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.
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