There have been over 125 comments so far… but one has me scratching my head.
“I looked at deploying Lean within our PNO, and ultimately decided against it, in part for two reasons:
- because Lean is about doing the same thing, albeit better and
- it is not as much customer/outwardly focused as we need in healthcare.”
Lean is not customer/outwardly focused? I hope this isn't a widespread perception or belief out there. I hope I'm overreacting to something that's not really a problem… but I wrote the post anyway.
I think PNO means “Provider Network Operations” in this context.
The person who posted the comment is a “President, Medical Group & SVP, Chief Strategy Officer” of an East Coast health system according to LinkedIn.
They don't list any Lean training in their profile. They don't have any color of “Lean Sigma Belt” certification. Maybe that's good since I'd hate to think their comment was something that came from training or education they received. Their comment comes from ignorance, I'd say.
It makes me wonder how much research and learning they did while “looking at deploying Lean.”
Did they read any book about Lean, yet alone my book Lean Hospitals?
Even if they just read the free preview chapter, the word “customer” appears ELEVEN times.
As Dr. Beverly Rogers wrote in a blurb, in part:
“Lean Hospitals is a foundational text for understanding the concepts and application of continuous process improvement in a healthcare environment, and provides practical guidance and concrete examples to eliminate waste and increase value to the customer.“
As we say in the Lean methodology, value is defined by the customer.
More than 20 years ago at GM, I learned from our Toyota-trained plant manager that our focus was on improving quality for the customer, improving on-time delivery for the customer, and reducing cost for the customer.
CUSTOMER CUSTOMER CUSTOMER
In the first chapter, I wrote:
“Because every type of organization — including health systems — should be concerned with issues such as safety, cash flow, customer satisfaction, and quality…”
Yes, Lean is about the customer. The book The Toyota Way uses the word customer 248 times, including:
“Long-Term Philosophy. Toyota is serious about long-term thinking. The focus from the very top of the company is to add value to customers and society.”
“This is why TPS starts with the customer, by asking, “What value are we adding from the customer's perspective?”
Toyota works hard to understand customer needs in deep and meaningful ways. The Toyota Way has stories about engineers going out into the real world to see how customers use minivans and other vehicles in daily use. That message of “get out of the office” and understanding customer needs comes through loudly in The Lean Startup or any other good book about Lean.
Even Toyota's free website on the Toyota Production System makes this customer focus clear. The Lean Enterprise Institute's “What's Lean?” page makes this clear too.
- Customer first; provide customers with what they want, when they want it, and in the amount they want it
- People are the most valuable resource; Deeply respect, engage, and develop people
- Continuous improvement (kaizen); Engage everyone each and every day
- Shop floor (gemba) focus: Go to where the work is done to find and solve problems
Lean is not just about looking at the details of your work and how you do things. It starts with understanding and meeting (if not exceeding) customer needs.
Back to my book, I tell a story about a hospital lab working to better understand one of its “internal customers,” the emergency department:
“As another early step, the lab's leadership initiated discussions with internal customers and learned that particular tests were deemed crucial by the ED for the sake of prompt diagnosis and improved patient flow. They were sometimes surprised to learn that tests the lab thought not to be time-critical were, in fact, considered to be so by the ED. It became more important to the lab to improve the relationships with those who ordered tests and used test results — a key part of the customer- and patient-focused Lean approach. With this better customer understanding, success would be defined by their customers' needs rather than being defined within the lab and their assumptions.”
The E.D., of course, is focused on the end customer – the patient.
There's another example, again from laboratories:
“In another example of better understanding customer needs, the lab had been having difficulty meeting turnaround times for complete blood count (CBC) tests with what's called a “manual diff.” The lab was “killing ourselves” trying to improve turnaround time performance. The ED told the lab that the only urgent part of the result was the basic CBC, not the more time-consuming manual diff counts. As the ED explained, “We don't need that right away; we can wait on the manual,” so the lab focused their improvement energy on areas that would more directly benefit their customers. The full-time project team learned and used the analysis methods outlined in Chapter 4 to trace the flow of testing work from specimen collection through the reporting of test results. As in most hospital situations, the flow moved across multiple roles in many different departments. The team focused on improving the overall flow rather than looking merely to optimize their own departmental definition of success.”
Back to the uninformed LinkedIn comment, there are many reasons, I guess, for someone to not embrace Lean. “It's not customer focused” isn't one of those reasons.
The other part of the comment, about Lean being only about doing what you're doing better… I guess they also didn't get exposed to anything about “Lean Design” efforts where we sometimes radically redesign our spaces and workflows when building new facilities.
Or, they didn't learn about the idea of using Value Stream Mapping or Rapid Improvement Events as a structure for reinventing how work is done.
It's frustrating that a lot of material is out there about Lean, the Toyota Production System, and customer focus, but what can you do when some people choose not to learn?