I am often asked by healthcare organizations beginning their Lean Healthcare journey, “What is the role of the executive steering committee during the transformation?”

In Lean Healthcare, true transformation involves the development of competencies that may not exist or may lie dormant within the enterprise.  Over time, these will become the way we work.  Therefore, the primary responsibility of the executive steering committee during a Lean Healthcare transformation is to provide oversight and direction until this becomes the way the enterprise works.

The key responsibilities involved in guiding the Lean Healthcare transformation efforts include:

1. Define a vision and transformational roadmap for the organization.  This helps employees at all levels of the organization understand where the organization is going, why it is important, what success will look like, and what they need to do, individually and collectively, for the enterprise to get there.
2. Support the vision/roadmap with a set of established milestones and goals.  This means developing and implementing a measurement system that supports appropriate levels of review.  Monitoring and measuring progress against these milestones and goals and, more importantly, making appropriate course corrections where necessary.
3. Define which value streams will be worked in and prioritize major improvement activity based upon relevance to strategic initiatives, customer impact, and ROI.  Improvement activity not linked to strategic breakthrough finds its way to the back burner fast.  Moreover, improvement requires investment of resource.  Nothing sustains investment like a solid ROI and thrilled customers, both external and internal.
4. Evaluate the effectiveness of Kaizen activity continuously.  Where it is ineffective, we need to understand why and adjust accordingly.  Where it is effective, we need to define mechanisms to redeploy resources or realize the value delivered by improvement events.
5. Drive the alignment of systems and structures to support the transformation.  Often, as we aspire and begin to develop something new, we continue to reward old behaviors and fail to recognize the new behaviors we are seeking.  When we get the behavior change, we transform the enterprise.  The specific elements involved include:

• Organization Design – Lean organizations are typically flatter, more horizontal, and less vertically siloed.
• Recruitment & Staffing – Lean leadership attributes should be included in job descriptions and postings.
• Training & Development – All employees should be trained in A3 and PDSA.  These should be included in new employee orientation.  No promotion into operational leadership roles without demonstrated experience in implementing and using lean management systems.  No promotion into executive roles without demonstrated fluency with Hoshin and change management.
• Performance Management – Lean transformational goals should be in everyone’s goals and objectives.  The performance management system includes not only results, but also the means by which results are achieved.  This plays out at both an individual and organizational level.  Service lines and departments have scorecards or dashboards that link into next-level efforts and are therefore predictive of next-level results.
• Reward & Recognition – This is most critical in the early stages of transformation and includes recognition of transformational efforts with incentive compensation tied to implementation and breakthrough results.
• Resource Allocation – If you want improvement, you must staff for it.  This can get expensive unless you have a systematized method for recognizing where waste was eliminated and freeing up resources to engage in further improvement.
• IT Integration & Leverage – Unless they support what we are doing, our IT systems are useless.  Often the data necessary to populate a simple dashboard, must be extracted from multiple and disparate systems.
• Communication – At a macro-level, we need to make sure we are transparent and communicate how the enterprise is doing with the transformation.  This needs to flow down in like kind, or rather, be emulated from the largest service-line to the smallest department.  At a micro-level, we need to make sure the hand-off between teams or departments are direct and in compliance with rules-in-use within all of our key processes.

This covers the primary roles and responsibilities of the executive steering committee in a Lean Healthcare transformation.  Over time, as we do transform, the items listed above are just the way we work and there is no longer a need for a steering committee.

This week’s blog was written by Brad Schultz, a Vice President with HPP.

Brad serves as a Lean Healthcare facilitator, business consultant, and executive coach internationally with HPP.  Brad began his career in manufacturing with GE Healthcare and joined GE’s Performance Solutions during its infancy and remained with the business unit for seven years. He provided significant leadership to adapt the firm’s products to the unique needs of healthcare clients and to translate the firm’s published materials into the language of healthcare.

Brad’s educational background includes a B.S. in Business Administration from Cardinal Stritch University in Milwaukee, Post Graduate Certification in Quality Engineering from Milwaukee School of Engineering, a M.A. in Business Administration from Marquette University in Milwaukee, Six Sigma Master Black Belt Certification from General Electric, and Front-Line Leadership Development Certification from Achieve Global.

