When implementing lean in a healthcare organization, it's not uncommon to encounter resistance from medical professionals set in their traditional ways. Resistance is natural in any lean transformation, but Kathryn Correia has pinpointed a root cause of healthcare lean resistance that goes much deeper than your standard skepticism. I recently sat down with Kathryn to hear her thoughts on this problem and her recommended remedies:
What’s the nature of this problem? Why are professionals so tempted to adhere to the standards of their professional organizations?
The nature of the problem is human nature. We are inclined to stick with what we know. Introducing a new way of doing things – even if it is for the greater good – can appear threatening. Medical professionals - physician and non-physician alike - will have the strongest allegiances to their professions. They first look through the lenses of their professional societies, where their allegiance is strongest, versus the lens of the organization or even the customer. How they look at a situation, an initiative, a new way of doing things, will depend on where they are philosophically rooted.
How did you first pinpoint the influence of professional identity and affiliations being the root cause?
It was certainly apparent during my work at ThedaCare in the early 2000s. We were working on a significant transformation of our patient-care delivery process, which drew resistance from the medical staff. I remember the medical staff in turmoil.
Our work focused on redesigning and reconfiguring clinician roles, all acute care processes and the physical care environments to make them more efficient, effective and patient friendly. This new model used lean methodology to achieve significant cost savings and quality-improvement results. The physician buy-in wasn’t always there. Don’t get me wrong, we did have early physician adopters, but others resisted.
After all, we were asking them to let go of their individual way – the way their medical school taught them – and embrace the standard work their peers developed. Their allegiance to the medical profession, which is laced with a good amount of autonomy as well as perfectionism, was part of their training. It takes a while to get past the superficial resistance to get to this issue.
Have you had to deal with this problem beyond the Thedacare Center; say, at HealthEast?
Sure. A year or so ago, I had the opportunity to talk with our medical staff leaders about this. I needed to put lean in context. For many of the HealthEast medical staff, lean was carrying a lot of baggage, misperceptions, and negative impressions – not setting them up for success. I took this opportunity, supported by our new CMO and COO, to set the table:
- For the customer/patient, lean is about delivering value:
- increasing benefits, decreasing burdens
- For healthcare professionals lean focuses on:
- respect, innovation and sustainable competitive advantage
We were not working around the resistance, we were working through it. We were working to see differently – together.
Why do you think it’s so important for staff to set their own standard work? Is it worth the added work?
The best means we know of for influencing change is creating standard work. I shouldn’t be the one deciding how standard work should look in a clinical area. Not only would I be wrong, but it would be incredibly disrespectful to the staff. This is not about a top-down approach to improvement. The physicians/providers need to be making those decisions – they are the experts. They know what changes need to be made, and how. If they could make those changes with the help of lean, they could impact and improve healthcare experiences for patients, families, co-workers and even the community as a whole. This isn’t added work, this is a transformation – moving from one way of thinking to another.
What are some effective coaching remedies for this problem?
The first thing I learned about coaching is to keep your mouth closed – your ears, heart and mind open – but your mouth closed. When coaching, it’s about asking the right questions and then listening. For some, letting go of their approach to work and adopting a new approach creates anxiety. You are supporting, informing and guiding them to the “ah-ha!” experiences that alleviate anxiety and ultimately ignite their passion to do the work.
What is something you would advise a coach to do/be aware of/etc. before addressing this problem?
Make it real. Doctors, nurses, healthcare providers in any role have a shared passion/purpose – patients. They will resonate with lean concepts such as value stream, creating flow across a continuum of care where patients move safely, gently, without falling through the cracks. When our employees, leaders and physicians understand the broader context of lean, their minds will open to the possibilities.