If there were a form of medical malpractice lawsuit that I would like to encourage, it would be against those consulting firms that promise hospitals that they will teach them how to "do Lean." I recently encountered a hospital in which a well known international consulting firm did it this way: Assemble 25 top level managers for a week-long off-site seminar, teaching them all the Lean terminology and getting them ready to do Lean projects. Then keep one or two of your consultants in residence for a few months to provide aid and comfort to the managers as they attempt to run rapid improvement events in areas of the hospital chosen by somebody as "high priority" areas needing cost savings. Then leave behind your "trained" cadre of managers to carry on -- which they cannot or will not do. Charge the hospital several hundred thousand dollars for this "service." But not before you have given Lean a bad name and, worse, have caused it to be associated with layoffs (or redundancies, as they say in the UK.)
I'd like to explain all the things wrong with this, but I would just get upset. Let me provide the simple explanation. You don't "do Lean." Lean is not a program. It is a long-term philosophy of corporate leadership and organization that is based, above all, on respect shown to front-line staff. There are two essential aspects, training front-line workers to be empowered and encouraged to call out problems on the "factory floor," and training managers to understand that their job is to serve those front-line workers by knowing what is going on on the front lines and responding in real time (when problems are fresh) to the call-outs. Yes, there are all kinds of methods and tools and terminology, and as Virginia Mason Medical Center's Sarah Patterson notes, "Lean provides a common language for process improvement." She also reminded us, though, that it is a focus on process, not on the outcomes. The idea is to "build key features into processes that are waste free, continuous flow." To do this we need to "grow leaders-- to respect, develop, and challenge your people."
I hope that those of you who have been following my commentary about our Lean workshops at Ipswich Hospital NHS Trust will have seen an emphasis on these points. You will have also seen that we employed on a pedagogical approach that relied heavily on going to gemba. You cannot teach respect for front-line staff by sticking people in an off-site conference facility for a week. You cannot teach people to notice the problems in work flows if they are not looking at the work flows. You cannot teach the principles of incremental improvement and experimentation if you direct managers and staff to spend all their "Lean time" on time-consuming projects in "priority areas."
Jim Craig (seen here shadowing a person during the workshop) told me this story after we were done. He was walking through a ward and heard a trainee grumbling about something. He went up to her and said, in a friendly way, "I happen to overhear that you were upset about something. Would you mind telling me what it was?" The answer was that, many times per day, the resident would need to print out a form from the computer. But the ward was a large ward, and the one printer was at the extreme end of the floor. So, when she was seeing patients at one end of the floor, the resident would have to spend 5 minutes each time walking across the floor and back as she collected the form. Jim said, "Would it help to have a printer at each end of the floor?" "Oh, yes," was the reply. Then and there, he called the IT department to arrange a printer to be delivered. Result: A very grateful trainee, who will now have more time to be with patients rather than fetching papers.
The Lean aficionados out there are already fidgeting, for they have noticed other potential solutions to this problem. And they are asking questions like, "What is the form itself, and does its production add value." Those would be good things to explore. The lesson, though, is that Jim was at gemba, heard the (unintentional) call-out, responded respectfully, and analyzed and solved the problem while it was fresh. I give him an A+ for demonstrating what he learned at the workshop. Well, let's make it an A- so he knows there is always the potential to improve!
I'd like to explain all the things wrong with this, but I would just get upset. Let me provide the simple explanation. You don't "do Lean." Lean is not a program. It is a long-term philosophy of corporate leadership and organization that is based, above all, on respect shown to front-line staff. There are two essential aspects, training front-line workers to be empowered and encouraged to call out problems on the "factory floor," and training managers to understand that their job is to serve those front-line workers by knowing what is going on on the front lines and responding in real time (when problems are fresh) to the call-outs. Yes, there are all kinds of methods and tools and terminology, and as Virginia Mason Medical Center's Sarah Patterson notes, "Lean provides a common language for process improvement." She also reminded us, though, that it is a focus on process, not on the outcomes. The idea is to "build key features into processes that are waste free, continuous flow." To do this we need to "grow leaders-- to respect, develop, and challenge your people."
I hope that those of you who have been following my commentary about our Lean workshops at Ipswich Hospital NHS Trust will have seen an emphasis on these points. You will have also seen that we employed on a pedagogical approach that relied heavily on going to gemba. You cannot teach respect for front-line staff by sticking people in an off-site conference facility for a week. You cannot teach people to notice the problems in work flows if they are not looking at the work flows. You cannot teach the principles of incremental improvement and experimentation if you direct managers and staff to spend all their "Lean time" on time-consuming projects in "priority areas."
The Lean aficionados out there are already fidgeting, for they have noticed other potential solutions to this problem. And they are asking questions like, "What is the form itself, and does its production add value." Those would be good things to explore. The lesson, though, is that Jim was at gemba, heard the (unintentional) call-out, responded respectfully, and analyzed and solved the problem while it was fresh. I give him an A+ for demonstrating what he learned at the workshop. Well, let's make it an A- so he knows there is always the potential to improve!
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