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Over the last six months, there have been a number of posts on this blog discussing standard work.  Will it discourage creativity?  What is it?  What is Leadership Standard Work?  How does it help achieve outcomes?  How does this support our Lean Healthcare culture?

In light of the heavy focus recently, I want to share our story to help tie it all together. This is an example of the application of standard work using a tool that helps with real time data collection.  It is the story of Sisters of Charity of Leavenworth Health System’s (SCLHS) Best Patient Experience Collaborative and the implementation of its tools.

At our nine hospital health care system, we identified three “fundamentals” that needed to be implemented to improve the patient’s experience:

• Redesign the care boards to integrate patient and family into ongoing discussions about the patient’s care plan.
• Implement Frequent Purposeful Rounding (we felt the term “hourly rounding” did not adequately describe our goals and made it seem more like a task)
• Implement Nurse Leader Rounding to provide real time feedback to employees

It is the third initiative I will address in this blog.  Nurse Leader Rounding is the clinical application of the Lean Healthcare principle of standard work.  It is daily, it reviews the work of employees, its goal is to resolve identified issues immediately and provide feedback to the nurses, and it is data based.

The problem is that life gets in the way.  Nurse Leaders are asked to participate in bed meetings, conduct employee evaluations, attend management meetings, and meet with physicians.   Patient rounds ended up taking second place.

The health care system goal was to achieve Nurse Leader Rounding on 80 percent of the patients on a daily basis, but we didn’t know how much time that required and the documentation was cumbersome.  The prior model involved the Nurse Leader completing the rounding and then returning to her office to enter the information into a spreadsheet.  How could that be successful?  Nurse Leaders’ lives are constantly interrupted and driven by the crisis of the day.

To help resolve the challenges associated with documenting the Nurse Leader Rounds and to standardize the process (at the same time customizing it), we instituted a number of ideas based on our Lean Healthcare knowledge.

1)      Change the priorities of the manager.  After one of our Nurse Leaders attended an off-site training session, she returned asking the question, “What is my job if it is not to manage the patient’s experience on my unit?”  This meant that the Nursing Leader allocated a set amount of time per day to round on each patient.  We initially set aside two hours a day.  This meant that the nurse leader had to re-allocate her time; she couldn’t go to morning bed meeting and she couldn’t attend other meetings that administration might schedule.  She needed to send a clear message:  My priority is the patient’s experience.

2)      Make the documentation process easier.    We set up a real time data collection tool using an iPad.  It is pre-programmed with the rounding questions and email addresses of key people who might need to follow-up in case of an issue (e.g. facilities, housekeeping or pharmacy). Utilizing an iPad eliminated the waiting between rounding and documentation, as well as the excess processing from transcribing notes taken during rounding into the spreadsheet.  This required some pre-work regarding the questions and the uploading of email addresses.  It also required some standard training for the Nurse Leaders.  We developed a resource book and provided about 20 to 30 minutes of hands-on training.  With that, the Nurse Leader was ready to go.

The questions the Nurse Leader asks during rounding cover:

• Care coordination among team members
• Effective pain management
• Cleanliness and clutter
• People to recognize with rewards and praise
• Observations of the care boards and patient and family feedback on how they are being used
• The effectiveness of frequent purposeful rounding

The following outcome examples from Nurse Leader Rounding demonstrate the impact of implementing leader standard work in a Lean Healthcare culture using a real time data collection tool:

• A patient had a diabetic diet order from the physician and had not received the right food from Nutrition Services.  In fact, the patient had received food that could have been detrimental to her.  The Nurse Leader immediately called Nutrition Services to provide the correct food.

• The patient’s care board had not been updated to include new medications or the patient’s diet, so the patient and family were working off old knowledge.  The Nurse Leader provided immediate feedback to the patient’s primary nurse who corrected the care board and used it to educate the patient and family about the patient’s changes.

