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Your Conversations on Lean Thinking and Practice in Healthcare

by Darlene Dumont
June 11, 2014

Your Conversations on Lean Thinking and Practice in Healthcare

by Darlene Dumont
June 11, 2014 | Comments (1)

Some of the best conversations we have at work happen outside of formal meetings, strategic planning sessions, or daily huddles—important as these things are. This is why we’ve begun running Open Space sessions at LEI conferences—to give Summit participants a chance to have the conversations they want to have with other attendees in a casually structured environment.

At the 5th Annual Lean Healthcare Transformation Summit last week in LA, I hosted two Open Space sessions with about 50 attendees, in total. In each session, we came together as one large group, not knowing what the final topics of conversation would be. As participants identified topics of interest, smaller, self-organizing groups formed to further discuss and learn from each other’s lean experiences. The energy of the teams was high and engaging. Those folks who volunteered to host conversations had everything to do with that. Thank you to everyone who participated in this open space! 

Below is a summary of the notes that each of the teams captured as they conversed and learned from each other. These are participants’ notes and recommendations, not mine, shared here so we can all keep learning and thinking about these questions. How would you answer these questions? Let us know in the comments!

1. When/how should we transition from an LPO-line journey to a line-led journey?

Some of the questions they discussed (and perhaps questions that all lean change agents should ask themselves): How do we orient new employees? What are you actually doing? Where is leadership? How do you introduce Lean to the ops managers? What is the follow-through? How do you know something is working (or not)?

In response to the question, “What does ‘lean maturity’ look like?” participants said comments like: Sustaining work, audit with a paper trail, data, involving both the patient and the frontline worker.

Other insights and issues: Too often Lean is a “flavor of the month.” Leaders don’t the walk the talk. Buzz words turn people off. Too often there’s a lack of respect for people. Make sure to create pull, not push. It’s important to make it safe for staff to share info and discuss problems openly. There’s “doing Lean” versus “becoming Lean”, and it’s importance to know the difference. At the end of the day, doing Lean is not about Lean.

2. How can we reduce no-shows in specialty clinics?

Most organizations average 7 – 20% no-shows.

Suggestions: Auto-call reminders (e-mail, text, phone). What would be the impact of penalty fees (bill for a missed visit on a sliding scale)? Get data from patients. Get stories from patients. Think: what is the purpose of an appointment? Or why do we have appointments?

3. How can lean practitioners, skilled in continuous improvement, lead a healthcare transformation?

Think: What skills/competencies are needed to do this? Have a strategy and deployment plan on why you are doing Lean. Teach leadership the concepts and tools (5S, standard work, etc.). Do not start with rapid improvement events without teaching leadership the concepts of Lean first.

4. How to implement jidoka in a clinical environment? “Pull the chord?”

One reason this is challenging is the culture of hierarchy. Another is siloed thinking. Think: People in hospitals are trained how to respond to patient emergencies everyday… how do we take these same behaviors and teach them how to apply them to their processes as well? Is it possible to get a “pull the chord” mentality when we see the ED overfilling with patients? Does anyone have an example of this?

5. How do you get clients to utilize the lean tools we have deployed?

Build accountability. Establish s tandard work. Ensure they understand how and why to use the tools. Get clients develop and use the tools with you. Celebrate wins and share more success stories.

6. How do you create sustainment at the senior executive level when “go forward” decisions are made based on budgets rather than vision?

Lack of documents before/after a change leads to a situation where people question the value. Proof of patient experience IS the vision… don’t lose sight of this. Create time for regular coaching / listening sessions. Be sure to do deep dive gemba walks… don’t just “water ski” over the top of organizational activities. How do we help executives to understand their role and their impact on sustainment … (e.g. own it versus rent it)?

7. If senior leadership buy-in is lacking, how do you build that up the chain?

Bring leadership to the front lines. Create excitement from successes. Know your goals, goals create challenges to work toward. Identify and organize around senior leaders’ pain points. Invite others to help you close those gaps and see the work to be done. Behavioral audits can lead to lean behaviors. Think about how to deploy the goals as much as identifying what the goals are. Goals must be on paper and in practice. Identify and escalate competing priorities. Create visual boards for the leadership team to see the information and material flow. Create connections at lower levels. Set up huddles, work one step at a time. Get clarity on roles. Have the right discussion at each level. Think: What’s happening at the gemba versus 10,000 feet away where the board of directors is driving activities. Solve a problem and share the results with others.

8. How do we get front line physicians and clinical staff to understand and embrace lean?

Desired behaviors: As a Medical Director (MD) - show more team behavior and create an environment of trust so staff will provide input/ideas. Be curious, ask questions, show respect. Use data to increase the awareness about the current safety/quality and identify what is acceptable or not… grant immunity. Bring patients into the mix. Create support for a lean management system. Connect lean with scientific problem-solving. Link lean to key competencies. Have a lean MD champion. Engage an MD’s competitive spirit. Center on the patient, not the provider.

9. How do we transition from a diverse “lily-pad to lily-pad” lean approach to identifying a focused and strategic approach as a lean organization?

Leadership buy-in is key. Identify key areas based on metrics and readiness. Commit resources.

10.  How do I influence my CEO to change from commander-in-control to a question-asking coach?

Clear expectations (tools and standard work). Institutional expectations of having a coach/sensei. Think: who will they accept as a sensei (internal or external)? Schedule coaching sessions in meetings and at the gemba that lead to feedback. Create a management system (including visual management). Create a trusting, safe environment.

The views expressed in this post do not necessarily represent the views or policies of The Lean Enterprise Institute.
Keywords:  healthcare
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1 Comment | Post a Comment
Mark Jaben, MD June 26, 2014
1 Person AGREES with this comment

#4- I can share several examples of 'pulling the andon' in an ED
#8- The resistance we observe among front line clinical staff is the most important and sensitive indicator of the real problems that need to be addressed.

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