Thursday, August 27, 2009

Healthcare - Do Passionate Practitioners Sometimes Slow the Spread of Lean?

Business meeting There is an excellent blog posting on the Lean Blog linking to video clips of an interview with Dr. John Toussaint, the CEO of Thedacare, a healthcare organization gaining notoriety for its successful application Lean. I will not summarize the content here - Mark Graban, who publishes the Lean Blog, has done an excellent job already – you can read his posting and access the video clips here - Thedacare News Coverage & More from Fox News.
However, I thought the first comment after Mark’s post, submitted by Michael Balle, asked an interesting question, “Why isn’t Lean spreading more quickly.” I’m not a Healthcare industry expert, but, for the sake of discussion, let’s assume Lean could be moving more quickly to improve Healthcare as well as other industries.
I recently made a presentation to a small group interested in learning about the application of Lean to Healthcare. The following discussion regarding the perception of Lean making a negative impact on Healthcare may shed some light on the subject.

I see two major concerns about Lean from the Healthcare community:
1. it will have a negative impact on the patient experience
2. it will have a negative impact on service providers by making things worse for the physicians, the nurses, the technicians, and so on … (they understand eventually this comes back around to impact the patient in a negative way)
I think people are seriously and legitimately concerned that Lean will have a negative impact on health care; that it will make it more difficult for the providers to do their job in the best way. They are saying, “Lean might reduce cost but at what expense?”
Audience member question:
You said the concerns are legitimate - I’m not so sure. Aren’t those concerns just “resistance to change”?
I don’t see it that way. I don’t believe healthcare providers have anything against reducing waste and lowering costs; they understand Lean is a way to accomplish those objectives and they know Lean has worked well in other industries. They just see the Healthcare industry as different. They are concerned applying Lean to Healthcare will make some things worse as it makes other things better. They are particularly worried it might make things worse for the patient.
To gain a better understanding, it is important to note how healthcare providers see their industry as different. They see Healthcare as more concerned about the “human experience” than other businesses. …I use the word human in this instance to make sure we don’t miss the fact that there is an important special perspective involved here.
Let me explain further- if you are making a car there is the perspective of the car. In the auto industry, efforts to improve production and quality often take on the perspective of the car and ask, “What is it that leads to the production of the best car?” But a car is not human. A car is a car.
In healthcare the product is a healthy human being, or better quality of life for humans, or affecting a cure for a human disease. The fact that we are talking about human beings makes it different – human beings and inanimate objects are different. If service providers know of Lean mostly as successful in industries dealing with inanimate products and services, and now it is being applied to an industry dealing with human beings – well I can certainly see a legitimate concern.
Audience Member
I understand what you are saying but I am not sure I agree. Making cars isn’t just about cars. People buy cars for a reason - so in the end it’s about what cars do for people – it’s about the impact on people. So there really is no difference.
Excellent point! What that reflects - and you are correct – is your deeper understanding of Lean. You realize producing cars is not just about cars – it’s about transportation; it’s about transportation for people.
Audience Member
…and status and other things.
Right again - and I’m glad you bring it up - cars are about all the other things they do for people as well. Again, I think your points reflect your deeper understanding of Lean. What I want to point out here is that when people from the healthcare industry are first introduced to Lean, it looks pretty obvious to them – working on humans is different than working on cars. And that makes the healthcare industry different. To a healthcare worker being introduced to Lean, the difference is justifiably very important. In fact, I think it is so obviously important, it will likely be pointed out again and again. If a Lean practitioner dismisses this important difference, or communicates a superior attitude by explaining the deeper understanding of Lean, before they recognize the valid concern and acknowledge its importance, they will not win many friends of Lean in the healthcare industry.
Audience Member
I can see what you are saying. It makes sense.

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