Pam Helander, Catalysis Faculty, discusses lessons learned while implementing a lean management system. Pam has worked in many roles within healthcare, from a bedside nurse to the executive level and has spent a large part of her career developing, implementing, and leading within a lean management system.
Creating a Lean Management System virtual workshop
Beyond Heroes by Kim Barnas
Peter Mariahazy: Welcome back to The Lens. I'm your host, Peter Mariahazy. Today, I'm joined by Pam Helander, Catalysis Faculty and Team Member, to discuss lessons learned while implementing a lean management system.
Pam has worked in many roles within healthcare. From a bedside nurse to the executive level. She has spent a large part of her career developing, implementing, and leading within a lean management system. Currently, Pam works with Catalysis in content and providing coaching to healthcare organization leadership. Thank you for joining us, today, Pam
Pam Helander: Thanks Peter glad to be here.
Peter Mariahazy: Pam, can you tell us a little bit about yourself beyond what I've already said and your experience with the lean management system?
Pam Helander: Sure, so, as you said, I'm a nurse by background. I have a doctorate in nursing practice and over 30 years in healthcare experience. I functioned in the role of bedside nurse, Quality Team Member- both Director and VP at the system level, as well as part of the lean system, as we were implementing it, and then I've also worked as an operations manager, in nursing and pharmacy at the department and at the system level. I started with the lean management system, as we were developing it. I was in the quality department, so I helped with the development and then I had a chance to use the management system, as I moved into the operations role in both pharmacy and at that VP level. So, I've had some experience in helping to support and coach and some experience in using it.
Peter Mariahazy: So the listeners of the podcast know, I mean we talk about the management system and how it's important in the healthcare industry. Give us your perspective, why is management system beneficial in healthcare, specifically?
Pam Helander: Um well, when we were starting the lean management system, we were having a hard time getting away from firefighting every day. And what we learned, with the lean management system, was that it was what we used to help us to see our business and then be able to proactively plan and anticipate what was going to happen and begin to develop our people as problem-solvers and really solve little problems and big problems every day. It also helped us to make connections throughout the organization. So, at all levels of leadership, you're connecting the work that's happening and the problems that we're seeing to make sure that we're all working on the same stuff as we develop our problem-solvers and create constancy of purpose. In the end, we were all rowing in the same direction to get us to the outcomes that we needed to for the organization.
Peter Mariahazy: I love the example of rowing in the same direction and as an example of systemic thinking, and you know you got to realize that you have an impact upstream or downstream, depending on what you're doing, don't you?
Pam Helander: Yeah, for sure.
Peter Mariahazy: Where do you recommend organizations start? You were at the beginning, you helped launch it, develop it, spread it. What should organizations look at when they start implementing and learning about a management system? What are some of the genesis steps they should take?
Pam Helander: Sure, so when I think about where to start, I think about understanding the end in mind and seeing the whole first. So, think about a puzzle, right? When you do a jigsaw puzzle you look at the box to see what picture you're going to create first and then, when you put the puzzle together it's much easier to see how the pieces connect. So, I recommend you learn about what's the whole first. What's a management system supposed to look like? We at Catalysis have opportunities for us to do that, right? You can read Beyond Heroes. It's a great way to see how the whole thing played out and got put together. You could attend a workshop or, even better, go see if you know somebody that has a management system in place. Go see what they're doing and how the pieces connect. Then, once you see the whole, then I think the best place to start is with the status sheet. And the reason I say that is because, when you use the status sheet, you as a leader are going out to where the work is happening and you're asking really general open-ended questions to try and understand and to hear what your…where people are thinking. Understand where they're at, and you can then guide and coach, and let them be the problem-solvers but you get to understand your business a little bit better. And you begin to proactively plan rather than react to what's happening around you so it's a great way for you to understand what's happening, get a basis, and then figure out where you want to go from there, as far as improvement goes. It also is a great way to set the stage for the rest of the elements in the management system. So I, I think the status sheet is a great place to start.
Peter Mariahazy: Well, it sounds like you have a strong belief in, as they say, going to the gemba, right? See where the work’s being done, to really get to understand and help people become real problem-solvers? So, in your experience, what are some of the common challenges organizations face when the rolling out a management system? There’s got to be fits and starts.
Pam Helander: I think the biggest challenge, at least for us, was when you start a management system, the rest of the work doesn't stop, right? So because you've decided to do something new, you can't just stop the world and then start this new thing and then restart. So you're doing kind of both at the same time. You're doing the current firefighting-running the business, whatever that looks like, and you're trying new ways to run the business by adding a status sheet, or adding a huddle, or trying to figure out how you're going to do an A3 on something, and so, when the fires come up it's easy to fall back in those old habits of firefighting. And, so you've got to have the discipline, and the patience, to really put this together. I would say the other thing that's a challenge is that people want to just put it all in place, right? We want to just have…to start all the elements all at once, and that doesn't work. You really need to take them one element at a time. Be patient, take your time. It can take weeks and months for each element to get put in place. As you develop your standard, try your standard. Coach to the standard and then adjust your standard before you move on to the next element in the process. So having that patience and the discipline to kind of go slow to get to the other side, while you're in the middle of all the other stuff that's going on in your world, I think, is hard.
