By Tony Heath, PhD, CPHQ, Lean Consultant with OptumCare, a business of UnitedHealth Group
Cultural Acceptance of Lean
Lean can sound mean to the people who hear it’s coming.
We all know that healthcare enterprises are under great pressure to cut costs. We also understand that much of our work is stupid and repetitive.
But: It’s Our Work and It’s Our Paychecks.
So when we learn that a lean egghead is coming to our workplace, few of us feel gratitude. Instead we ask “Who is this person?” We wonder what our bosses have in mind.
For those of us with the scars of a layoff in the family, there’s also fear and defensiveness.
Lean is a cultural change in an organization which will bring great challenges and changes for everyone.
Lean first arrived in healthcare less than 15 years ago. Originally, a few hospitals acted on their curiosity and trekked to the manufacturers who had adopted lean. Some hospitals consulted with the Japanese creators of lean. Some read everything they could find.
Everyone tried what they had learned and stumbled over far too many Japanese words.
Today, there are more websites, books, and webinars on lean in healthcare than most of us can consume. A few lean experts have become famous and there are scores of consultants.
While a lot has happened in short order, I think we’re still in childhood as a discipline.
The Errors of Youth
One area in which we commit errors is the interpersonal side of lean.
- Believing in lean tools, we sometimes charge ahead to do the bidding of the Vice President.
- We conduct a kaizen event, map a value stream, or lead a 5S, forgetting the essential principles of lean.
Bob Emiliani reminds us regularly that real lean is built on Respect for People. Joe Swartz reminds us that lean is about continuous improvement. Jim Womack reminds us to Walk the Gemba.
The common tread in these messages is how it’s the people that matter. We should be listening and teaching them, not doing lean to them.
At its best, lean is empowering and fair for everyone. Physicians, nurses, administrators, housekeepers, and everyone else needs to collaborate to make our processes better.
Importance of Lean Leadership
Our leaders recommend things that take time, trust, and love for every worker. These feelings don’t come easily in our changing environment.
A special mention of business leadership: lean only flourishes when our leaders get it. They must have the courage to model the culture of lean.
Are we quality improvement employees responsible for building this culture? I don’t think so. Many of us don’t have enough influence. But we can ask the leaders of our organizations to prioritize the culture of lean and we can live it ourselves.
Road to Lean Success
As a lean and six sigma facilitator for a large payer and provider organization, I have struggled with my personal impotency in changing the culture. But like you, I don’t give up easily.
Here are a few rules I have made for myself:
- Practice what you preach. Demonstrate lean to others by living it proudly. I use a kanban method to manage my projects, keep a relatively neat desk, and promote efficiency in every way I can.
- Slow down, take a deep breath, and take time to listen. Everyone likes being heard and speed leads to mistakes.
- Remember basic human empathy. “Do unto others” is an ever-good mantra.
- Remember to think and talk about trust. While most of us do what we are told, we do it better when we trust our leaders and each other. Are you trusted as an agent of change?
- Remember to take the time to teach others how to see and fix future problems. The highest goal of lean, in my opinion, is continuous improvement by the people and for the people.
To summarize, I believe it helps to talk to others and read as much information on lean practices as possible.
I attend the conferences of NAHQ and the state affiliates. But being a continuous learner doesn’t make me a better lean leader.
Being a better partner, a better parent, and a better friend does.
About Tony Heath
Tony is a certified lean process improvement consultant and a black belt for OptumCare, a business of UnitedHealth Group. He has been leading continuous improvement within the healthcare industry for 18 years. He holds a PhD in Family Therapy from Purdue and currently serves on its Midwest Board for the Association for Manufacturing Excellence.
Tony enjoys native gardening, making great coffee, and drinking great beer and good whiskey. He is a lean fixer of everything broken.
His motto is: Better, better, better.
Emiliani, B., Stec, D., Grasso, L., Stodder, J. (2007). Better thinking, better results: Case study and analysis of an enterprise-wide lean transformation. The Center for Lean Business Management.
Graban, M., Swartz, J. (2012). Healthcare kaizen: Engaging front-line staff is sustainable continuous improvements. Productivity Press.
Womack, J. (2013). Gemba walks. Lean Enterprise Institute, 2nd Edition.