• During a tough week, a unit had a number of patients with behavioral health issues.  Through Nurse Leader rounds, the level of dissatisfaction among the other patients on the floor was identified along with the reasons for the dip in patient satisfaction scores in the weekly report.  Before instituting the real time data collection tool, the Nurse Leader would not have been able to effectively do a root cause analysis.

What makes Leader Standard Work different in a Lean Healthcare environment?

First, we clarified the primary responsibility of the Nurse Leader: to manage all aspects of the patient’s experience.  Second, senior leaders provided the framework and support for the Nurse Leader to execute on these expectations.  Third, we used innovative tools to make it easy to capture stories and data, in turn being able to quantify the results.

Today’s blog was written by Barbara Davis, MA, Vice President of Performance Excellence at Exempla Good Samaritan Medical Center.

Barbara is responsible for leading the organization in the areas of care management, patient safety, regulatory requirements, and performance improvement using Lean methods. 

Barbara has more than 25 years of experience in health care quality and performance excellence with a diverse professional background including the Colorado Business Group on Health and a private consulting practice.  She served as the vice president of clinical quality systems at the University of Maryland Medical System in Baltimore, Maryland, and prior to that worked at Kaiser Permanente, Ohio Region as well as at Fairfax Hospital in Fairfax, Virginia. 

Barbara received her master’s degrees in Healthcare Administration from George Washington University.  She has served as a senior examiner on the Board of Examiners for the National Malcolm Baldrige Quality Award and is a founder of Colorado Performance Excellence, the state quality award. She teaches quality and patient safety as an affiliate faculty member at Regis University. 

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My wife Alice and I love to attend musical and theater performances.  Musicals allow us to lose ourselves in the fantasy of a story for a couple of hours, and the talent and skill exhibited by the performers is nothing short of incredible.

I have loved the theater since high school.  I aspired to be an actor during my college days, before realizing that I didn’t quite have the stage presence that it takes to succeed!

During the last couple of years I have viewed the performances through “new eyes” as we say when we talk about Lean Healthcare.  Some of you reading this will agree, some will smile, and others will say, “How in the world did you come up with this analogy?”

The most recent show we saw was Flashdance, The Musical, adapted from the 1983 movie.  The company is currently touring the country performing and preparing for the show’s Broadway debut this fall.  In Nashville, where we watched the performance, the show opened on a Tuesday night and closed the following Sunday.  With both matinee and evening performances, the company performed the show eight times in 120 hours—each time to a new audience, each expecting to be entertained by an outstanding performance.

As I watched the show, I was struck by the fact that the dancers had to have confidence that their fellow cast would be in the same place, doing the same movement every time (8 times just in Nashville; hundreds of time on the tour).  The theatrical experience depends on precision in dance and standard acrobatic moves – every time.  Because some of the movements are potentially dangerous, especially if fellow actors are doing something different from what is expected, it is essential that there be standard work.  No variation, no exceptions.

Certainly this figurative analogy is a bit unique, but then again, maybe not.  The thing that strikes me the most about the singing, dancing and choreography that we see is just how important it is to eliminate variation and create standard work.  It is essential both for the performers and for the people being entertained by the show. It is the key to success for a show that is performed multiple times, with the same outcome expected each time. The same should be true for healthcare.

As you know, one of the goals of Lean Healthcare is to eliminate variation and create standard work in processes.  One of my colleagues, Janet Dozier, recently wrote a blog, Does Standard Work Destroy Creativity?  Here is one particularly important point she made:

“When standard work is consistently and uniformly adhered to, it drives continuous improvement by exposing problems within the process.  Making problems easier to see inspires planned experimentation to discover better ways to perform the work. Standards are the foundation for continuous improvement.  Without them, you can’t effectively measure where you are.”

Even though the Flashdance company is on tour, the cast members continue to rehearse and expose problems within the process. But, they stick to standard work until they have decided, as a unit, to change the performance.  They all know disaster would occur should one cast member decide to arbitrarily change a dance movement without involving the other performers.  We must work together to reach a point when healthcare workers are engaging in similar behavior as they perform their jobs.

As Mark Graban says in Lean Hospitals:

“Having standardized methods helps ensure a consistent experience and consistent care for the patient.”

