Mark's note: Today's guest post is from Tony Manos (bio at the end of the post):
I was talking with a hospital CEO last week and we had a very wonderful conversation about all the great changes going on at her facilities. I was curious to get her opinion on a specific point. I asked her “Why aren't more hospitals and healthcare organizations embracing Lean?” As we all know there are some exceptional healthcare organizations that are doing wonderful things by utilizing Lean techniques and more importantly, Lean thinking. Many more are starting their journey, but why is it that for the most part, healthcare as an industry isn't moving faster with Lean?
Her basic reply was that healthcare tends to be reactionary. Many times things aren't put into motion until rules are imposed upon them. Take the recent insurance reform enacted by the federal government; there are many aspects of the changes that aren't very well defined and won't be imposed for years. Why would you work on improving something if it is just going to change later? Another aspect of her answer included that if you are so busy doing what you are supposed to do there is no time to add new things. I was very intrigued by this.
In order to frame the amount of effort I have encountered to move organizations along on their Lean journey I would say (half jokingly) “If you think it is hard to implement Lean on the shop floor than go to the office and it will be ten times harder.” Not because the concepts are hard to implement in an office or service setting. It is harder because of the people (meaning the resistance you may first encounter).
Then I would say “Try doing Lean in healthcare, it is ten times harder than that.” Once again, not so much about the concepts, I think it has to do more with the resistance to change. Then for fun, I say “Try it in Government, it is ten times harder there.” For my final nudge I say “Try it in Education; I don't have a scale that goes high enough.” Once again, this is just to give people a feel for what they might encounter.
I'm not saying that it is 100 times harder to implement Lean in all hospitals than it is on the manufacturing shop floor; that would be missing the point. Just realize that with the time and experience we have implementing Lean on the shop floor is much greater than in other areas. I remember seven years ago helping a hospital with their Lean implementation and they asked if there was a DVD they could watch for Value Stream Mapping. Of course at the time, there wasn't. What I realized then is that many organizations just want specific answers to their specific problems. They weren't willing to learn and apply Lean thinking, tools or techniques. I still run into this today.
Another way that I used to look at it is that healthcare was always about ten years behind manufacturing when it came to adopting new methods. Do you remember the 1980's? The big three automotive manufacturers realized that they had to improve the quality of their cars. There was a big push in general for all manufacturers to improve their quality. I noticed that it took about a decade for healthcare to grab this concept. Then in the 1990's many manufacturers starting Lean or maybe even six sigma programs. Where is healthcare now? They are lagging even farther behind accepting these ideas.
So my general conclusion is that we are not going to change healthcare overnight (contrary to what the government says). They will adopt Lean at their own pace. I just hope we can help them do this sooner rather than later.
Tony Manos is a Catalyst with Profero, Inc., where he provides professional consulting services, implementation, coaching and training to a wide variety of organizations, large and small, private and public, in many industries focusing on Lean Enterprise and Lean Healthcare.
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