Saturday at the Society for Health Systems conference, included an excellent keynote address from Roger Gerard, from the ThedaCare health system, co-author with Dr. John Toussaint of the book On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry.
Some key points:
Roger made a great point that the idea of “creating a burning platform” is often an exercise in “how do we manipulate people?” He thinks intentionally creating and using a crisis is “manipulative” and “creates disengagement.”
He thinks it’s silly when leaders say ” we have to go to the Gemba to help,” when they should be going to learn and listen, instead.
Roger admitted that, early in the acclaimed ThedaCare journey, they made some mistakes. It was too much of a top-down initiative and the entire senior leadership team was not fully aligned. They started with Lean in decidedly non-clinical areas (such as freeing up cash in the revenue management cycle), but they erred by not properly engaging physicians and there was too much blaming back and forth.
Roger said “we failed miserably to ensure early staff/provider awareness, involvement and compensation. They had an ambiguous unwritten policy on no layoffs. With that and other problems, “we were going through the motions, but were not ready for the ride.”
Nobody’s Lean journey is perfect. It’s great that Roger can admit that.
Roger defines Lean in a nice, succinct way: “Figure out what the work is, take the waste out, further satisfy the patient needs.”
He had provocative thoughts on the idea of a leader “driving culture change.” He said, “it’s highly disrespectful,” as if “somebody said to you, ‘I’m going to change your personality'” as an individual. He said it’s “arrogant” to think you can drive culture change — that you have to respect and honor the existing culture. He added, “o We have to come into our orgs listening and learning, understanding the culture” and “o The culture will change, but you have to respect the community as a complex system.”
Roger also had brilliant thoughts on the common complaint about “resistance to change.” He said, “Resistance is a teacher – every time somebody resists something, you are about to learn something.”
Let that sink in… instead of complaining about the “resistance” (and blaming the people for being resistant), instead be ready to learn from it. Roger added, “How can you handle resistance? Welcome it.”
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