When I was a teenager, I worked as a lifeguard in the summers.  I remember one day, when I was still in lifeguard training, overhearing a conversation between two classmates discussing a Lean Healthcare Management System Meme - Leaders should "save the save". lifeguard who worked at a local beach.  “He’s amazing,” said one of them. “I heard he’s saved ten people already this summer.”  The person he was speaking to was suitably impressed.

Our instructor, however, was not. Overhearing this conversation, he had a response and he wanted to make sure the whole class heard.

“The best lifeguards never have to make a save.”

His perspective was that the role of a lifeguard, and the impact a lifeguard could make, started much further upstream than at the point of a save.  A save is actually the last chance to respond to an issue, utilizing the largest and most disruptive intervention a lifeguard has.  There were probably earlier signals that could have triggered a smaller intervention, eliminating the need for a save.  Looking at it this way, this means the “best” lifeguard is the proactive lifeguard that prevents the need for a save.  Further still, we should think of saves as an action requiring review. They should be something to huddle on and problem solve around, not as an indicator of success.

It’s a lesson that has stuck with me. It applies directly to management, particularly in healthcare organizations developing and implementing Lean Healthcare management systems.  If we think about when and how we reward staff and leadership, the stories of success often revolve around some sort of heroic action.  However, in order to be aligned in a Lean Healthcare environment, the organizational systems and structures must both support and reward how we want individuals to behave.  Sure, we want them to “make the save” if that is the situation in front of them.  But we also want to avoid getting back to that place for a second time.  Instead, where we should go is to get the answers to the questions:

  • How did the situation get so bad that this heroic action was needed?
  • Was there something we could have done earlier to have avoided that level of intervention?”

Compare the visual of the lifeguard running in slow motion, pulling the distressed swimmer out of the water to one where that lifeguard is patrolling the beach, intervening more often, at the first signs of potential distress.  Unfortunately, non-events are far less exciting.

Similarly, the proactive healthcare leader who prevents the larger issues from occurring is typically more visible but in far less heroic-seeming ways. In a mature Lean Healthcare organization, problem solving occurs earlier in the process and as close to the issue as the issue can be uncovered. The systems and structures need to support both the change and the ability to sustain that change.

At this point, the response could effectively be a whistle or a request to swim closer to shore.  Or maybe we even need to keep people out of the water for a few hours due to rough waters.

All these options should be considered preferable to a save, and rewarded as such, no matter the job.


Today’s blog was written by Jamie Wilson, Senior Manager with HPP.

Jamie has more than 10 years of healthcare experience, spanning management consulting, hospital administration, business development, and hospital operations performance improvement. She currently leads Lean Healthcare transformations and performs specialized consulting for HPP.  Jamie received her B.A. in Sociology with a dual concentration in Health and Medicine, Deviance and the Sociology of Law, graduating Summa Cum Laude from University of Pennsylvania. Additionally, Jamie received a M.S. in Healthcare Management and Policy from the Harvard University School of Public Health.

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