Establishing and Sustaining a Lean Management System

Posted on by Kim Barnas

This is the first blog in a four-part series focused on sustaining lean transformation in healthcare organizations.

In my decades of experience applying Lean thinking to improve how hospitals function and collaborating with hundreds of healthcare leaders to help implement system-wide Lean healthcare initiatives, I’ve come to understand one thing: The challenge is not about creating short-term change. The real challenge is creating sustainable change. Lean leaders must have the infrastructure and support to create and maintain momentum and make continuous improvements.

Let me explain.

The basis for every successful (and lasting) Lean healthcare implementation is having the full support of the organization’s leadership – the board, the Chief Executive, and the executive team. After all, the goal is to change how the entire hospital system functions in order to improve operational results and enhance patient outcomes. If the hospital’s top leaders don’t support Lean principles and apply the tools to their day-to-day activities, the full benefits of Lean (and anticipated improvement changes) will never be realized.

Healthcare executives must take specific measures to ensure their Lean initiatives are sustainable and their achievements will last for the long haul. Most importantly, to sustain Lean momentum during periods of organizational change, leaders must commit to the development of a Lean operating system. Without this commitment, the life expectancy of Lean could be dramatically shortened.

Like the latest fad diet and exercise infomercials, health system leaders are in a constant lurch to seek fast, system-wide fixes that will:

  • Provide better patient care
  • Enhance employee engagement
  • Improve operations, and
  • Reduce costs

But these flavor-of-the-day improvement systems aren’t built to last and rarely produce sustainable tangible results.

I maintain a strong commitment to Lean principles – applying not just the day-to-day tools and practices but creating an explicit Lean management or operating system. This system will have many sub-systems. These systems will change and improve over time. The foundation is that Lean is a proven improvement methodology. Lean in the past has been used as a set of tools and sometimes applied without regard to the human component around foundational principles and behaviors. This led some to think that “Lean is Mean.” We have considered not using the term lean to see the principles and philosophies in a better more comprehensive light. We have used the term enterprise excellence interchangeably, but the reality is, no matter what you call it, Lean produces lasting results that truly change the system. Through my work and collaboration with many colleagues, I’ve seen first-hand the success that hospitals achieve when leaders commit to change the culture and stick with their commitment to use Lean as their preferred system of improvement.

“One of the biggest barriers to our implementation of Lean was dispelling some of the myths about the methodology,” said Jeff Mainland, Executive Vice President at the Hospital for Sick Children in Toronto. “Medicine is highly evidenced based. Once we were able to show that Lean is really based on good evidence and showcase some of the outcomes other organizations had when implementing Lean, we were able to implement more successfully.”

Mainland also said it’s important not to underestimate the heavy demands of change management. “The journey is long. We’re now six years into our journey and we still have a long way to go. Yes, we have achieved great results but there’s much more to do.”

When properly implemented, Lean management systems will deliver results long term and hospital leadership can sustain the change as long as it is rooted in a clear vision and strategy that is communicated and embraced by all who are involved. In the upcoming blogs of this series, I will share about the process around establishing and sustaining a Lean management system using principles and behaviors established to obtain proven results.

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