I recently blogged about a healthcare improvement job posting that had me scratching my head when the interviewing process included an process improvement exercise that specified NOT talking to employees or patients.
Today, I'm blogging about another job posting that was sent to me by somebody I know at a children's hospital. Again, I don't want to name names, but this is a hospital I know well and have done some successful Lean work with.
But, even with that departmental success, the hospital has had, I think, four different directors or VPs of process improvement over the past decade. They've used Lean, Six Sigma, and every combination of those ideas. But, nothing (and nobody) seems to stick. And it seems executives are more delegating improvement and culture change than directly leading it.
I'm not sure if this job posting suggests a new, better direction, or just more of the same.
It's a “senior director of process improvement” role for the population health part of the organization (so it seems NOT to have the entire health system for its scope).
“The position will leverage prior health care industry experience in applied PDSA, Six Sigma and Lean concepts to develop and implement operation process improvement initiatives aimed at achieving outcomes of better care and better health at a substantially lower per-capita cost.”
The goals seem right… not just lower cost (since Lean is more than that), but also better care and better health.
Note that it says “prior health care industry experience.”
Yup, as it says later:
Process Improvement within the Health Care Industry, required.
PDSA Cycle within the Health Care Industry, preferred.
I think it's unfortunate when a health system limits their search to those who are already inside the healthcare club. So let's say an experienced Toyota leader decided to retire… the hospital wouldn't consider them? I can understand valuing healthcare experience, but filtering out outsiders before even having the chance to interview them is a wasted opportunity.
Does a healthcare process improvement person NEED to be an expert in healthcare? No, especially when that Lean leader knows how to work with others – the key stakeholders and the experts in doing the work. A skilled Lean facilitator teaches and coaches others on the improvement PROCESS rather than being the expert with the answers.
An experienced Lean person from another industry could collaborate in ways that are listed in the posting:
“They will work collaboratively with multiple internal and external provider and community groups, including healthcare providers, social service providers, business and industry leaders, governmental agencies and other community coalitions. This individual will effectively engage multiple stakeholders within the system, evaluate data from multiple sources, and keep children and their families' perspectives paramount in opportunities in process improvement.”
The right candidate, even an outsider to healthcare, would certainly be customer focused as a core mindset.
I've seen too many health systems, sadly, screen out really good candidates who had no healthcare experience. Does that mean EVERY outsider can navigate the healthcare environment? No, but that's what job interviews are supposed to be for… not resume screening.
Lean or Six Sigma or Whatever
The posting seems really confused about what methods they are looking for. Even after more than ten years of various process improvement projects and leaders, it seems they don't know what methodologies they support or expect to use. They REQUIRE “process improvement” experience in healthcare but also PREFER “PDSA cycle” experience in healthcare. That's confusing too.
Is Lean not PDSA at it's core? Toyota would say so (even if they use the term PDCA… it's the same idea).
As I quoted above, the posting asks for “PDSA, Six Sigma, and Lean.”
The posting also calls for:
Black Belt Six Sigma Certification, preferred.
Again, that would rule out an experienced Toyota person (or myself… and I don't think the person I know at the hospital sent me the posting because they wanted me to apply for it). I'm sort of technically certified as a a “Lean Black Belt” from my days at Honeywell, but it's not a Six Sigma certification.
I gave some feedback to the person who sent me the posting, suggesting that the Six Sigma preference might scare off some otherwise good candidates.
I asked what methodologies their leaders support and was told:
“I believe we are committed to a balanced approach whereby we have a portfolio of tools and use the one most appropriate to fit the situation.”
My concern about viewing Lean, Six Sigma, etc. as “a portfolio of tools” is that approach often gives the appearance of progress (through improvement activity), but it doesn't seem to lead to much sustainable change.
Toyota would, of course, not portray Lean as a bunch of tools. Lean is not just “process improvement.” It's also a management system and a philosophy, as their people explain. When Lean is most successful and sustainable, it's part of a culture change that's LED (not delegated) by the CEO and other leaders.
The posting does reference the idea of “philosophy” and “practice” – but how much can a mid-level change agent influence the culture?
Proactively integrate the philosophy and practice of continuous quality improvement to meet desired goals and metrics across the system.
Where Does Culture Change Come From?
Much of the goals in the job posting make it seem like executives expect this single mid-level person to change the culture. This senior director appears to not have a team or any direct reports. An individual can run projects and get input from others, but can they really change the culture?
Some of the “specific knowledge, skills, and abilities” for the candidate and role include:
- “Use appropriate interpersonal styles to establish effective relationships with customers and internal partners; interact with others in a way that promotes openness and trust and gives them confidence in one's intentions.”
- Interact with others in a way that gives them confidence in one's intentions and those of the organization.
If I were interviewing for this job, I'd ask how the executives I'd work for promote “openness and trust.” How much is that a part of the culture already? Do executives give employees confidence in their intentions?
