Many hospitals have experienced very successful, sustainable Lean Healthcare activity. As well, many hospitals have also participated in Lean activities that have not gone as planned or have been followed by deteriorating results over time.

No attempt at improvement is a complete failure, as long as we learn and strengthen our approach for the next process improvement effort. It is healthy to stumble, then to reflect on what caused the failure. Here is a hard question that I first heard from a Lean colleague, Dave LaHote, president of Lean education at LEI.:

What is the most common or root cause of failure?

As with any good coaching question, it isn’t easy to answer. It requires a lot of reflection. Mr. LaHote would advise you that lack of agreement is the answer. While a spirited debate on the answer to this question could certainly be held, for now let’s accept it as true.

That being the case, how do we get to agreement? In many cases, agreement can be achieved with dialogue and reasoning. If disagreement persists, the application of the scientific method can help. The most important piece of agreement is the understanding that it takes time to reach. People have a tendency to resist change, and typically they cannot be convinced of the value of change overnight. Launching into the work with a plan to achieve buy-in from involved parties later will result in long-term failure of the effort.

By allocating the time for agreement before engaging staff in improvement, we set a foundation for long-term success. We need to go slow to go fast.

I’ve seen many Lean Healthcare events fail due to a lack of agreement in the chartering or planning process. Successful improvement requires allocating time to achieve these things in order to avoid failure:

  • Participation at every level of the organization.
  • Determining the activities that each level must perform and when.
  • Communicating role and responsibility to each level.
  • Gaining agreement and a commitment to performing these responsibilities reliably.
  • Addressing the above issues before the improvement work is launched.

Here is an example:

An improvement team working on timely transfer of patients from the emergency department to the floor is preparing for a rapid improvement event.

A critical aspect of this work will be the willingness of the med-surg floor to accept the patient within a certain amount of time, say 30 minutes.

The process will need to be developed. The staff in med-surg will need to have the support of their managers in the change, which means they will need to find the capacity to do this work, and there will need to be measures and coaching from these managers.

Have the managers agreed to do their part of this work ahead of time? If not, we know what will happen. The managers won’t have this implementation as a priority with all the other tasks they need to do throughout the day. That means that the measures and coaching won’t occur. This in turn will lead to sub-optimal implementation and it will be unlikely that the goal will be met or sustained over time. It is better to have that conversation with the managers before starting the work, surface the problems or barriers that the managers have in accepting these responsibilities and resolve them beforehand.

Similar conversations and agreements will need to occur with the executive team members, the improvement team lead, the facilitator, the team members and the frontline. They all have specific roles to play in the success of the improvement.

Getting to agreement on roles and responsibilities before a project is launched will significantly increase your chances of success. Investing the time before the event is well worth it. Otherwise, you will spend extraordinary amounts of time following implementation dealing with the problems based on confusion or lack of agreement of roles and responsibilities. In the worst-case scenario, you will have spent the time and energy of many people to attempt an improvement that has not sustained itself. Morale is low and you’ve created a self-fulfilling prophesy that Lean doesn’t work.

With just a bit more time invested up front in getting to agreement, this doesn’t have to be the case.

Go slow to go fast.

Dr. Munch will be facilitating a workshop at the upcoming Lean Healthcare PowerDay – Improving Quality Management to Prepare for the New Healthcare Environment.  This workshop will cover requirements and tools for leaders and staff to improve processes that deliver safer, more reliable care.  Participants will learn how to dismantle a culture of “blame,” and how to reward the right behaviors to prepare for CMS’ Value-Based Purchasing and Hospital Readmission Reduction Programs.  For more information on all PowerDay workshops and sessions visit www.LeanHealthcarePowerDay.com .


Today’s blog was written by Dave Munch, M.D. and HPP Senior Vice President and Chief Clinical Officer.

Dave oversees all of HPP’s clinical and Lean Healthcare engagements. He plays a lead role in new services development and HPP’s continuous adaptation to the healthcare industry’s ever-changing needs.  Dave previously served at Exempla Lutheran Medical Center as their Chief Clinical and Quality Officer.   Dave has been a frequent speaker on the subject of leadership effectiveness and Lean transformation for a number of healthcare organizations including Institute for Healthcare Improvement (IHI), The University of Rochester Medical Center, Yale-New Haven Health System, Tulane University Medical Center, Pittsburgh Regional Health Initiative, Institute for Clinical Systems Improvement (ICSI), and the Voluntary Hospital Association (VHA).  Dave has served on the Agency for Healthcare Research and Quality’s High Reliability Advisory Group, has an extensive background in hospital operations, health plan governance, physician organization governance and clinical practice in Internal Medicine. 
Dave received his M.D. from the University of Colorado’s Health Sciences Center. He is also a faculty member for the Belmont University Lean Healthcare Certificate Program.

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