I was asked an interesting and thought-provoking question the other day:
“Are there any hospitals where you'd suggest not trying to adopt Lean or situations where it might be counterproductive or harmful?”
This question came from a PhD management professor who was, in my estimation from his comments, somebody who thought Lean was a bunch of overhyped hogwash. He kept citing studies that “prove that Lean doesn't work in healthcare.” Any time I talked about the reality I see and experience (admitting the risk of “confirmation bias”), he kept asking me for studies that proves that it works. He was asking the wrong question. I can prove that Lean “does” work or “can” work, but that's it.
I'd readily agree that Lean is not easy and that many organizations aren't capable of meaningful Lean adoption or transformation. Attempts at Lean don't always lead to measurable or sustainable success, but that's often due to the attempts being half hearted and superficial – a few tools or projects here or there – instead of a sincere attempt to change the culture and the management system. The idea that Lean often “doesn't work” doesn't mean that “Lean never works.”
So back to his question. Here's a scenario that I thought of in the discussion that would probably be harmful or counterproductive.
Let's say a hospital starts giving Lean training to employees. Maybe they are running a few Rapid Improvement Events. But, let's say the CEO and senior leaders aren't learning or participating. They think “that Lean stuff is common sense” and they think Lean is somehow about fixing the front-line employees.
In a likely scenario, if they have hired or brought in a capable trainer / consultant, they are going to be talking about aspects of Lean culture that make a huge difference. The consultant(s) might encourage employees to start pointing out problems, to speak up about quality and safety risks, and to try to shake up the status quo.
It's very likely that the CEO and senior team aren't on board with that. From the Lean training, a nurse is inspired and emboldened to point out a near miss or an error (it's likely, in an organization that has a very broken culture as a starting point that many employees would be too afraid to take a chance by speaking up).
If the CEO and executives react badly, in a “Non-Lean” way, such as blaming and punishing the individual instead of looking at the process and systems, there's career harm, financial harm, and psychological harm that might occur to that nurse. Trust is further eroded, staff get more cynical as stories spread about that nurse being blamed or punished or fired as a result of speaking up.
A scenario like that probably leaves the organization worse off than it was before. Is that Lean's fault?
If you don't have a minimal level of trust in the organization, can you (should you?) even try to do anything with Lean? If the executives aren't humble and engaged and willing to learn and participate, should you even try?
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