lean_teamAs more healthcare organizations adopt Lean as a means of managing and improving the care they provide to their community, I frequently work with a Lean executive champion or Lean director struggling with hiring and retaining capable, competent and committed staff.

It is easy to enter a circular conversation defining these terms that are often used interchangeably. For the purposes of this discussion, I am defining capability as possessing the qualities needed to do a particular thing, competency as effectively demonstrating knowledge and skills to achieve an objective, and commitment as being dedicated to the cause or activity.

I find that Lean healthcare practitioners require different levels of capability, competency, and commitment depending on where their organization is at and where they desire to go using Lean.

The Lean newbie organization

In the beginning of a Lean journey, most organizations focus on learning the technical aspects of Lean. At a minimum, the internal Lean staff should be capable and competent in project management and facilitating a conversation to a desired objective. Being comfortable in front of a group is an essential skill while training capability is another positive asset. It is helpful if your Lean staff is competent in problem solving, possesses basic quality tools, and has healthcare experience.

Oftentimes, I hear the debate advocating for the hiring of an engineer versus a clinician. I find that either discipline will add value to your team. I always recommend focusing on the capability of the candidate’s skill sets as opposed to a specific degree.

Early on, your staff will mainly focus on coaching problem solving techniques, such as A3, and facilitating kaizen. Learning the tools of Lean can be done on the job with either an internal coach or external consultant. At this stage, a capable new Lean healthcare practitioner can establish competency by following standard work to achieve successful results. Lean healthcare practitioners can further develop their skills through support activities such as conferences, training seminars, and certifications to boost your staffs’ knowledge and skills. However, Lean is learned best through application, so do not count on sending your staff away for a seminar and suddenly expect that they are now competent to drive your Lean program.

Connecting improvement to running your business

The initial technical aspects of Lean can energize your organization as you see waste eliminated through process changes, in turn making the right work easier to do.  Shortly after implementing changes it will become evident that altering processes requires changes in management and leadership behaviors in order to sustain improvement.  Your Lean team will soon need to know how to coach not only front line staff and managers but all leaders throughout the organization in the skills of Lean Management.   The Lean staff still needs capability in the fundamental skills of training, problem solving, and facilitation, however it is time to add additional skills to their resume.  The effective Lean healthcare practitioner will need to grow in his or her competency to enable the following:

  1. Recognize waste in managers’ and leaders’ work
  2. Access and analyze data and train operation leaders to do so
  3. Coach others and give feedback to managers and leaders as they coach their direct reports
  4. Deal with difficult situations and people
  5. Understand the changing healthcare environment and more specifically their own organization’s vision for the future

The Lean team supports change in the organization’s management system by coaching the implementation of visual management for both strategy deployment and daily management.  They assist managers and leaders in creating standard work to tie behaviors to process change, which support departmental and organizational goals.  Ultimately as operations become proficient at visual management, leadership standard work and problem solving, coaching of individual managers is transitioned from the Lean team to their direct supervisor or executive.

Ideally, the Lean healthcare practitioner has the experience and knowledge of actually managing others in order to assist managers with their own personal change to function as a Lean Leader.  The competent Lean healthcare practitioner will adjust his or her coaching, facilitation, and training to the unique circumstances of each person or team, and he or she starts to utilize standardization to achieve customization.

Developing systems and structures for continuous improvement

As the organization evolves in its understanding and use of Lean, the Lean healthcare practitioner’s competency also needs to continue to evolve.  The use of kaizen as a means to make improvement becomes more judicious.  At this point it is helpful to have criteria to allocate resources for kaizen and a decision-making structure to ensure alignment to strategic priorities. Lean teams will now be involved in facilitating local improvement, coaching management and leadership, and assisting the organization in structures and systems to support the long-term strategic plan and the short-term annual plan deployment, implementation, review and course correction.

At this stage, the advanced Lean healthcare practitioner must possess a strong understanding of global healthcare issues related to quality, cost, and satisfaction, as well as the skills to facilitate high-level discussions related to strategy deployment. The goal is not for the Lean healthcare practitioner to make the decisions about where the organization is headed but to ask the questions of the executive, middle management, and front line leaders to help them decide the direction for the organization.

As your Lean program evolves you may find it necessary to have different levels of Lean practitioners who can support the varied needs of your organization.  It is also likely that you will need a plan for recruiting new Lean practitioners either from internal or external sources.  Your organization will also benefit if you plan for the career development of your Lean practitioners within your team, including their movement to management positions within your organization.

What are your experiences with developing a capable, competent, and committed Lean team? 


Maureen Sullivan, Senior Manager for Lean Healthcare and Process Improvement at HPPToday’s blog was written by Maureen Sullivan, senior manager at HPP.

Maureen has nearly 30 years of healthcare experience in clinical nursing, management and quality leadership.  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 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 as a certified professional in healthcare quality (CPHQ).

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