In healthcare, standardized daily work is key for a successful and safe experience for patients and staff.

Given there is variation in everything, and no two things are identical, the key is therefore to identify and reduce the variation. Whether it is theater or healthcare, variation is prevalent to a wide degree.  Just as Broadway performers strive to reduce variation and create standards for how they perform their roles in every performance, so should we.   It is an ongoing challenge to continue to reduce the amount of variation in what we do.  In doing so, we improve the odds that our processes will be successful and that our patients will be well cared for.

Today’s blog was written by Jay Conner, Ph.D., a Senior Manager at HPP.  

Jay has more than 30 years of experience in communications, human resources, and human resources development.  He has worked in both higher education and in the private sector.  In healthcare, he has consulted in training and development, executive and managerial coaching, recruiting and hiring, employee relations, performance management, compensation, employment law compliance and employee manuals and handbooks.

Jay holds a B.A. from Georgetown College and an M.A. and Ph.D. in Communications from LSU. 

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Before I worked in Lean Healthcare, I worked in Lean Manufacturing.  During my manufacturing days, my boss explained a concept that has stuck with me. He said, “Managers in Lean-focused organizations need to think more about Lean management and a little less about Lean tools.”  His comment recognizes that all organizations exist to deliver value and any of the efforts associated with managing the value stream are fundamental leadership tasks.

It’s easy to become infatuated with the collection of Lean tools that have surfaced during the last 40 years but, application of these tools may not necessarily alter the value delivered to your patients if there is no management system to support them.  Healthcare organizations engaged in their own Lean Healthcare journey may occasionally need this same reminder—just using the tools is not enough.

Let’s revisit a few reminders on the basics of management systems:

1. All value created in any organization is the end result of a lengthy sequence of steps called a value stream (read more about value stream mapping).  Improving the flow of this stream must be done continually to ensure that customers always receive maximum value.
2. The flow of the customer through the value stream is typically horizontal. That is, the flow occurs horizontally across the organization.  However, nearly all companies, including the vaunted Toyota, are organized vertically by function, usually for basic and practical reasons. This paradox represents a big challenge for leadership.
3. Maximizing value requires that someone work continuously to improve the delivery of value on behalf of the customer. Improvement efforts typically require support, either from internal or outside sources.

Specific strategies to help leadership transform a management system to a lean management system are:

1. Every value stream should have a designated person responsible for identifying and overseeing its entire flow of value and for coordinating its continuous improvement. These improvements should be aligned both with the needs of the patient as well as those of the business. This does not mean that those who work in the value stream have two bosses. Top leadership must assure that both value stream leaders and functional leaders coordinate to make sure that all communication to those engaged in the value stream is both direct and unambiguous.
2. A system of simple daily metrics is typically in place to remind and inspire those that do the regular work of what constitutes value to the customer.  Managers should give regular attention to these metrics, using both liberal praise and focused questioning to those who provide the information.  This routine sharing of status and results should ultimately include everyone who contributes to the value stream. It should never be a negative event (i.e., no “shooting the messenger” allowed). Top leadership must insist on and support this critical daily activity.
3. Last but not least, unanswered questions or performance gaps identified through daily activity must lead to improvement experiments.  These improvement efforts should use a standard, systematic problem solving approach (like the A3 problem solving format) and utilize the full toolbox of other Lean tools to improve the delivery of value. Again, top leadership must make sure that managers have both the knowledge and skills to coach and support the use of the tools.

Gaining knowledge of specific Lean tools is always interesting and exciting. However, as Jim Womack once said, “A carpenter needs a vision of what to build in order to get full benefit from a hammer.”

Today’s blog was written David Krebs, Senior Manager with HPP.

David, a Six Sigma certified engineer, oversees various HPP projects and Lean Healthcare projects for clients throughout the United States.  David is also a licensed Professional Engineer in the state of Tennessee, with more than 30 years of experience in a variety of process and systems intensive industries, as part of firms in the U.S, Germany, and France.  David has achieved and maintained QS-9000 and ISO-14001 certification & received Nissan’s “Quality Master Award” on three occasions.  He holds a Bachelor of Science degree in Mechanical Engineering from the University of Detroit & an MBA from the University of Notre Dame. 

