Part of my role at Catalysis is to work with our Catalysis Healthcare Value Network members to help them accelerate the cultural transformation at their organizations. One way we do this is through what we call the discovery process. The goal of the process is to get a broad perspective on how an organization is progressing on their lean journey. The resulting report identifies gaps and facilitates Catalysis and the organization co-creating a plan to close those gaps. During the discovery visit, the Catalysis team gains perspective by going to gemba, having conversations with, and observing the members of the senior leadership team, operations managers, and support managers.
Gaining this perspective on multiple healthcare organizations from all over the country has helped me gain clarity on what it means to transform in the pursuit of organizational excellence. I have noticed that organizations that are mature in their lean transformation have a few notable things in common.
The senior leadership team is involved in the transformation
You can easily tell if the senior leadership team is involved by watching how they work. Involved leaders are out in the work, not behind a desk. At mature organizations leaders are interacting with staff in an encouraging and positive way. They are in the gemba asking good questions with the intent of learning.
Operational areas demonstrate engagement in improvement efforts
Another way you can tell that an organization is mature in its lean transformation is that the operational areas are engaged in improvement. This includes both the frontline staff and their leaders. When frontline staff are engaged in improvement, they feel they can safely bring up suggestions or point out problem areas. When leaders are engaged, they make time and space for improvement work to be completed, coach frontline staff in problem solving, and celebrate successes.
They have a lean management system in place
There are many components to a lean management system, some easier to observe than others. When looking for evidence of a lean management system I look for up to date visual management that operational teams interact with on a daily (or even shift – by – shift) basis when they huddle. These teams will frequently have a performance scorecard posted with linkages to their top-level strategies. When visiting a mature lean organization, you can also observe routine use of standard work, audit of that standard work (kamishibai) and leader standard work.
They teach and coach problem solving
As an organization progresses on the lean journey, teaching and coaching problem solving becomes more prevalent. One way to see this is to look for signs that they are using problem-solving tools, like a pareto chart, fishbone diagrams, or A3s. I also like to listen to the types or questions being asked. When you are in a mature lean organization you will hear open-ended questions and questions that do not point to an answer. Often you will also observe teams using a problem-solving routine, like kata.
The support functions in the organization are included in the transformation
Building a culture of continuous improvement is not limited to operations. In organizations that are mature in their transformation, support functions are also engaged in the transformation journey. One way you can tell they are engaged is that these areas treat operations like they are their customers. You will also see evidence that the support areas like IT, HR, marketing, etc. are working on improving their own processes so they can better serve operations.
I have had the opportunity to go to gemba at many healthcare organizations and I am always humbled by the good work that is going on to improve healthcare for patients. My biggest ah-ha from my observations is that nearly every place I have been has pockets of excellence; yet very few have achieved system-wide or hospital-wide spread. I don’t find that discouraging, rather just the opposite. Changing organizational culture is hard work and takes time. I am always inspired to see the enthusiasm for improvement that extends from front line staff up to the senior leaders.
Paul Pejsa, Director
Lean Healthcare Transformation Summit