Zealous guardianship of the status quo is a very common barrier encountered by healthcare delivery systems attempting to adopt and implement lean healthcare.  It is amazing to witness the extent to which this behavior is present in nearly all organizations interested in pursuing the lean healthcare journey.  During Kaizen Events this guardianship manifests in one of two ways:  1.) either an amazingly strong reluctance to change or, 2.) proposed changes to current state that are so enmeshed in what we have today as to be nearly indistinguishable.  How this guardianship is approached and managed during an event can mean the difference between “bold moves” and “rearrangement of the sock drawer for the tenth time”.

There are four things facilitators, coaches and leaders must keep in mind when dealing with guardianship of the status quo during a lean healthcare transformation. 1.) Honor the past. The segments of the value stream under consideration have been developed by the participants of the event or their forerunners.  At times there can be an unspoken and even unconscious sense that to change is to dishonor what is currently in place and what it took to get there. 2.) Challenge the team. Team members must be adequately challenged to the extent that the need for change is undeniable and a healthy dissatisfaction with the status quo has been created. During a Kaizen Event direct process observation goes a long way toward the accomplishment of this objective but more is required to truly embolden teams. It is also important to keep in mind that the event team is only a cross section of the extended team when implementing.  3.) Create and communicate a new vision.  Teams need to know that what they will build is better than what they already have…not only for themselves but for the extended community as well. By building in constituencies beyond just the participants, systems thinking is promoted.  This is an essential step, combined with honoring the past in empowering teams to let go, to adopt something new, and to take bold moves. 4.) Engage the team. This seems so fundamental that it almost questions its mention in this article. Engaging the team, however, moves well beyond their active participation in the event. It is a process of creating internal champions, one at a time. 

The Scientific Method, applied while testing solutions, will ultimately prove or disprove the quality of the “bold moves” selected for implementation. However, regardless of the quality of the solutions or counter-measures, unless there is acceptance, there is no net improvement. Things must change from current state toward future state in objective reality. This means that ultimately, along the way, every mind in the organization must be engaged. Facilitators, coaches, and leaders that recognize this and that understand that honoring the past, challenging the team, creating and communicating a new vision are prerequisites to engaging the team, will find their fields well prepared when planting the seeds of lean healthcare. Those that fail at this should not be discouraged as the lesson will repeat itself, again, (hopefully not and again and again…) until learned.

This week’s blog was written by Bradley Shultz, a director and consultant for HPP. Before joining HPP, Bradley was serving as Vice President of Operations & Quality for Infinity Resources Inc. where he pioneered the application of Lean, Six-Sigma, Work-Out™, and CAP (Change Acceleration Process) in the retail market sector. Bradley began his career in manufacturing with GE Healthcare and was working as a Manufacturing/Quality Engineer when GE adopted the Six-Sigma methodology from Motorola. In 1995, GE Healthcare began providing consulting services based upon these tools to its customers through its Performance Solutions business unit, pioneering the application of Six-Sigma in healthcare. Bradley joined Performance Solutions in 1996 during its infancy and remained with the business unit for seven years. Bradley’s educational background includes: a Bachelor of Science degree in Business Administration from Cardinal Stritch University in Milwaukee, Post Graduate Certification in Quality Engineering from Milwaukee School of Engineering, a Master of Arts degree in Business Administration from Marquette University in Milwaukee, Six-Sigma Master Black Belt Certification from General Electric, and Front-Line Leadership Development Certification from Achieve Global.

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