Peter Mariahazy: Well, and you touched on something, you know, and tied to capacity and people basically doing this and the regular work at the same time. You know, any hints you have for someone who's implementing a management system and how to help coach and support and really encourage those people that are probably feeling like they're doing double work? Any ideas there?
Pam Helander: Yeah, I think it starts with the leadership, right? So you got to have the leaders involved in, and willing to try and learn together, and give them permission to not do something, while you're learning this. That might be one major piece that I think if you don't have the leaders support and involvement, you might not do as well. Another thing that I would recommend is to do a model cell. So you take a group of maybe eager people. Somebody who thinks like this, who's really kind of one of those early adopters and you, you begin with a small group of people, whether it's one department or a couple of departments and you develop the standards together, and you try them, and you take each piece of the management system through that process. Make it your own. This is about your organization. So we did, we called it business performance system, other people have adapted it and called it whatever worked for them in their organization. So the elements are pretty much the same through all the management systems, but how you make them work in your organization is really what makes it work for you. So you've got a culture you need to, you know, think about that. Your people have their hands on it- touch it, make it their own. And then, make sure that you implement all the elements. Again, one, at a time, as you stand them up they take time. Have the patience. It could take you a year to stand up all of the different elements. Then, once you've done that you can start to decide, how do you want to spread that. Now you've got some people who know how it works, can coach with you, can demonstrate the success, can really be the voice of, “Why did you know? Why did you think this worked? What did it change in your life?” Right? So thinking you're going to implement this everywhere, all at once, you're not going to have an easy of time. Whereas if you pick a model cell, have a couple of early adopters to get you where you need to go.
Peter Mariahazy: Pam, well awesome that some great hints. Do you have any other advice that you would give to people who are just beginning to implement the management system?
Pam Helander: I'm, like I said, go slow. One element at a time. Understand the whole before you jump into each element. Start with just trying to understand your business. Go to gemba, be vulnerable. Be humble in your learning, so be vulnerable in letting people know, “I'm learning this” to “I'm going to follow the standard work as we wrote it” and “I'm going to have it in front of me and I would expect the same from you and we'll learn together and adjust our standard as we try it”. So, I think that's probably the biggest things.
Peter Mariahazy: Okay, sounds like very much a shared journey that if everybody's walking it together, then you're learning together, and it makes it stronger. So, any final thoughts you'd like to share with our listeners on this?
Pam Helander: Um,yeah. I think you know, one of the things that we learned was once we had the management system in place, our leaders were very clear they don't know how they got work done in the past and they couldn't- they couldn’t keep going without it being we noticed that our firefighting was down significantly. We were able to achieve our outcomes much faster. So, remember, I said it takes time to get it in place, and you have to go slow. But when you go slow at the other end, you can move much faster and be much more productive and you get to see how your team becomes problem-solvers instead of throwing it over at the manager or the leader to say, “You solve the problem this way.” You solve it together, you learn together, you grow up. It's just a much better way to get the work done. Again, find some leaders that are willing to try something new and begin with them. Those early adopters will become your biggest champions as you continue to roll it out, and they'll be the ones that teach and coach this new way of thinking so that you can spread it. The other thing is, we generally talk about starting a management system with operations, which is absolutely where you should start, right? Those people that are touching the patient every day that are the operations of your organization, but don't forget that your support departments have operations as well. And so you want to make sure that eventually you include them in the implementation of your management system so they can better support operations. So they have pieces that I think about. When I was the quality manager and my boss said, “No, no that's for the operations team to do that management system thing.” And I said, “Timeout. Wait a minute. We have a management system in our work as well, right?” There's things that we do that operate that are operations based - we have to collect data, we have to run reports, we have to be ready for Joint Commission, we…there's…we have to do charts on…it's all of those things are part of the operations of quality. So we need to have a way to measure our success in progress and problem-solve our work as well. HR has an operation system, finance has an operation system, IT has it. So all of those other areas that are considered support areas also need to be included as you develop your management system and, when you do that, you get everybody, literally everybody in the organization, really working together to deliver the outcomes.
Peter Mariahazy: That's a wonderful way to close out. Thank you. That it's all about teamwork and working together. Pam, thank you so much for taking time to talk to us today.
Pam Helander: Thanks for having me.
Peter Mariahazy: And we want to thank all of you for listening. Please visit createvalue.org to learn more about our Creating a Lean Management System Virtual Workshop and check out Pam's most recent blog posts, “Where to Start When Implementing a Management System” and “Common Struggles to Implementing a Management System”. You can also follow us on LinkedIn, Facebook, Instagram and Twitter for the latest and greatest. Stay tuned for more episodes designed to help healthcare leaders support their organizations on a journey to organizational excellence.