Beyond Heroes: A Lean Management System for Healthcare
by healthcare management leader Kim Barnas is the story of an organization that extended the culture of excellence from solitary individuals to an entire healthcare system.
Hospitals have long relied on the heroics of brilliant nurses or doctors acting alone to save the day. Such heroics often result in temporary workarounds and quick fixes that leave not only patients and quality care at risk but also increase costs.
Like a growing number of healthcare organizations around the world, ThedaCare used lean thinking and the principles of the Toyota Production System to improve the quality of care, reduce waste, and become more reliable. The core work of this transformation involved changing the culture, including how individuals at all levels responded to problems, thought about patients, and interacted with one another.
Whereas lean thinking was incompatible with ThedaCare’s old top-down, hero-based system of management, Barnas, during her tenure as senior vice president of ThedaCare, worked with a team of people to create a lean, stable management system to spur continuous improvement.
Using the stories of ThedaCare’s doctors, nurses, and administrators to illustrate lean principles, Beyond Heroes
shows how ThedaCare developed the following essential components of a new management system focused on continuous improvement:
- Daily status reports, or conversations between managers and supervisors or clinical leads
- Daily team huddles to widen the conversation about opportunities for improvement, roadblocks, and ongoing projects
- Managing to the established standard by auditing standard work in order to achieve, teach, and coach for best practices
- Front-line problem solving using the scientific method
- Transparency regarding defects as well as accomplishments
- Advisory teams to fill in gaps in the managers’ areas of expertise, provide fresh perspectives, and take responsibility for the overall performance of drivers (targets or goals) in that area
- Scorecards for each manager developed and maintained by the advisory team to track progress against drivers
- Standardizing the work of leaders to create a repeatable, reliable system of managing for improvement
Barnas explains, “These elements add up to developing people, solving problems, and improving performance across the board rather than in solitary individuals.”
She adds, “By extension, ten years from now, our business performance system will not look like it does today. As we move forward with continuous improvement, each iteration of our system will help us evolve into the next best practices, with healthcare providers and administrators moving together in the same direction to meet the needs of patients.”
In addition to exploring the eight essential components of the lean system, Barnas introduces four executives from healthcare systems across North America who have implemented ThedaCare’s system, sharing the lessons they learned along the way.
She concludes, “Beyond Heroes
is not just a call to action or an argument for a better healthcare system. It is a necessary roadmap through the rocky terrain ahead, one that healthcare leaders can and should customize to their special needs.”
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