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As a Lean Healthcare practitioner, I partner with healthcare facilities to focus the entire organization on the elimination of waste in the systems and processes.  We do this by focusing on what adds value for patients.  It sounds simple. Focus on adding value for the patient.  However, achieving simplicity through so much complexity that has been practically hardwired into the delivery of care models is very difficult.  Daily I am reminded of what Apple founder Steve Jobs said: “Simple is hard to do.”  He was right.

Facility Design
I often see cutting edge technology while working as a lean healthcare practitioner.  The innovation is truly second to none and has added to our overall lifespan and quality of life.  However, the facilities that house this innovation are often not designed with the true understanding of supporting processes.  It often appears that the building was designed in advance of the processes.  The processes are a direct result of the building and not the other way around.  In these cases, the patient is often forced to go through extra steps in the process, additional travel, additional motion, and increased waiting due to the total throughput time.

Equipment Capacity

The CFO of a healthcare facility really wants to see the equipment utilized.  The return on assets is best met when the lab equipment is doing tests and the diagnostic machinery is occupied.  However, while doing Lean Healthcare observations in the “Gemba” (the place where work is done) I often see entire suites of equipment that are “lights out.”  It is also common to see several ORs that sit for days at a time or are poorly utilized.  In some of these cases, the organization feels they need more capacity and they are actually looking to build more.

Excess Space

Lean healthcare is about having what is needed, when it is needed, where it is needed, and at the time it is needed—all to support the value to the patient. Anything more is waste.  Across the country, the variances in the space that is used for the same process volume is massive.  In some cases, the space designed and used for identical processes is nearly three times more in one facility versus another.

We have a lot of work to do to in order to be able to deliver maximum value to our patients through Lean Healthcare, and based on the above observations, we have a long way to go to fully implement the system. The “management salad” approach of tossing together a kaizen event, a cup of shredded A3, a drizzle of OD, some sun-dried leadership Kum-ba-ya, and a crumbly topping of half-baked strategy deployment turns into nothing more than a mushy bunch of ineffective tools if there isn’t a deliberate system and intent driving all that activity. Piling on more tools is a path to lots of activity only. The success of those activities will vary and will likely be unsustainable over a length of time.

Many are moving swiftly in the direction of Lean Healthcare.  However, as a whole the industry needs a change in thinking and acting.  As a whole, we think we are focused on the value add for the patient, but saying it and making it true are worlds apart.  With what I’ve been exposed to, I have concluded that it is far too difficult to sneak in a little bit of value for the patient.  It has been shown time and time again that most of a caregiver’s time, however valiant their efforts, are heavily dampened by waste within the care delivery system.

Simple is hard to do. Simply delivering value-added care, simply having just what you need to do the work, simply using the resources that you have in an effective manner. What complex and time-consuming paths have you had to follow in order to achieve simple?

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You may have heard the saying, “Culture eats strategy for lunch every day of the week,” or some variation on this.  Recently a colleague and I discussed the validity of this statement.  He contends there is no scientific data proving such a phenomenon.  I, on the other hand, have been in many organizations where major change initiatives have failed due to existing habits and behaviors not conducive to supporting the change.  By the end of the discussion we agreed that change and organizational culture are inextricably linked.

So what does this have to do with Lean Healthcare or other performance improvement initiatives?  Most of the major change initiatives of the past 20 years (TQM, Reengineering and Employee Engagement Programs, among others) have both a technical element and a human element.

The technical elements of change are generally approached through training and “learn by doing” practice in real work situations. These are essential elements of the learning process.  If the people engaged in the change process do not have the necessary skills, a learning cycle needs to be designed and implemented.

Yet, what in addition to training is required?  If a new tool or required change is compatible with the current behavioral norms of the organization, then the adoption process accelerates.  For instance, an organization steeped in Plan, Do, Check, Act cycles will more readily adopt A3 problem solving due to the positive relationship of the two.  However, if the norms are incompatible, then being exposed to and practicing the use of the tool is insufficient.  The behavioral norms have to change concurrent with exposure to the tool.

