For numerous reasons, the most critical ingredient in a successful transformation from a traditional organization to a Lean organization is executive leadership.  Yet we frequently hear the executive team saying they simply don’t have the time to align, learn, review and support the Lean transformation.  We also know that if they don’t do the standard work required, the initiative will most certainly fail and any improvements gained will not be sustained.

Knowing this I recently asked the executive team at one my client hospitals to give examples of waste they encounter and cause on a daily basis. They made a list and organized the causes according to the eight wastes we look for in Lean Healthcare. Here is what they came up with:

Defects: Meetings where the objective is unclear; Meetings with no timed agenda; Not following the timed agenda if there were one; Decisions not made when they should be because of not knowing how to make group decisions; Single point accountability person not assigned when tasks are agreed upon; Assignments not carried out; Initiatives that die because sound change; management principles are not followed; Overproduction: Too many meetings at all levels, especially the executives; Everything is a priority due to lack of alignment and Pareto thinking;  Firefighting, instead of process improvement (enabling defects to continue); Handling the same paper work several times; Having multiple meetings on the same topic when one should do; Having multiple improvement teams working on the same type problem; Telling staff something one on one that could be told once in huddle, staff meeting, or email; Having staff meetings, out of habit, that add no value; Doing work that should be done by subordinates, especially when this would help with the subordinate’s development; Waiting: Meetings not starting on time; For others to show up at meeting;  Catching late attendees up on what has already been done; For information to make a decision; For data to make decisions; Unnecessary layers of decision makers; For a superior, who has a tendency to procrastinate, to make a decision; For multiple leaders in the same area to agree on decision; Not Clear: Guessing on what to try to improve because the organization is not aligned; Confusing requests and fear of asking for clarification; People who love to “tell” but never listen; Not having a plan that includes who is responsible for accomplishing the plan; Not knowing who to contact for next step or who is responsible for the next step; People not clear who is the final decision maker; Transport: Forwarding emails unnecessarily; Paperwork for multiple layers of approvals; Inventory: People invited to meetings who don’t need to be there (e.g. executives, out of “courtesy”); Having multiple people from the same department at a meeting when fewer would suffice; Lack of flex staffing where appropriate; Having meetings where a few people always dominate;  Multiple competing initiatives; Motion: Walking to a meeting when the meeting could have been done by phone; Planning multiple Gemba walks with no thought given to location sequence; Excess Processing: Cc more people than necessary on email; Pursuing perfect data forever before making decisions; Meetings are an hour even if the agenda can be covered in less time; Multiple phone calls to get something done; Chartering an improvement team on something that is a “just do it”

One might organize these differently, but you get the idea. When asked, some executives estimate that 35 percent of their time is non-value added. So yes, executives are too busy to support Lean initiatives.  But, that doesn’t mean what they are busy doing is adding value. Because of this, the opportunity cost is huge.

Suggestions? Call a time out. Look at how you work. Start changing the way you work. Time spent by executives reducing waste will benefit the entire organization.  Doing more of the same will only give you more of the same.


HowellTerryRSToday’s blog was written by Terry Howell, Ed.D., senior principal at HPP.

Terry has 30 years of healthcare leadership experience with a focus on performance improvement, patient experience, quality improvement, and strategic planning.  He served as chief quality officer at a large academic medical center in Minneapolis where he was responsible for oversight and coordination of performance improvement, patient experience, clinical risk, safety, accreditation and organization-wide planning.

Terry received a Doctorate of Education degree in Counseling Psychology from the University of Tennessee followed by post-doctoral work in Organizational Development.  He served on the faculty of the Institute of Healthcare Improvement, the Healthcare Quality Improvement National Demonstration Project and has taught graduate courses in Tulane University’s International Medical Management program.

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