This is a companion post to yesterday's “3 Reasons the General Public Thinks Hospitals Can't Improve.” Lean zealots often take for granted that, not only does Lean work, but that people want to improve.
Before we dive into teaching people Lean tools and Lean management methods and Lean thinking, I think we should step back and ask some more fundamental questions.
These questions are:
- Do we need to improve?
- Do we think we can improve?
- Do we think Lean is a methodology that will help us improve?
Years ago, I would often default to starting with question #3, or at least starting with trying to convince healthcare staff, leaders, and physicians that Lean is the way to drive lasting, sustainable improvement.
But I learned other more fundamental questions or concerns would get in the way.
1. Do we need to improve??
Many organizations and the individuals within would often answer “no” to that question without thinking. I recently heard one hospital leader say “we were getting all of these awards, and I don't know why.” When hospitals rely on benchmarking comparisons and Top 100 lists, it's easy to think you're the best of the best when you're really the (I really feel awful typing this, but I've heard many Lean hospitals use it) “cream of the crap.” Being better than your competitors and benchmarks should be no consolation when you all have the same systemic waste in your systems and processes. Another healthcare leader I know called it “delusions of excellence” (again, I feel like a jerk typing that, but it's their words, not mine).
Now let's say you can get people past the “we need to improve” hurdle. You have to ask the next question:
2. Do we think we can improve?
Many organizations and the individuals within might recognize the need to reduce hospital acquired infections, but they might think it's a mission impossible. They might be cynical and discouraged after previous improvement programs that didn't make improvements or didn't make lasting change. People might see the gap but then think it's hopeless, the idea of closing the gap. If you didn't get hung up on Question #1, you might get tripped up on Question #2. “Yes, we should try to get better, but anything we try won't work, so let's not try” — that's a unfortunate mindset when you find it.
3. Do we think Lean is a methodology that will help us improve?
Now if your organization or leaders are arguing the finer points of Lean or Six Sigma or other methods, you might have already won the battle of Questions #1 and #2. Question #3 is pretty much what this blog is about, so I won't go making the case that Lean works and that, specifically, Lean works in healthcare. Or, I should say, it CAN work. Success with Lean is not guaranteed – as attitude and leadership are the most important factors, not your ability to learn Lean methods. As some say, Lean isn't that complicated, but it IS very different.
What do you think? Have you run into problems with Questions #1 and #2 with your organization or with your clients?
For those readers who aren't in healthcare, do you struggle with those questions in your organization?
How do you get the answers to #1 and #2 to be “yes”?
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