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Encountering Problems and Resistance

10/13/2020
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The doctor entered with a comforting bedside manner. We small talked. She asked about my work and I answered, in short. “Lean? You mean that Toyota thing?” In spite of the mask, I could read ‘Oh Brother’ on her face. “Yeah, we tried that here.” 

I had just sat for twenty minutes in a small waiting room with three other people, one of whom kept coughing, even though I’d timed my arrival to avoid exactly that. And soon, the doctor and an assistant would spend five minutes searching for a pack of ice. This, while my anxiety was running high before a procedure I’d never had. Things could have gone better. They always can.  

Meanwhile, less than twenty-four hours later, within the same healthcare delivery system but at another site where I usually receive care, I pulled into a makeshift drive-thru and got a seasonal flu shot without leaving my car. It took about three minutes. There was no talk about Lean. No time for it. 

Admittedly, these two visits involved very different processes. The scheduled visit for a flu shot is easy to define. Its single activity is quick with minimal steps (no handoffs) and consistent timing. The other visit involved a consultation and procedure. It’s more complicated (handoffs) and open-ended, resulting in longer and less predictable cycle times which contain more work.  

And so, more problems. Achieving flow is harder in the latter scenario. Which is all the more reason to instill Lean Thinking and Practice (LT&P).

The current state is partly a matter of perspective 

The “bad” visit was an outlier. For years, this healthcare system has cared for me well, primarily at the site where I just received my flu shot. I’ve also taken assurance at the evidence of LT&P I’ve noticed over the years: 

  • Values such as “patient-centered care” 
  • Visits with flow, even across departments and caregivers 
  • Means to give and get feedback  
  • Huddle boards with visualized performance indicators 
  • A3s posted on the walls, suggesting collaborative problem-solving and intentional capability development 
  • Conversations with caregivers who’d expressed positive views on Lean 

Regardless of my observations, the doctor says her experience with the “Lean…Toyota thing” has not been good. Unfortunately, hers is a common experience. For too many people, Lean is random (vs. purposeful) activities to reduce costs (vs. improve performance multi-dimensionally) and eliminate jobs (vs. develop capability) done to (vs. with) them, focused on localized (vs. total system) efficiency (vs. quality) first, promoting individual heroics (vs. steady teamwork). (As hard as that sentence was to read, sadly, I think it illustrates well the schizophrenia of many “lean implementations.”) 

When the doctor expressed her negative view of Lean, I changed the subject; I was there as a patient, not as a lean coach. (Plus, I was about to be stuck with some needles!) That said, as evidenced by this e-letter, the exchange has stuck with me.  

Keep on keepin’ on 

The truth is – LT&P is hard. For those whose lives it has improved, and whose businesses have been saved and strengthened, it’s well worth the effort. But still, it’s damn hard work. And getting it “right” is harder still, especially across multiple sites with hundreds, if not thousands, of people. Some, like my doctor, end up not so well engaged. 

Which is why it has been so great to recently participate in several virtual lean gatherings, including LEI’s own Virtual Lean Learning Experience – VLX. I’ve heard from leaders at places like GE Appliances, New York Presbyterian Hospital, and a school district in Menomonee Falls, WI. They’ve told remarkable stories about tackling problems, some with dire consequences, using LT&P, emphasizing the need for perseverance.  

They’ve also reported outstanding results! For example, GE Appliances CEO Kevin Nolan reported that quality and productivity are at peak levels, in spite of corporate lawyers and accountants working on the line due to callouts. And Pat Greco, former superintendent of the Menomonee Falls School District, told how LT&P helped turnaround her underperforming school district. Today, they’re top ranked in terms of student achievement. Needless to say, I’ve been inspired and encouraged!  

2020 Hindsight 

Several years ago, an interviewer put to me a hypothetical situation. I was asked how to respond to a manager who’s resisting Lean. I answered, “For starters, I’d stop talking about Lean. I’d want to find out what mattered to them, what they were struggling with. In other words, what problems they were trying to solve.”  

Truth be told, at the time of that interview, I had just started learning that lesson. Even today, I’m still trying to make it instinctual, habitual, part of my day to day.  

I wonder, how have the doctor and her staff been engaged around Lean? Is it understood as a way to quell the noise in the work, creating the capacity to enjoy the company of patients and focus on their care? Has LT&P been shown to be a viable way to improve things that matters to them? Can she, as the site leader, imagine how to instill LT&P throughout her medical practice?  

Addressing these questions ain’t easy. But it is the fulfilling work of Lean Transformation.  

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