Today's reader question comes from somebody who has been put in the position of what I call “the lone wolf” in a health system. This happens a lot. A health system hires or designates one person to be “the Lean change agent.” It doesn't matter how amazing and/or experienced this individual is… I'd very skeptical about the organization's Lean journey.
That's not the fault of the lone wolf. The organization is putting the lone wolf in a bad position. They're often not being set up to succeed, unless perhaps that lone wolf is joined at the hip with the CEO (and I rarely hear this happening).
The question came in via email… I'm going to chop it up and make a bit more of a dialogue than it was in our exchange.
“Hi, I'm the LEAN facilitator at [redacted health system]…”
Hi, nice to meet you… you don't have to put LEAN in all caps, as it's not an acronym, but let's get to the more significant issues. :-)
I'm sorry that you're the only facilitator. That's a really tough position to be in. I hope I can help.
OK then, I am currently implementing a
LEANLean Daily Management system within the hospital. I am following the model outlined in Brad White's book where the departments begin huddling and sharing information.
That's great. I saw some of Brad's early work in San Antonio when I lived there. You might want to check out the podcast I did with him about his book:
I don't think I've ever seen a “Lean facilitator” go “implement” a “management system.” I think a facilitator can, at best, teach, coach and…. facilitate. If you look at the example of Kim Barnas and ThedaCare's hospitals, look what she led there, as documented in her book Beyond Heroes. I also did a podcast with her, by the way. Kim was at the hospital president level. Yes, they had Lean facilitators and outsiders they would readily call “sensei.” But Kim didn't delegate her responsibility. She led the push and the drive for Lean Daily Management, along with other executives.
What's the situation at your health system?
In our approach, “quick wins” are discussed and implemented.
Great, I'd call that “Kaizen” — a very important part of this complete, nutritious management system.
I coach the leaders of the units to listen and respond efficiently to the staff needs. All of this works well until the next phase in which front line staff are coached to identify inefficiencies and develop metrics. The staff are very engaged and understand what is needed.
Great, I hope you're also coaching the unit leaders to not just respond (which sometimes means “give answers” and “implement solutions”). Responding is better than ignoring staff concerns. But, better yet is a system where we get employees thinking to come up with solutions or countermeasures to test. And, leaders can free up time for staff to work on testing and implementing changes to see if they are indeed improvements.
It's also very helpful for staff to understand the key metrics or measures that they should help improve (as much as they can improve them by continually improving the existing system). Sometimes, the system needs redesigned or reinvented, and that drive usually comes from leadership, since those are big, complicated changes (like ThedaCare's development of Collaborative Care or their new care model in primary care). Those weren't driven by a front-line staff idea… those were strategic initiatives.
Back to your story and situation…
However, this is a point where leaders must change their approach and embrace participative leadership. I am blocked every time despite how much coaching I provided. Administration supports Lean…..but is not to the point where they are willing to round on boards, etc. How do you overcome this issue? In some instances the staff is demoralized because they are excited about the journey and then instantly realize nothing has changed. Help!
I hear this lot… administration says they “support Lean.” What does that mean? That they made a statement one time? Are they giving lip service to Lean? Or are they looking in the mirror and realizing change starts with them? That they can't delegate culture change?
Are they “supporting Lean” or “actively engaged in Lean?” Are they “practicing Lean?”
If leaders aren't willing to go round on boards (and, better yet, round on the people and spend time out there at the gemba beyond a short huddle), then are they really “supporting Lean?” Are they doing enough?
If you can't get them to read a book like Beyond Heroes, if you can't inspire them to try something new, I don't think I can help from the outside. I don't have any magic beans or hypnotic powers.
I understand some employees being demoralized (not to mention the “lone wolf” feeling that way). I don't blame them. If the executives aren't motivated by reports of employees being demoralized, maybe there's no hope?
Maybe the best a “lone wolf” can do in this situation is work on some local projects that make a difference and forget about organizational transformation? Or find a new job where leaders WANT to transform and are willing to lead it (with some help)?
I am a nurse who is a self-taught Lean Facilitator who could write a book on Lean Strategies that fail….LOL.
I'm glad you still have a sense of humor about it, or maybe it's “gallows humor.” That's one way to cope.
I wonder if your situation is like the old TQM failure scenarios?
Being a lone wolf is hard… being asked to be a self-taught lone wolf is even more difficult.
One lone wolf I met once… she was brought in from the project manager function and she told me, “I got told I'm in charge of Lean Sigma, so I figured I'd better go find out what that was…”
It's one hypothesis to think that she could succeed… but I'd guess it's unlikely (which isn't her fault or yours).
Yet….my organization treats me like I have invented the light bulb. I do have a lot of support, but I am reading so much information that what I know now, may change in 6 months. I really want to make Lean Daily Management happen for the organization without shoving it down Director & Manager's throats.
You can't shove anything down the throats of people… nor can the CEO, when it comes down to it… questions like that are one reason why I do this change management simulation and workshop.
But it's hard to convince people they need the workshop (or a better approach to change leadership). I'm in no position to shove anything down anybody's throat either.
But back to your scenario, I bet my readers have some advice that might be more helpful and less cynical.
How much leadership “support” and involvement do you really need? What's most helpful? What's your advice to the lone wolf?