First, the existing culture, or the composite of behaviors and habits that members of an organization engage in order to conduct daily business and solve problems, must be mapped.  There are many tools available to do this including “The Organization Culture Assessment Instrument” (Cameron and Quinn) and “The Leadership Circle” (Anderson), among others.  Assessment methods such as these are designed to expose the underlying operating system composed of the lived values and behaviors of the organization.

Once the current culture is identified, the leadership group engages in purposeful dialogue to understand the impact these norms have on the current change initiative.  This shared knowledge can then be applied to the development of cultural change strategies that support the desired set of norms and behaviors.

To illustrate, I once worked with an organization whose culture can best be described as command and control.  The new CEO sought to “install” performance improvement tools and methodologies throughout the organization.  He chartered a group of middle managers, without vice president involvement, to address the current poor financial performance of the organization.  The group gladly accepted and charged forward, generating many new change ideas.  Within short order, it became apparent the managers did not know how to implement the changes using simple performance improvement tools, hence a knowledge deficit and a learning opportunity.

Most problematic was the insidious nature of the command and control culture.  Every change idea was blocked by members of the leadership team.  Turf protection increased and middle managers, seeing the incongruence in what they were hearing from the CEO and what they experiencing, became disillusioned.

In order to successfully implement performance improvement, the CEO, in collaboration with his direct reports, middle managers and employees, developed an organizational vision and a set of core values that overtly stated expected behaviors.  The chartered middle manager group was revamped to include a blend of leaders and middle managers with a stated mission, a set of expectations and group ground rules.  The CEO established coaching sessions with each of his direct reports using the values as expected norms – “rules of the road.”  Lastly, a training program on performance improvement was implemented for leaders, middle managers and front line supervisors.

Over the following year, the culture began to shift and organizational performance metrics improved.  Lest I mislead, this was a messy process and many times along the way it appeared the culture strategies were ineffective.  In my experience there never is an easy change process, especially when the current state culture is not conducive to the change initiative.

Culture can be changed, but time, patience, brutal honesty and constancy of purpose on the part of leadership are a must.

Bill has 30 years healthcare leadership experience in both system and individual hospital settings in the Mid-West and North-East, and oversight of change management activities and Lean Transformation engagements.  This experience includes serving in an executive capacity in Quality, Operations and Human Resources. 

He holds a Masters in Health Administration from Xavier University and a Doctorate of Philosophy in Organizational Behavior from the Union Institute and University.  

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“But this isn’t an assembly line!”

When you start talking about standardizing processes in healthcare, people begin to perspire, lips clamp tightly and are pursed thin.  The declaration, “we don’t make widgets”  is oft proclaimed.  You see, “healthcare is different,” I am frequently told.  “We’re dealing with people’s lives and every patient is unique and most are complex….this isn’t an assembly line!”

When I left the automotive industry and joined healthcare, my response to such statements was that everything involves a process.  Whether you’re building cars or delivering life-saving patient care, it takes a sequence of highly coordinated tasks and processes to deliver the end result.  When this sequence of tasks is standardized, you’re well on your way to radically improving patient safety and eliminating significant sources of waste.

Standard work establishes the best method to perform a task with the least amount of waste while providing the best patient care.  It is an agreed-upon method and procedure for the best sequence and timing to perform a task.

Standard work is frequently misinterpreted and misunderstood.  Generally, people have a tendency to resist standard work until there is understanding of what it really means and how it impacts both themselves and the organization.  People don’t want to do their work the same way every time, nor do they think everyone should perform work the same way.  For this reason, it is not uncommon for healthcare providers to be cautious of jumping onto the standard work bandwagon. Medicine is a combination of art and science after all.  Surely, implementing a “standard” is comparable to throwing darts at the artistry that is needed to understand the nuances of medicine.  If standard work was rigid and unchanging, this point of view could indeed be valid.  However, it is important to understand that standard work is neither rigid nor inflexible.  Quite the contrary, standard work is alive and should change in response to changes in work conditions.

