It's not exactly uncommon for lean newcomers to view it as an additional burden on already-crammed schedules. And that's certainly not uncommon for healthcare executives whose days are consistently packed with meetings, email correspondence, paperwork, compliance assurance and more. Chris Weisbrod has seen many healthcare leaders even refuse to go on simple gemba walks, claiming they're "too busy." The Lean Post sat down with Weisbrod recently to hear his experience with this problem - plus his strategies for resolving it.
Why do healthcare leaders often think that they don’t have time to walk the gemba?
This is a result of working in an organization that has little focus on strategic direction, too many strategic initiatives and no ability to deselect what initiatives the organization should work on. When everything is important or the organization is always chasing the latest shiny-bright opportunity, it causes chaos and leads to leaders thinking that one does not have time to go to gemba.
Why is this such a problem? What might happen to a hospital whose leader never walks the gemba?
A leader who never walks the gemba will be missing out on the best opportunity they will have during their tenure to connect with employees. By getting to gemba one realizes that the front line can fix the problems that plague healthcare. Leaders sometimes tend to think their own role is to fix these problems. It is not, the role of leadership is to set the strategic direction, develop and coach staff and remove barriers to improvement. The traditional organizational hierarchy is a triangle with the front line at the base of the triangle and senior leadership at the point or top. This hierarchy needs to be flipped so that the frontline employees are at the top. They deliver value to the customer and thus are the most important people in any organization.
I heard a story of a hospital CEO who claimed she was too busy for gemba walks, but said she "didn't need to anyway" because she had all the performance metrics to tell her what was happening. Is that valid?
Partly valid as performance metrics are certainly important in helping leadership understand the current state in their areas. But if this is all one relies on, then they are missing out on quite a bit. Data and metrics do not tell the whole story. One must be able to understand when variation has occurred and if it is common cause variation or an abnormality. If it is the latter, then going to where the work is being done and understanding the abnormalities is crucial for leadership.
And now the million-dollar question: how can I convince them that there IS time to walk the gemba?
I would ask leadership, “How can we afford to continue to do business the way we always have? Let’s start with small changes and experiments around going to gemba, focused around the few main strategic goals of the organization, the True North.” Build your daily management system from top down to the front line around these. When you see this in action it is a beautiful thing to witness. For example, you could arrange for a front line employee such as a nurse explain to leadership how the A3 they are working on ties into the goals for the department and the organization. Healthcare needs to change and leadership spending time in the gemba where the value added work is being done is a great way to start that change in an organization.
I recently listened to a talk by Mark Graban in which he brought up the point that coaching and developing is hard at first for leaders; but if they stick with it it pays off. In essence that’s what getting to gemba should be: Coaching and developing your people, and in the end leaders will have more time for the things they should be focused on like strategic initiatives. On a trip to an ED at Nemours Children’s Hospital in Wilmington DE, a nursing director told my visiting group she spends over half her day in gemba. The visitors were floored by this and asked about emails, meetings and all the other non-value added work that consumes leadership’s day. She responded by saying, “I am out working with staff to problem-solve in real time and negating the need for emails around the problem and meetings or committees to work on the problem. By doing this it has freed me up and given me time to focus on what’s important in my areas.”
Learn more about lean healthcare from Chris Weisbrod and others at the 2017 Lean Healthcare Transformation Summit, to be held June 7-8 at the JW Marriott Desert Springs Resort & Spa in Palms Springs, California. Learn more and register here.