After years of experience in healthcare, I have come full circle—from receiving the advice of consultants to now being the one providing the advice about implementing Lean Healthcare.  In this time, one piece of advice has stayed the course—the change under discussion will never happen without Senior Leadership involvement.   Whatever “it” is, every healthcare executive already knows they need to be involved and likely get more than a bit nauseated when they hear the message preached from a consultant’s pulpit. 

Achieving a successful Lean Healthcare transformation is driven by implementing standard work (changes in behavior) at all levels of the organizations.  While learning about best practices is always a good place to start, executives responsible for this type of cultural change need to personally and honestly answer three questions in order to make real change within their own context. 

  1. WHAT do I need to do differently to be involved?  

Many best practices exist to characterize what leaders need to do differently.  My personal guide in recent months has been Steven Spear’s organizational competencies described in Chasing the Rabbit (you may now know it as The High Velocity Edge):See problems where they occur, Solve problems where they are seen, Share the knowledge and Sustain performance by developing the first three competencies in others.”

  1. HOW do I get there?

Conference rooms and offices do not contain the critical processes providing value to our patients.  Thus in order to see and solve problems, the first step is to get out and go to where the work is done. 

Sharing the knowledge and sustaining by developing others is an interesting balance.  Sharing requires the actions of showing and telling.  Most executives have a wealth of experiences they can tell others.  Developing others requires asking questions in order to expand problem solving skills and ensure problems are solved within the current context.  Telling often comes in the form of a solution that was implemented elsewhere.  The risk of relying on our own experience and telling is that we may not truly understand the root cause of this particular problem and we have not helped our direct reports to become better problem solvers.

  1. WHEN will I know that the change is for the better?

In implementing Lean Healthcare, the ideal state is to grow an army of problem solvers who continuously improve performance in their daily work.  How do you measure that?  In its simplest form, it comes down to how many problems are being solved and by whom.

So as I jump down from my consultant pulpit, I must confess, I am personally working on asking the right question instead of telling the wrong answer.  So I will ask you… What you are doing today to improve your leadership involvement?  How is that working for you?


This week’s blog was written by Maureen Sullivan, a senior associate at HPP. Maureen has over 28 years of healthcare experience in clinical nursing, management and quality leadership to Healthcare Performance Partners. Previously Maureen was the director of lean and quality improvement for Exempla Lutheran Medical Center and successfully led the implementation of Lutheran’s Lean production system from 2004 to 2008. As a registered nurse, Maureen’s clinical experience is in medical surgical nursing with progressive responsibilities in nursing management at the front line, middle management, and administrative levels. Maureen has an associate degree in Nursing from Joliet Junior College in Joliet, Illinois and a bachelor of science in nursing with an emphasis in healthcare management from Metropolitan State College in Denver, Colorado. Maureen achieved certification from National Association for Healthcare Quality, certified professional in healthcare quality (CPHQ), Colorado State University in process mapping, and University of Michigan in lean healthcare.

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