The Relationship Between Processes and Outcomes in Lean Healthcare

The Relationship between Processes and Outcomes in Lean Healthcare

Will you be one of millions of Americans who participate in a National pastime during this Thanksgiving holiday?  No, not Turkey, or shopping — I’m talking about watching football while fighting a full-on food coma.  As you watch, pay attention to end of game interviews. When interviewed, the game winning coach will typically talk about the great team effort that earned
the victory. It will likely sound the same if the team deserved to win due to doing all the right things in practice and preparation, or if it was sheer dumb luck that resulted in victory.

I get to travel to many hospitals and clinics.  No matter where I go or what hospital system I am in, it is continually reinforced to me that “leadership matters,” just like it does in football.

Yes, it does matter — however, I want to offer a reminder that management in a Lean Healthcare driven organization differs from that often found in the traditional healthcare organization.  What’s so different? To me, the single most significant adjustment that has to be made as an organization begins to migrate to one driven by Lean healthcare principles is recognition that repeatable, consistent success requires commitment and attention to process. This begins with the strong, never wavering, belief by leadership that good outcomes will absolutely and inevitably follow and result from good processes!

To add perspective (and yet another gaming analogy), here’s an example of bad process being justified by a good, yet unlikely, outcome. Statistical savant Paul DePodesta (Jonah Hill represented his character in Moneyball) reveals an experience he had in Las Vegas:

“I was in Las Vegas for a weekend playing blackjack. A person at the table to my right had 17 and said they wanted a hit. The whole table stopped and even the dealer asked if he was sure he wanted a hit. Finally he said he wanted a hit. The dealer deals the card and of course it was a four. What did the dealer say? “Nice hit.” But I’m thinking, you’re kidding me. It was a terrible hit. Even though it ended up working out, it wasn’t a good decision.”

DePodesta has rightly declared that the Blackjack player’s decision to defy the laws of probability and take a card was terrible thinking and not justified just because it worked that one time.  This story illustrates the relationship between processes and outcomes in a Lean hospital or organization:

–       A bad process that yields a good outcome is likely ‘Dumb Luck’

–       A bad process that yields a bad outcome is predictably ‘Poetic Justice’

–       A good process that somehow yields a bad outcome is just a ‘Bad Break’

–       A good process that regularly yields a good outcome is ‘Deserved Success’

One point especially stands out to me: the first scenario is truly a case of the “wolf in sheep’s clothing.” Just because we can deliver the expected outcome through an extraordinary effort, does not make it the right thing to continue to do. True Lean leaders typically are not comfortable with the recognition that the ability to reliably achieve Deserved Success depends not on a robust process but on an extraordinary effort. Improve process and achieve the success that your organization deserves!

Do you have process outcome examples of Dumb Luck, Poetic Justice, Bad Breaks, or Deserved Success’ ?  Please share them with other readers in the comment section below.

This week’s blog was written by David Krebs, Senior Manager with HPP.

David, a Six Sigma certified engineer, oversees 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.  He has achieved and maintained QS-9000 and ISO-14001 certification & received Nissan’s “Quality Master Award” on three occasions. 

David earned 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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