Today's post is an addendum from Saturday's post on the apparent death of a health system Lean program: “Why Would a New Healthcare CEO Kill a Lean Program?”
If you read that post, there's an interesting comment from a Presence Health employee that doesn't shed too much more light on this:
“From the standpoint of a current Presence Health Employee~ my opinion is that the RIEs failed because they were aggressively site specific. At a time when Presence Health is “Becoming One” I do not believe the RIEs took the entire ministry into consideration when planning events. Decisions and “experiments” where being made and conducted through a site specific lens, and this was often in contradiction to the spirit of the new organization.”
As I commented in response, I'm not sure why a goal of common processes or a health system that's actually a system would be a reason to stop with Lean. Unless hopefully they are really just re-booting the effort instead of killing it altogether.
As I alluded to in the post Saturday, there was a sad story about a hospital that I featured in the 2008 1st edition of Lean Hospitals that basically killed their promising program when a new CEO was hired from the outside. As Adam Zak, one of the top Lean-focused executive recruiters said, it's a shame that the board (apparently) didn't hire a CEO with Lean experience.
— Adam Zak (@LeanRecruiter) May 1, 2016
Looking back at my notes from 2011, one hospital leader at this other hospital said, basically:
- Even though there was progress in the lab and with ER design, “management was not leading with Lean principles.”
- “We never did anything with it,” she said (I think meaning that they didn't build upon the initial early results that were somewhat isolated instead of being a hospital-wide initiative)
Another middle level leader who was deeply involved with Lean said:
- Lessons learned? There's a risk that comes with leadership changes.
- She asked, “Is it worth even trying at a departmental level if senior leadership isn't on board?”
- The CEO needs to want it as a culture for the organization, not just for improving departments.
- “Lean has become a dirty word” around here, she lamented.
She also said, in a different conversation:
- We abandoned things… (meaning Lean principles)
- Every single department director has changed, CEO has changed. Some aspects of LEan they are doing maybe, but not keeping up with data, except for the lab.
- Not using the “Lean tracks” in the E.D. anymore (this was a “split flow” design)
- Kanban system in the O.R. was falling apart.
- “It's really all about leadership. It's not about the workflow, things will go down the drain without leadership support.”
That's all really sad. It goes to show that early progress doesn't always turn into an organization-wide culture change and Lean transformation.
I had titled the section about the hospital as:
“The Beginnings of a Lean Enterprise”
I guess there was a question mark. It sure seemed like it had been heading in that direction.
The corporate VP for Lean had talked about their “no layoffs due to Lean” commitment:
That was a good sign.
They had improved the E.D. significantly:
And they anticipated that the use of “Lean Design” methods (and they were early adopters of this) had made a huge difference:
They didn't just “design” it Lean – they built it using these designs that engaged staff in understanding how to build smaller spaces (thereby reducing costs) that worked better for everybody involved.
In reading what was in the book, it becomes clear that the hospital was using projects as a way to improve. Many of these were 12- to 16-week projects that really transformed a department, not the typical week-long Rapid Improvement Events. The consulting group I used to work for, ValuMetrix Services as part of J&J, helped lead these projects and helped teach Lean methods and Lean management (that was one goal of these long projects… to not just do stuff, but learn how to manage differently).
That said, the method didn't spread quickly enough or high enough. After about three or four years, the whole Lean approach was disowned when the new executive leadership came in. The corporate VP of performance excellence got it… but it seems that the executives and the board weren't impacted, educated, or involved enough as they had been at systems like ThedaCare and Virginia Mason Medical Center.
I wonder how many stories are out there like that today… a promising Lean program that won't survive beyond the first few years… and what the right countermeasures are?