Lean: It is all About the Learning

This year I attended the 5^th Annual Lean Healthcare Transformation Summit, and I was excited to hear James Hereford, COO at Stanford University Medical Center give his keynote presentation.  He had a lot to share, and I had a lot to learn.

First, Hereford explained that lean is nothing new.  Henry Ford was following lean principles when he designed flow into the early assembly lines in Highland Park. But what is new is that lean thinking has the power to fundamentally transform the way healthcare is delivered. He bases this thought on the years of experience he gained while experimenting with lean at Group Health Cooperative, the Palo Alto Medical Foundation, and now in his role at Stanford.

However, unlike applying lean thinking in manufacturing, healthcare has a much more complicated operating environment.  No other industry has the amount of specialized buildings, the high priced capital equipment, such a large number of labor intensive specialties, and such a highly engaged customer base as healthcare.  On top of this, the high level of education of its workforce has a natural tendency to question each and every change that is being proposed to the system.  When front line staff has a PhD, they are intensely curious about how changes will affect them now and in the future.  In addition to these aspects is the highly regulated and litigious nature of healthcare, and how one mistake can be measured in lost lives.  With all of this at stake, Hereford wonders why lean was not invented in healthcare.

So, if Lean Healthcare is that important, how come not every hospital is lean?  To start with, lean requires a high level of commitment from each person at the hospital.  The leadership cannot just decide one day that they are going to be lean, because not all of the decisions can be made at the top of a lean organization. When an organization is ready to embrace lean thinking, he suggests there must be a disciplined and distributed leadership. The basis for this leadership style is standard work with a management system that keeps everyone focused on the customer.

According to Hereford, to have a successful management system you need three components:

1. Strategic Deployment focused on your True North goals. This will allow you to avoid the trap of doing too many things at once, and not being able to fully accomplish the projects you do start.

2. Value Stream Management that aligns with the other value streams in the organization.  The key is to operate each individual department efficiently, and still keep an eye on the patient experience as they move between value streams.

3. Active Daily Management System to keep you focused on metrics that are directly tied to your True North goals, in an incredibly complex operating environment.

Successful lean implementations happen when staff owns the process and the patient experience. This happens when you create ownership and responsibility at the point of value. Senior leaders need to understand that each of their new “programs” require additional work at the front lines.  Leaders need to be strategic in assigning these projects.

Many organizations use value stream mapping to identify the gap between the current state, and how things should be (or the ideal state).  Each time you close one of these gaps, the individual improvements move you closer to a transformational change.  These small steps can be great at breaking down silos, and will start the hard conversations required to create more value for the patient.

It is much better for healthcare leaders to coach their staff how to solve problems, rather than solving all the problems themselves.  After all, at the end of the day leaders still have their own problems to solve.  If you try to be a hero and solve everyone’s problems, you will quickly own all the problems in your department.

Lean is really about concentrating on learning. If you only pay attention to the outcomes of each experiment, you will lose confidence as soon as you have one failure or make a mistake.  It is better to focus on what you learned during the failure so you can apply and share this knowledge with the rest of the staff next time.  This keeps the focus on the process, not the person.

What is going to keep people motivated to make improvements to the system? How can we create a learning organization?  In some healthcare organizations, they start with a model line. They choose one area and go deep into the system; learning every detail and improving it to the best it can be.  Then, after they have optimized this one aspect of the business, they share this learning with the rest of the organization, and ultimately, the rest of the healthcare community.

Hereford also addressed one of the biggest wastes in healthcare – which is the under-utilized talents of the hospital staff.  Healthcare leaders everywhere are still searching for the best way to engage these highly educated and highly skilled people in the improvement process.  What are you doing to address this in your hospital?

So, we would like to hear from you, by posting a comment below, please explain how you and your health system are engaging the people who matter the most in your organization.  How are you making sure you are not wasting the talents within your organization?

Steven Bollinger
Director Product Development
ThedaCare Center for Healthcare Value