The primary customer in healthcare is ultimately the patient, but who is the customer of leadership?  Who provides the direct value to the patient?  Lean Healthcare leaders understand in a purist sense that their work is non-value added to the patient.  Value to the patient comes from improving processes to enhance the direct caregiver’s ability to provide value.  Thus, the customer for leadership is the staff who provide direct value to the patient.  Just as front line has waste in their work, leadership needs to examine and eliminate waste in how they spend their time.

Recently, I had the opportunity to work with a hospital that was committed to getting leaders to spend more time in problem solving with staff at the Gemba (where the real work of the organization is done).  In assessing their current state, they found that 67% of a leader’s time on average was spent in formal and informal meetings.  As they examined the time spent in meetings they realized two types of waste responsible for the lack of value in meetings; meetings were either “batched” or “botched”.

Batched (Waiting):

Leadership identified that they provide value by helping staff do their job better or by helping staff with employment logistics (e.g. salary, benefits, scheduling, etc.).  The majority of information was communicated in once a month staff meetings.  Even though staff meetings were mandatory, attendance was consistently around only 70% during any portion of the meeting.  Throughout the meetings those who were actually working a shift left to care for patients.  Information was saved from one month to the next to share with staff.  In place of the monthly meetings, managers tested having short daily huddles (5-10 minutes) to share information for the current week.  Information was also tailored to clearly identify what the staff were expected to do differently.  By transitioning the monthly staff meeting time into daily huddles, managers were able to shorten the wait for information distribution from as long as 3 weeks to only a few days, and standards were set to convey only the information that was meaningful to the particular floor or unit.  Eliminating the monthly meeting saved hours of non-productive time each month for staff—especially for one patient care unit who came into work only for the staff meeting.

Botched (Defects):

The other waste identified was that meetings were unproductive.  Numerous examples were given of meetings with no agenda or clear purpose, critical team members being absent from the meeting, and lack of preparation or follow up for the meeting.  These lean leaders recognized that standard work for meetings did not exist.   As the team developed standards, they found that only 40% of their current meetings contained the critical elements identified in their new meeting standard work.  The team identified at least 4 hours of time on average for leaders to redeploy to time spent with the front line staff in Gemba Walks.

Applying the same principles of identifying and eliminating waste in all processes is essential to fully implementing Lean Healthcare in your organization.  Take a look at your own leadership standard work.  What other wastes can you identify and eliminate in the meetings you attend or perhaps do not even need?

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.  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 and a bachelor of science in nursing with an emphasis in healthcare management from Metropolitan State College in Denver, Colorado. Maureen achieved certification from the 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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