Why Lean? Start from Need!
I'd bet one that one of the greatest indicators of success for a Lean effort is tied back to the original question of “why are we doing Lean?”
Taiichi Ohno, one of the inventors of the Toyota Production System, always said “start from need.” Great advice to this day. “… doing Lean” is something I almost hate to say, since “doing Lean” isn't the point. For the Toyota, the point is to make money in the long-term and to serve their societal purpose. The same should be true for hospitals (“no money, no mission” as many would say).
If your hospital or department can't articulate why they are “doing Lean” (again, I cringe at the phrase), it's probably a sign of trouble.
Bad reasons for Lean might include:
- The hospital down the road is using Lean
- I heard about Lean at a conference from a famous hospital
- My boss says I need to use a process improvement strategy
Even if you have slightly better reasons, how do you measure success? If your reasons for Lean are along the lines of “we need to get better” is that need for change “nice to have” or “must have?”
I'd propose the following are some compelling reasons for you and your team to fight to make your Lean efforts successful, because they are tied to organizational success:
We are having to cancel surgical procedures because pre-admission tests aren't getting done on time. We're losing a ton of money in the process and angering the surgeons, who threaten to take their patients elsewhere.
We don't want to spend millions to build a new laboratory, so we'd rather make more effective use of the space we DO have. Oh, and we also can't attract enough skilled medical technologists to our small town, so we really need to improve productivity and reduce stress so the techs I *do* have don't get frustrated and quit.
We desperately need to reduce central line infections in the ICU because it's the right thing for our patients and our hospital suffers a financial loss when an infection occurs.
Our primary care clinic is losing money and we need to improve service (reduce waiting times) to attract more patients or get more productive so we can cut hours and not spend as much on labor.
Outpatients wait for 15 weeks to get in for an MRI; we are losing business to competing hospitals where the patient's care won't be as good… our hospital loses the opportunity to provide care that comes after the MRI and the diagnosis.
When situations like those above are “must have” to the organization… then you have a fighting chance, a “burning platform,” if you will, for driving change.
If the goal is focused on implementing Lean tools, such as “our goal is to do 5S this year throughout our ancillary departments” or “our goal is to run XX kaizen events” then you're probably less likely to make an impact. You can probably “do without” 5S, so the incentive and drive to make that work than if the problem statement is “A patient could have been harmed because we couldn't readily find suction tubes when they were needed… so by implementing 5S, kanban, and standardized work, we'll make sure that NEVER happens again.”
If you're “struggling with Lean”, you might ask yourself if you're struggling with identifying and defining the right problems… the right needs, as Ohno would say.
What are your experiences with this?