When standard work is consistently and uniformly adhered to, it drives continuous improvement by exposing problems within the process.  Making problems easier to see inspires planned experimentation to discover better ways to perform the work.  Standards are the foundation for continuous improvement.  Without them, you can’t effectively measure where you are.  Standards are the yardstick by which you analyze and test improvements that can then be systematically adopted by everyone.

When continuous improvement activity becomes part of your culture, creativity will flow from employees at all levels of the organization.  Problem solving at the front line often results in creative solutions never dreamed of in the boardroom.  Recognition for solving problems and making improvements builds self-esteem while skill levels increase through training to the standard work.  As the training becomes more effective and widespread, communication increases. People know what they’re supposed to do, when to do it, and how it should be done.

So, by all means, set up an environment of improvement activity that becomes part of daily work and see creativity skyrocket!   Once standard work is in place, creativity bubbles to the surface as people continuously improve their work.  This results in improved morale and job satisfaction, which can also lead to reduced turnover and, yes, improved creativity!

Needless to say, none of this happens overnight.  It’s a long process that requires a lot of determination and even more perseverance.

Does standard work destroy creativity or perpetuate it?

Let’s look back at past articles that discussed how standard work can be implemented in healthcare:

• Lean Healthcare:  Implementing the Standard Work, by David Munch, M.D.
• Becoming a Transforming Leader – What Does Your Daily Standard Work Reflect by Michael Kellner
• The Standardization Gospel by Teresa Carpenter
• Redefining your “Real Job” through Leadership Standard Work by Steve Taninecz

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The Belmont University Lean Healthcare Certificate Course is now registering for July and August course dates.

The program is an intense one-week course that gives participants a hands-on, learn by doing experience applying Lean philosophies and tools in a healthcare environment.  It is taught and facilitated by Lean practitioners, leaders, and coaches each with multiple years of successfully applying Lean in healthcare organizations.

The Lean Healthcare Certificate Program is designed for anyone in your hospital or healthcare organization who wants to better understand and apply Lean concepts.

For more information on the Belmont University Lean Healthcare Certificate Course, agenda, and registration information visit www.BUleancourse.com .

Upcoming Courses:

July 15 – 19, 2013
August 5 – 9, 2013

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What is the most important resource you have and how do you manage it? 

Before you read any further, take your eyes off of this page and stop for a moment to reflect on this question and then read on.

What was your answer?  It may be interesting to pose this question to some of your colleagues and see what they come up with.  It could be a very interesting discussion and could lead to some interesting actions.  Also, did you answer this from a personal perspective or a professional one?

Let me pose to you that the answer to this question both professionally and personally is time.

From the lyrics of “No Time to Kill” by Clint Black, my favorite country artist:

If we had an hourglass to watch each one go by
Or a bell to mark each one to pass, we’d see just how they fly
Would we escalate the value to be worth its weight in gold?
Or would we never know the fortunes that we had ’til we grow old?
And do we just keep killin’ time until there’s no time

How many of you thought that the most valuable resource is people?  People are extraordinarily important in what we do in healthcare but it is what they do with their time that really matters to our patients.  Interestingly, our patients are also investing their time as well, not only for the time they spend in the experience of care but possibly with the time they have left on the planet.

So, are you measuring time with respect to your people? With respect to yourself?  Can you tell me how much of your day is spent in the various categories of tasks and responsibilities that you have by percentage without guessing?  Can you tell me how much of your time is spent in value-added work and non-value added work?  How much of your time is spent in meetings and how much of that time is value added to you? To your patients?  Is there any measure of the effectiveness of all those meetings you go to?

One of the most common barriers to successful Lean Healthcare transformations is the lack of executive and middle management engagement in the improvement efforts including their ability to support and sustain those improvements.  These activities are competing with other things on their very full plates that take their time. Unless they deal with all of those tasks, the time it takes to do them, the inefficiencies in them, the prioritization of them, and so on, they will simply not have the time to engage adequately in organizational improvement efforts.

