Lean Healthcare Visual Management BoardAs Lean Healthcare leaders embrace spending more time at the Gemba, both staff and leaders alike will naturally begin to value data more than ever.  A daily management system is a powerful way to surface and solve problems that need to be resolved to achieve operating targets, and more importantly, allow the staff to do a better job for the patient.

Recently, I was reflecting on the cultural issues that had to be confronted and conquered in order to implement a daily management system at a large hospital I’ve worked with.  This organization is just beginning their Lean journey, and to get things going in the right direction, we committed to a few basic guidelines:

  1. Begin to institute a blame-free culture. If we want to create an organization where regular review and analysis of process performance is a key strategy, it must be encouraged to be fully transparent.  Everyone must be convinced that the organization needs to know which processes are working and which are not. Our initial goal was to convince all involved that the daily data discussions served to either endorse that our standard work did what we wanted it to, or that the standards were either too difficult to follow without variation or simply not sufficient to satisfy the customer’s needs.
  2. Improve access to data. Making the data as easy as possible to collect and display was something that everyone needed help with. It was demonstrated repeatedly that when the staff could successfully collect the data and understand the information enough that they were able to review and explain it, a critical tipping point occurred in willingness and ability to solve encountered problems.
  3. Be ready to help! Solving problems in regular work processes frequently requires assistance from other departments. We used a daily walk to define who needed help and what kind of help was required. Then, independently, the leadership team developed a help strategy which was discussed with the requesting team during the next daily review. Importantly, we were cautious about commitments and deadlines. Our guideline for response was to under-promise but always over-deliver.  Training in the basic Lean concepts and tools is helpful to leaders during Gemba walks.  The target state is to enable those that do the work to propose, evaluate and implement solutions. To do this, all staff need to learn to use a proven problem solving methodology such as A3.
  4. Set goals. After the staff became fluent in collecting, presenting and discussing their process performance results, it was time to ask what they thought our goal should be. We resisted any immediate answer and typically asked the team to carefully consider and discuss the question and propose something at a future visit.  We were aware that their ability to propose a goal, as well as understand the level of performance stretch associated with their goal, constituted valuable diagnostics of how well they were doing as a team and how well they had grasped the basic Lean concepts and tools.

Getting an effective Gemba Walk program started is a significant effort.  However, remember that you are recruiting and developing an army of problem solvers that will ultimately make your leadership role much easier and more fulfilling.  Be patient but persistent. Leadership should remain flexible on the timeline as all teams and processes are not the same, yet remain absolutely firm on the goal.  Enjoy the walk!


Today’s blog was written David Krebs, Senior Manager with HPP.

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