mark Graban's Lean Blog you've seen this already, but I wanted to put my spin on it, as I am in a bit of a different position than that of a true consultant. I am employed by the hospital in a full-time process improvement role, and if you've ever worked in healthcare, you know how differently you are viewed by clinical staff depending on whether you work with them or were hired by their management as "outside eyes."  So here is what I think:

And please let me explain, because this isn't always the case. For what doctors, nurses, and managers/executives think I do, those perceptions usually change somewhat within the first 5 minutes of us meeting/talking. Once they understand why I am working with them, those feelings go away and we generally build a nice working relationship. Even more, once they've been to lean training, they can't believe they even thought that in the first place; I've had a couple of people apologize to me because they just didn't understand my role in the organization, and how I could help them.

• My Friends: My friends think I'm some sort of mad scientist/engineer
• My Mom: My Mom thinks I pretty much run the organization and that everyone should  be amazed at what I do.
• Doctors and Nurses: Doctors and Nurses think I'm trying to tell them what to do.
• Managers: Managers think I am there to be their project managers, do all the ground work so they can take credit.
• Me: I think I'm fostering a strategically aligned culture. I am trying to have everyone rowing at the same speed, in the same direction.
• What I Really Do: I am here to help solve problems. Coaching, Mentoring, and Teaching employees to become problem solvers so they can implement lean tools and make improvements that will  make a difference in the way they provide care to patients.

So you're "doing lean?"

The possibilities for improvement in healthcare are seemingly endless, not to mention they’re undoubtedly necessary, and a lot of organizations are looking to lean as their improvement methodology.  In the healthcare industry today, healthcare costs are on the rise, reimbursement rates are on the decline, and payment reform is here. But what does that really mean? What it means is that Hospitals will soon be expected to care for patients in a low cost - high quality environment, with patient outcomes being more indicative of their reimbursement rates than the type of care that was received. Unfortunately, the majority of “lean” healthcare organizations do not align their improvement efforts with those changes. Too many high level employees, on too many committees, with too many objectives. A lot of large healthcare organizations don't even say "goals" anymore, they say "Strategic Objective" because by not saying goal, they don't have to be specific.


Its all about right-size countermeasures. Don’t initiate improvement projects and call it “lean” just for the sake of saying you’re “doing lean”. Lean is a business system which needs alignment throughout the entire organization with clear (SMART) goals, so that whatever we are trying to improve, it is the right thing and the most important thing. 

I started this blog to share some of my views and experiences from working as an Industrial Engineer in healthcare. Certainly, we (and when I say we, I mean anyone working in performance improvement in healthcare) have our work cut out for us, so it would be nice to use this blog as sort of a sharing of best practices as well. Whenever we don't have to re-create the wheel, its always helpful. We can solve the issues in healthcare delivery today, but its going to take some work. I hope your not afraid of getting your hands dirty...