Common Struggles to Implementing a Management System

The goal of the management system for organizational excellence is to develop people to solve problems and improve performance. An effective management system will also open lines of communication from the CEO to the front-line staff, the front-line staff to the CEO, and every level in-between. As recent events plunged the healthcare system into crisis mode, we witnessed many organizations relying on this management system to help them adapt to rapidly changing conditions. This has prompted numerous organizations to consider implementing a management system.

A management system cannot be built overnight, it takes time and dedication to create a strong and successful system. Through my own work and experience with many healthcare organizations I have noticed some common struggles that organizations face as they develop their own management system.

Practicing A3 Thinking

It takes discipline to work through the process of scientific thinking. Proper A3 thinking requires taking time to plan, do, study, and adjust (PDSA). Sometimes organizations struggle because they think they know the answer or the cause of the problem, so they don’t go to gemba (where the value is created) or really look at what is currently happening. Other times people “fix” something and are quick to move on to the next problem and neglect studying the impact of the change that was made. A tell-tale sign that the A3 thinking process is not being used is when the same problem resurfaces over and over. The best way to reinforce A3 thinking is with proper coaching and support from leadership. Leaders should be asking humble inquiry questions and encouraging their team to keep an eye on the results of improvements to ensure the desired outcome is achieved. It is equally important to celebrate the great thinking and work of the team while reinforcing the process with the next problem to be solved.

Remembering to Observe and Adjust

One purpose of a management system is to provide structure for continuous improvement. Sometimes organizations spend so much time creating a new process and implementing it, that they forget to go back and see if there are even better ways to do the work once a standard has been created. If an organization does not take time to look at a process and adjust, they may notice that a new process inadvertently built in new waste or caused defects down the line. Process observations is one way to work through this challenge. Once a standard is established its important to build in time to watch the process to see how it is working.

Connecting the Daily Work to Driver Metrics

Often when an organization begins to implement a daily management system, they start by asking frontline staff to tell them about their headaches in an effort to surface problems and gain easy wins. It can be hard to say no to working on a problem that has been surfaced, especially by staff. Trying to work on everything can take the focus away from the driver metrics, or the work that will contribute to the True North goals of the organization. Once a team has begun to feel comfortable surfacing problems and is getting more comfortable with using PDSA cycles, it is important to start shifting thinking to aligning the problems identified with the driver metrics that they impact. This will help everyone to stay focused on the most meaningful work and help to prioritize improvement work.

Prioritizing Improvement Work

It would be impossible to work on every improvement idea at once, which is why it is necessary to have a process to prioritize the work. We have all seen improvement boards that have many improvement slips in the work-in-process section, but the slips are not moving to completion.  Sometimes they are there for weeks or months. This is an indication that a prioritization process may be lacking. Utilizing a PICK chart is a great way to help stay focused on the work that will have the greatest impact on the organization’s True North goals. A PICK chart is a method that allows prioritization based on impact and level of difficulty to solve. Establishing business rules for each department is another key to success when it comes to prioritization. Things like limiting the number of improvement slips in process and setting parameters around the time frame for improvement slips to progress toward completion are highly recommended. To reinforce that improvement work is a priority, it is essential that proper time is allocated to work on the improvement ideas.

When sharing the observations above, our intent is to help organizations recognize when they might be struggling and to provide some guidance in overcoming these common pitfalls. Remember that the goal of a management system is to develop people to solve problems. It will take time, patience, and persistence to get there, but a well-developed management system can help any organization on the journey toward organizational excellence.

Pam Helander, Faculty


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