Lean in Hospitals: Running Free vs. Coordinated Efforts

There’s a choice to be made in how hospital leaders approach implementing lean: either let lean run free or force lean efforts to be coordinated.

In the ‘running free’ approach, power is distributed to departments and groups to make improvements => the on-the-floor experts focus on their issues and make changes that allow them do the right things, the right way.

People are empowered to change their environment. Lean becomes incorporated into the culture and mindset of the hospital staff. Change and efficiencies are realized where the rubber meets the road.

Hospitals have a history of this approach, based on the theory that since change is so hard to accomplish, small changes anywhere are sure to make the situation better.

But is that really better? This uncoordinated approach can lead to waste-shifting rather than waste-elimination, and the voice of the customer is very easily lost.

While small teams work in their silos, patients flow through the entire system, using resources at almost every level. The lack of coordination minimizes each Lean accomplishment because the work is isolated in the individual environment, leaving the patient to work around the inefficiencies of a non-systems based approach.

It makes me wonder if instead, leaders should begin with goals derived from the ideal patient experience, and then work on Lean projects that produce strong, standardized processes across the hospital or hospital system.

Hospitals/healthcare is the slowest industry to change, so we can learn a lot from manufacturing.

What do you think? Should we focus our efforts in a coordinated manner or allow the running free mentality to continue?

Alicia C. Simmer, a senior healthcare consultant with KHC, shares some insights on implementing Lean in hospitals. She runs Lean operational improvement projects for healthcare facilities and new facility planning projects, and she can be reached at asimmer@khcthink dot com.

Ron Pereira
March 3, 2010 - 2:12 pm
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I am not sure if I’ve ever commented on a post on my own blog… but since I didn’t write this I guess it’s OK!

My thoughts on this matter are that I think efforts should most definitely be coordinated no matter if you’re working in a hospital or factory floor making widgets.

But, to Alicia’s point, I have seen SO many organizations approach lean and six sigma with such blinders that they cannot see the forest for the trees.

What does everyone else think?

Oh, and thanks for the great article, Alicia! I look forward to hearing more from you soon!
Sheila Andrews
March 3, 2010 - 9:44 pm
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I tend to agree but also feel that there are situations when any improvement is better than no improvement. So if doing 6S in an area is all that we can expect for this week, this is better than no 6S.
Mark Welch
March 4, 2010 - 7:52 am
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Great post, Alicia, and it prompts a LOT of thought…

I tend to favor a blend of the two. I truly believe management needs to be aware of the current efforts that are going on so they can manage the value streams and avoid suboptimizing, but if the lean culture/effort is too controlled and stifling the day to day lean thinking and problem-solving will be stifled. One way to make this happen is simply to have a good electronic dashboard on a common drive where all lean efforts (reasonably large scope) are posted. I strongly believe in the idea of the Wall of Fame concept in various areas of a hospital not only to keep co-workers informed of the areas in progress/completed, but for the recognition they deserve. Use of a board like this is done in the spirit of day to day problem-solving – the idea of observing an opportunity, attacking it, and fixing it, which empowers and satisfies staff.

I hope my thoughts on this don’t seem wishy washy, but I think if the positives of each school of thought can be maximized and the negatives minimized, a very good system is possible.

Nice post. Hope to see more of your thoughts on here!
Mike
March 4, 2010 - 9:48 am
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Optimizing small areas, can be looked at as optimizing individual cells or even individual value streams. Key take-aways from one cell or value stream kaizen activity may be useful in other cells or value streams. Sharing experiences goes back to implementing standard work. If that sharing of wins and new ideas is stifled, standard work is lost cell to cell, department to department, or value stream to value stream. That’s when you start getting waste-shifting and uncoordination. So put me in the boat that both approaches have to be addressed.
Narayan
March 31, 2010 - 3:07 am
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My thoughts are triggered by Mike’s comment. Is there any standard practice where sharing experience is the focus. Where a worker from some area walks through other areas and shares some thought for improvement that occurs to him, in the other person’s area?
Mark
April 1, 2010 - 1:24 pm
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There have been so many improvement fads in every industry that most management teams are cautious. The health chain I worked for dipped its toe in the waters of Lean Six Sigma before deciding to take the plunge. The small victories that were gained in diverse areas became the justification they needed to incorporate the methodologies system-wide. In this case, it was not an “either/or” situation, but a “this first, then that” approach. I do think this evolution is best, however, rather than efforts remaining splintered. The lessons learned and resources leveraged make a world of difference.