Lean Healthcare

Crossing the Chasm of Lean Transformation, Part 1

By Jon Miller Published on December 30th, 2005

A friend of mine who is a VP of Operations at a Midwestern hospital asked me two questions a few days ago. The first was “What is the percentage of Lean implementations that fail?” This is a loaded question, and not one for which I have a ready answer. If anyone has done the research and has the answer to this question, please share it with us.
The second part of her question was “Do most organizations have a centralize office or a person overseeing Lean efforts?” Combined, these questions indicate that her organization is standing at the brink of failure or success, deciding about crossing the chasm of Lean transformation.
Her question helped identify something about Art Smalley’s article that was nagging at me. Art Smalley made a good observation in his article that it’s not about using tools, it’s about developing people and focusing on what make you money that makes Toyota as Lean and successful as they are. This and his many other points I agree with, but somehow his comparison of the Toyota factory in West Virginia with the rest of the manufacturing world attempting a Lean transformation did not fit for me.
The expression is a bit overused in management literature, but I think “Crossing the Chasm” is appropriate to describe the situation many organizations (including my friend’s hospital) attempting to implement Lean find themselves in. The process of Lean transformation is to change the culture of the organization into one that believes in and works towards continuous improvement of profitability by developing people and processes. In the case of Art Smalley’s article the chasm is between companies who think Lean is about applying the tools of Lean and those who make problem solving and working towards cutting cost to improve profit part of the fabric of management.
In the case of my friend bringing Lean to her hospital in the Midwest, the “chasm” is that between companies using Lean specialists, kaizen teams, and “centralized” Lean promotion offices to those companies where Lean has truly become “the way we do things around here” by having kaizen be “decentralized” or persistent and pervasive as part of the company culture. As “crossing the chasm” indicates, we think you need to start with one and advance to the other.
Art Smalley’s Toyota factory in West Virginia has crossed this chasm, long ago. Most of the rest of us are still trying to evolve from event-driven, tool-focused, “show Lean” to making the elimination of waste a daily habit for everyone. While Art Smalley’s article did a great job of raising the issue of the need for organizations to cross the chasm, the question of how to get there is not addressed, and leaves the reader feeling mistaken for implementing Lean tools but not the Toyota culture.
The “event-driven” Lean, the “value stream map everything” approach has come about partly because in the absence of Toyota telling us in a detailed way how to get Lean, authors and consultants have filled the gap. This is not necessarily a bad thing, when it is effective. But by itself it has not proven to be sufficient so voices like Smalley’s are important.

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