- Establish and commit to a long-term business direction…
A long-term focus is classic Deming thinking. Taking the long-term approach is POINT #1 of The Toyota Way management philosophy. It's listed first for a reason. Many organizations copy Lean tools, but it seems not many try copying long-term focus.
I'd be curious to ask executives how THEY practice and promote long-term thinking.
- Vividly communicate a compelling view of the future state in a way that helps others understand and feel how business outcomes will be different when the vision and values become a reality.
I'd also ask if executives do a good job of leading by example on that front.
- Demonstrate a poised, credible, and confident demeanor that reassures others and commands respect; convey and image that is consistent with the organization's vision and values.
That one phrase would give me pause. What's the view and mindset of the executives in this health system. Do they “command respect” (thinking they are entitled to respect) or is respect something to be earned and given to you through others?
Oh, and the job is listed as being “sedentary:”
Sedentary – Exerting up to 10lbs. occasionally or negligible weights frequently; sitting most of the time.
Does the system expect this person to be in meetings most of the day, instead of being out at “the gemba,” actively working with people? I wouldn't expect to do a ton of lifting, but I'd expect to be standing and walking a lot… not sitting.
What Do You Think?
I wrote about this job posting on LinkedIn and got a lot of interesting responses.
Some comments included:
Only a fool would take the job. Zero chance of success.
Command respect? Does this job come with a cattle prod?
Untenable position. Barbed wire canoe, up a mucky creek, without a paddle comes to mind
Unfortunately the mentality shown in this job description is FAR more common than the Lean Leadership we all know SHOULD exist. This is one reason so many of us who love the Lean methodology/philosophy find ourselves as the first ones out the door when an employer's finances go south. I've talked with FAR more Lean professionals who find themselves going job to job – including myself- because the Leadership either doesn't get it or doesn't want to. Either they decide to leave or they're shown the door. Bottom line – we have to work and so we sometimes take these less than desirable jobs because we have to pay the bills.
I'm finding more and more job postings which are very similar, making the requirements of what is generally reserved for higher level employees for lower level employees. Unfortunately, they will find someone who isn't quite as qualified to do this job and they will meet their end game which is to pay someone at Director level rather than at senior executive level. They'll find some over zealous, over confident professional to take this on who will probably fail.
This is a good one, thank you! It is interesting how organizations post positions that require candidates to meet expectations that are at least 1 level up, while the current workforce function 1 level down. The disconnect is so significant and the team becomes dysfunctional. Respect is earned, not commanded. The leader must possess emotional intelligence and executive presence, to say a few, in order to be respected.
The lean support role has an obligation to communicate and positively reinforce lean behaviors which requires us to not just “do all the lean work” but to ensure the culture understands and executes creating a lean culture that lives with the people on the floor. If something else is “commanded” it will fail as you know. I've left a lean role because of this expectation and continued unhealthy behavior of senior leadership. There was no other alternative. Although I really learned how to manage up with that experience and I'm so grateful for that. In this case, HR, who writes the job descriptions and senior leadership, who has a misunderstanding of a lean support role have an opportunity to align. I wonder if you could interview for this role and provide this helpful feedback for them?
I don't think I'd waste their time by interviewing for this, as it's very unlikely this is a job and role I'd want to take. I did offer, through my contact, to talk to the hiring manager (I don't know who that is or their role) to give free feedback and advice. That was about two weeks ago and I guess they aren't taking me up on that offer. I'd like to help because I respect the organization and their mission. They have a lot of great people (and patients) who would benefit from better processes and a better environment. I just don't think that role could really create that difference.
I find it interesting that healthcare leaders seem a little confused about leading. I would think the director level is operationalizing the leadership direction. Seems a bit backward.
There is a disconnect there about the organization's vision. Seems like that needs to be further developed before letting the process improvement leader loose to define and operationalize it.
I think that your initial assessment was right on the money. Senior leadership does not want to take responsibility for the culture. Things like HCAPS scores (the customer is always right) are strangling the professionals and creating new problems and roadblocks to an industry already in crisis. Whatever the metrics were intended to illuminate and solve, they are not getting the job done. The message is essentially confusing in healthcare; what is the mission? Profit, efficiency, appropriate and compassionate care? Regardless of philosophy, these goals are in constant conflict in reality. We will need real leadership to find the way forward.
Mark, after reading this, I feel your pain. My experience, especially in non-profit healthcare, is that senior executives either don't know how (more common) or aren't willing (least common) to do those things and believe it's best to delegate to “underlings” to execute. It's also part of the problem of accountability in healthcare. Senior Executives should breathe the value, exhibit the behaviors and hold those accountable to the same. That's hard, especially when boards don't hold executives accountable (non-profit). Probably much more to say on this topic. Just wanted to say to you, thanks for your bravery in your posting.
I hope that “bravery” is helpful to somebody. I know I'm being critical. But, I'm also frustrated that I've offered to help, as a member of the community, and apparently they don't need or want the help.