This is the 8th in a series of blogs devoted to organizational transformation. We have covered Purpose, Process and now are going to cover the hardest part, People.
In a system wide transformation the most challenging part is transforming the way people think. Coming from a top down autocratic environment (which is the current condition of most healthcare organizations) we are actually rewarded based how much “control” we have over decision-making. We ascend higher in the organization because we are able to get things done, our way as individuals not as a team. With more responsibility comes more resources, we can choose our projects our subordinates will work on (without their input) all along building our individual personal portfolio so that we are considered indispensable by the organization. In other words, we are rewarded for being heroes.
The traditional organization chart, showing who has authority over what activities, was once celebrated as a triumph of rational thought. But we now know that it has two major flaws: the rigid grouping of people vertically by function and the hierarchical top-down command structure. The problem with this structure is that it focuses vertically on the needs of the departments and their employees, instead of looking horizontally at the needs of the customer or patient. The challenge in a lean transformation is to focus on the patient when structure is designed as a series of silos. A patient wants a seamless care experience, with a team of knowledgeable people caring for him and treating his disease or injury from start to finish, instead of being handed off between caregivers in different – and sometimes rival -- camps.
Using this logic, lean management emphasizes creating cross-functional teams that are gathered around a product – or, in the case of healthcare, around a patient’s condition or journey through the hospital or medical office. The patient becomes the organizing focus. When a company structure is viewed through the lens of this more collaborative, team-driven style, the hierarchy of the organizational chart – in which the boss bosses and everyone else obeys – suddenly appears unworkable. And yet, the vertical org chart is so embedded in the idea of how healthcare is conducted that it is very difficult to replace.
After all, think about those who are drawn to top management jobs. They tend to see themselves as born leaders with superior judgment and management skills. In healthcare, many of those leaders are also medical doctors, who have been trained to be firmly autocratic. Once all those leaders are clustered at the top in positions of authority, getting them off their hierarchy is a true challenge. What can we possibly do change this? Our experience suggests a few things are critically important.
Leaders must go to the gemba. The gemba is where the work is actually done. In other words where the value is created for the customer in this case the patient. By going there leaders begin to understand the barriers their staff face each day. We have an example of a leader going to the gemba on video at the end of this blog. You will notice that she is actually following a standard work sheet.
Leaders must follow standard work. The leaders need to establish what they actually do each day when they go to the gemba. What are they looking for? How do they make decisions? How do they prioritize resources? If these processes aren’t codified and followed by all leaders in an organization mixed messages are sent to the doctors and staff performing the actual value adding work which leads to distrust and cynicism.
Leaders must participate on teams. That means take a week off and do a kaizen event with front line staff or participate in a three-day value stream analysis. In order to begin to deeply understand the problems in the organization the leader must take the time to study the problems. This also sends a message that leadership is serious about lean and that it’s not just another management project of the month.
Leaders must learn the tools and philosophies of lean so they can mentor, facilitate and teach. They learn this by doing not by reading a book so getting the “hands dirty” on events and daily problem solving is the way to get educated.
Define the problem before jumping to solutions. We are rewarded in today’s environment in healthcare if we have all the answers. We rarely step back to really understand the problem. One of the most powerful processes a leader can learn is how to effectively identify the problem to be solved. The team members on the front line usually have the answers if the leader will let them speak.
These are a few of the traits of the lean leader. My next final blog on the subject of organizational transformation will be regarding the change of behaviors necessary for a new lean culture to take root.
Leave a Reply