Today’s post doesn’t throw back too far… it looks back at a post from just last month: “Doctors Get Upset With Being Pushed, Bad Leadership, Clumsy Incentives; Try to Unionize.”
What’s a bit more of a throwback is receiving a comment on that post from a long-time friend of this blog, Patrick Anderson. I believe I first met him at one of Cindy Jimmerson’s conferences back in 2008 or so, when he was the executive director of a tribal consortium in Alaska.
Back to Patrick’s comment… I thought it deserved to be posted here as a fresh post, with his permission. Instead of demanding better productivity, Patrick worked with staff to get them to identify barriers to productivity. Listening and leadership go hand in hand…
By Patrick Anderson:
I administered a rural health organization with an 18 bed hospital. The prior executive had recently mandated seeing additional patients without, according to what I was told, regularly visiting the hospital. Of course as an experienced Lean executive, that’s the first thing I did. I visited every part of the value chain in the hospital. I found a caring, compassionate staff, working in incredible dysfunctional systems.
After my visits, but early in my tenure, I discovered a PowerPoint that had been presented by the medical staff to administration about nine years before I arrived, and found confirmation for the PowerPoint requests. Ruing my first conversation with the Medical Director, I talked about my approach to addressing issues at the hospital. After a 20-minute conversation, she told me that “She was over the moon.”
I spent time listening to concerns of medical staff. But I also looked every aspect of operations: Pharmacy, Laboratory, Records (EHR and paper), Billing & Coding; recruitment; maintenance; food service; Information Technology; and our rural delivery systems. I formed leadership teams with a very clear focus. We focused on our patients.
With input, the Medical Director and staff talked about changes needed to increase productivity. They wanted to do that because their patient load was so high, they couldn’t deliver quality care. Overflow patients often had nowhere else to go because we were the only provider in a huge area. It did not take long for them to buy in because I let them know that my role was to teach, coach and mentor the team into providing outstanding care.
And the PowerPoint? It addressed issues like hiring medical assistants (we had only one for every five FT providers); a poor EHR; a severe lack of competent IT support; and a host of others. We laid out a strategy with key executives to address each issue through Kaizen. By addressing support issues for medical staff, they said they could increase productivity by about 50% without compromising the quality of their interaction with patients.
I was learning the concepts of Humble Inquiry at the time, and had a great chance to practice during my introduction to this organization. I didn’t issue mandates. I listened and reviewed what information was available to me and let our medical staff know that the time they spent with patients was their time. My goal was to create more of it by addressing every issue of support.
It takes a long time for us as executives to learn what our role is as leaders, strategic thinkers and chief relationship officers. Opening and keeping lines of communication open are critical. When that is lost, you can only struggle to do the best you can, but systems tend to deteriorate when communication breaks down. One of the goals of a process, articulated by Steven Spear, is to facilitate flow though unambiguous yes/no communications. I use that goal when analyzing any process. It helped me break down barriers with medical staff. A simple question for me, for example, was could the addition of more medical assistants improve patient care? From my discussion with the Medical Director, I learned in the first 20 minutes that they were doing their own administrative work every day, and that we could make hours a day available by allowing them to offload work to medical assistants. Make sense? Yes. To both of us.
It’s harder to visit the workplace, walk the processes and value streams, analyze pathways tighter with the involved staff and invest wisely in what helps staff do their job. And it’s a difficult balancing act to work with a pull system that is dysfunctional, but believes its doing a good job. For an executive, there are so many moving parts to consider and improve that you risk relationships not only with the medical staff, but all of their supporting processes.
Without an experienced coach, teacher and mentor, an executive new to Lean, especially with a lay board of directors, has to walk a complicated minefield. Good guidance is important. With eight years of successful Lean executive and strategic leadership, I still had to think and analyze a multitude of decision points every week. I made it easier on me by involving the people working in those systems do that for me where I could.
What Patrick describes is more difficult than just giving orders from on high or just demanding higher levels of productivity. But, it’s also a more effective approach. What do you think? Can you emulate Patrick’s approach, regardless of your level of leadership?
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