Thursday, June 04, 2009

Rescuing Lean

When Physicians See Lean as Unhealthy, Bad Medicine

photo of surgery courtesy of sxc.hu asterisc21A recent blog posting, Criticism of Lean at Park Nicolett Hospital, and the comments following the posting, brought out an important issue facing passionate Lean practitioners. I consider myself among this group. Check out the ninth comment below the posting - it appears to be from someone in the health care industry, possibly a physician, who has recently been part of a Lean deployment effort at a hospital. The commenter, who appears to be sincerely upset, sees Lean in a very poor light. For example, he made the following point which summarizes his thinking

"Running around with stop watches on a nursing floor and putting up charts about flow and such do not encourage "buy-in". Nurses and doctors are there to serve the patients. They do not view patients as part of an assembly line."

Clearly the commenter's viewpoint of "Lean" is negative and not a fair representation of "Lean", but, for all we know, may be legitimate based on the experience of how "Lean" was introduced into the hospital environment in question. To be fair, the commenter, who signed the comments as "anonymous", may represent a rare, outlier viewpoint not consistent with others at the hospital at all.

For the sake of discussion, let's suppose the following:

  • the commenter is a physician who has been involved in a lean effort
  • the implementation has missed the mark in a few ways; maybe
    • the implementers relied too heavily on "tools and templates" and essential "Lean" management and "Lean" social aspects were absent
    • project selection was not truly driven from the "bottom up"
    • the effort advanced with physicians under-represented or otherwise not "on board"
  • the physician now has a sincere, strong negative view of Lean
  • the "physicians" as a group share this same negative view of Lean
  • other groups still see "Lean" as good but the effort will not be nearly as strong as it could be without the physician "buy-in"

What is the approach you must take to rescue "Lean" in the eyes of the physicians?

Based on my experience in a variety of industries, the following must be done:

  • take "Lean" back to its core meaning - principles and methods used to add or strengthen value
  • review the cooperative nature of "Lean" - all stakeholder groups should see Lean as "good"
  • use basic terms everyone agrees represent "good", for example "Lean" is about getting more of what you want and less of what you don't want
  • discover value through the eyes of the physicians
  • translate value, or "getting more of what you want", into the real world benefits the physicians agree they would like to see happen, for example, maybe they would like "more time with patients"
  • list the issues and pick one near the top of the list to solve
  • partner with the physicians to solve it or significantly improve it
  • make "lean" principles and concepts part of the problem solving effort
  • take only the time the participating physicians are willing to give based on the perceived value of the issue (in other words - don't waste their time)
  • make your effort light on complicated tools and heavy on common sense, hard data, and real world experience
  • work through implementation and beyond addressing all group concerns
  • work thoroughly to put the changes in place as a system-based solution; one that will last
  • verify the physicians as a group see the improvement as "as a better way"; one they will protect

Applying the above in the right way will correct the problem (the right way - common concern, common understanding, common goal, executive support, group agreement, group resolution, group benefit). Physicians as a group will now see "Lean" as good and will agree to contribute to the effort.

Moving forward, to keep the physicians "on board", the local deployment leader must tell the physicians to hold the "Lean" effort to the standard of "more of what you want and less of what you don't want". Explain the standard applies to the physicians as a group. The deployment leader will need the backing of executive management and the freedom to take corrective action when the standard "takes a hit". Correcting problems as they crop up along the way will demonstrate to the physicians their interests are being taken seriously and emerging problems are being quickly resolved to their satisfaction.

Applying the same standard and protocol to all stakeholder groups will keep all groups on-board and the effort moving forward with maximum benefit and minimum waste.



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