After gemba at many health systems in the last few months, there is one common theme that is recurring: Lean is considered as the add-on to improvement, not the improvement system itself.
From academic medical centers to community hospitals I am finding that the lean method is being isolated as just another project to lower cost. This in contrast to the organizations successfully implementing lean which view it as THE improvement system. Our experience at ThedaCare was to create one improvement system designated the ThedaCare Improvement System which was the only improvement system. Sure, we had clinical improvement in one corner, and 60 day workouts in another, and 6 sigma techniques in a third corner but when we started the lean journey we decided to transform the organization we decided that as part of the implementation process we required a single improvement system which was clear and communicated as the only set of tools for improving care. This was hard but frankly, our staff and physicians were sick of the lack of consistency the organization used to solve problems. In fact, we couldn't solve problems because none of us knew how; let alone how to sustain improvement.
The value of creating a common improvement system is that it removes confusion at the front line. If everyone is trained in PDSA (plan-do-study-act) and every time a defect is encountered a PDSA is done to understand the problem, the root cause, and identification of countermeasures it creates a sense of confidence that no matter the problem there is a process that people understand and know will help them solve it. A teacher once told me "the essence of education is repetition". One PDSA won't embed problem solving in a culture but a dozen might work to get our front line workers solving problems every day. This won't happen if we ask them to learn dozens of different techniques and each improvement facilitator uses a different tool box.
The argument from clinicians sometimes is "that lean stuff is fine for cost control but it doesn't work on patients". How about Bolton, U.K., a 23% reduction in stroke mortality after a year of value stream mapping and kaizen events. How about 0 medication reconciliation errors for 3 years running at ThedaCare’s Collaborative Care unit after redesigning the inpatient care process using lean. There are many other examples.
Why is the lean methodology not being used as the improvement methodology? I think as Mark Graban has commented on his blog recently part of the problem is poor implementation which then leads to wrong conclusions about the methodology. The fact is if quality, cost, and staff satisfaction don't improve all at the same time the implementation process is flawed. Unfortunately there are many lean implementations that are flawed and doctors and nurses begin to believe that the initiative is just about cost reduction. This is another reason it's important to integrate all quality improvement processes into the lean transformation. Since this is such a big problem in healthcare today we need to figure out away to address it. I invite you to send me some ideas on what you have seen work. Is it simply a top down decision to change this or is it something else? How do we get the doctors to understand that lean is the improvement system not just a cost lowering initiative? The Center is very interested in supporting an educational event addressing this, so thoughts any of you have regarding what we should create would be welcomed.
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