Therefore, we need to apply Lean principles to their individual schedules, their management systems and their leadership methods if we are to be successful in creating the time to engage.  We must take things off of their full plates if we are to put something else on.  The responsibilities of Lean management and leadership cannot be a bolt-on to, but rather must be a replacement of, other activities. This must occur through prioritizing or creating efficiencies in their current work that gives them the capacity to assume these new roles.

• Don’t:  Just tell the managers they need to support the Lean activity then complain when it doesn’t happen.

• Do:  Map the value stream of a manager’s work using the eight wastes and the four rules in use.  Identify the value added and non-value added activity.  Determine the target condition to help prioritize their tasks including the added work they will need to engage in continuous improvement.  Use Lean Healthcare principles to redesign and define their daily, weekly, monthly and annual standard work with measures and visual management.  Coach them for as long as it takes to achieve stability. Use A3 to course correct if you run into barriers.

In A Factory of One: Applying Lean Principles to Banish Waste and Improve Your Personal Performance, Daniel Markovitz takes a fascinating approach to using Lean principles that we normally apply externally and instead applying them internally to an individual’s work.  It guides the development of a person’s standard work using visual management at a personal level.  One of my favorite examples is the use of time as a metric for the effectiveness of meetings.  Most of the time an hour or two is blocked off for a meeting and the whole allotment of time is used whether it is needed or not.  Talk about putting the cart before the horse! Meeting attendees should be present to deal with the issues listed in the agenda, not to spend a specified amount of time together.  If one uses time as a measurement of the meeting’s effectiveness, then it becomes a priority to remain focused on the management of the agenda, staying on topic and dealing with the issues as quickly as possible so the meeting can end early and give back time.

Consider time as a valuable resource and worth measuring at many levels.  It will tell you where the waste is and where the opportunities are.

“Time is what we want most, but what we use worst.”
William Penn

This week’s blog was written by Dave Munch, M.D. and HPP Senior Vice President and Chief Clinical Officer.

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While recently explaining Lean Healthcare concepts, I was told that we were just repackaging old concepts.  I think the individual who made the comment was looking for me to protest.  However, much to their surprise, I agreed.  I shared that Lean Healthcare is built on proven principles that have been around for decades.  Specifically, I referred to Deming’s 14 Points.

To those who aren’t aware of Dr. Deming, he is widely known as the “father of quality”.  He is perhaps best known for the “Plan-Do-Check-Act” cycle popularly named after him.  In Japan, from 1950 onward, he taught top management how to simultaneously improve service and quality as part of the U.S. government’s efforts to rebuild Japan after World War II.  Deming is credited with helping revive Japanese manufacturing and was seen as somewhat of a hero in Japan.  Ironically, in the United States we didn’t widely accept Deming’s philosophies until the end of his life in the late 1980′s and early 1990′s.

You can find out more about Deming’s 14 Points in this previous post, and here as well.

I believe you will find many parallels between Lean Healthcare principles and Deming’s Points.  I especially like the 14th  point:

“Put everybody in the company to work to accomplish the transformation.  The transformation is everybody’s job.”

This concept includes ideas such as:

• Improve your overall organization by having each person take a step toward quality improvement
• Analyze each small step, and understand how it fits into the larger picture
• Use effective change management principles to introduce the new philosophy

So many people that are new to implementing Lean Healthcare focus only on the tools such as Kaizen, 5S, or 3P.   However, by taking some lessons from the past we can learn to look beyond the tools.  We can look for transformation.  Thanks, Dr. Deming!

What is your organization doing to take Lean beyond tools?

Today’s blog was written by Tom Stoffel, Vice President with HPP.

Tom has led healthcare organizations in both the development of high-level Lean Strategies down to hands-on implementation of Lean in a clinical setting.  He has achieved the levels of Certified Lean Specialist from the Business Improvement Group and the National Institute of Standards and Technology (NIST), along with being an ASQ Certified Quality Engineer.  Tom is the developer of TGI Healing Healthcare – a brand of Lean Healthcare training tools designed to share lean principles through hands-on learning. 

Tom holds an Engineering Degree from the University of Michigan.

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