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Lean Healthcare: Q&A with speaker and author Mark Graban

Corepoint Health's annual user group conference offers optional pre-conference training courses designed to educate and improve the attendees' professional IT skills, typically involving health data standards and interoperability. In 2016, we've added a different angle for one pre-conference course that is designed to help customers successfuly and proactively manage change using Lean business principles. 

We invited Mark Graban, an internationally recognized expert in Lean healthcare, and author of the books "Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement" and "Healthcare Kaizen: Engaging Frontline Staff in Sustainable Continuous Improvements." 

If you're attending Corepoint Connect 16 and are interested in learning more about the Lean Healthcare workshop, email us today [1]. The 4-hour workshop will be held from 8:00 am to noon on Wednesday, Oct. 11. 

I reached out to Mr. Graban to ask him a few questions about the benefits and challenges of using Lean principles in healthcare:

How can technical teams comprised of analysts and interface developers benefit from Lean principles?

Long story short… If it’s not benefiting everybody involved, it’s not really Lean. Lean is not a “zero sum game” as we’ve seen with other management approaches. Generally speaking, the adoption of Lean principles should lead to better circumstances and results for customers, employees, and the company – win/win/win, if you will.

A Lean workplace should be more calm and less stressful because the work and customer needs are well understood and the right staffing levels and required resources are in place to get the job done the right way. A Lean workplace is more engaging because employees are listened to and partnered with management instead of just being told what to do.

Since a Lean organization better understands customer needs (and is better positioned to deliver solutions), the long-term financial situation, job security, and advancement potential will be better, as well.

That all sounds like Shangri-La or Nirvana, perhaps… a Lean environment is challenging and puts people to the test in terms of problem solving skills, teamwork, and creativity, but it’s a supportive workplace that I’d prefer compared to the “traditional workplace” alternative.

What are some of the biggest challenges that you’ve seen healthcare professions encounter when applying Lean practices?

One challenge is a general cynicism and lack of trust that too often exists in healthcare. Healthcare professionals often don’t trust their leaders (a distrust that’s been earned through past layoffs, cost cutting, and not being aware of the challenges that front-line staff face). Leaders often don’t trust that their employees will have valid ideas to help improve patient care and the organization.

So, a vicious cycle needs to be broken, a cycle where leaders don’t ask employees for ideas and employees don’t speak up because they think they won’t be heard anyway. This requires leadership… and a commitment from leaders that things will be different with Lean.

One cause of staff cynicism is the past failure of “programs of the month” and one reason for failure of other programs is that staff got a lot of training, but management didn’t change their approach… since Lean is not just a process improvement methodology (it’s a management system, philosophy, and culture), leaders need to lead by example and change their approach instead of just asking staff to change.

What are some of the biggest misconceptions you’ve found that healthcare professionals have about Lean?

It’s not just in healthcare, but it’s the result of an unfortunate name that was chosen 30 years ago – “Lean production” as a more general descriptor of the Toyota Production System. When I talk to Lean newbies in healthcare, they often think “Lean” means layoffs or cost cutting, as people will say things like, “We’re already Lean… we’re understaffed as it is.” Lean, of course, is about having the proper staffing levels, not being bare bones. Lean isn’t an acronym for “Less Employees Are Needed” – but again, the old management habits in healthcare, sadly, is to cut costs through layoffs and reductions in service to patients.

Lean is actually an alternative to the old approaches of cost cutting through layoffs, productivity improvements through working harder, and reducing errors through asking people to be careful (which doesn’t work, anyway). There’s also an unfortunately misunderstanding that Lean is just about efficiency, cost, and patient flow.

The core of Lean methods is about reducing defects and quality problems through better system design, error proofing, and shifting from “naming, blaming, and shaming” (as has been the norm in healthcare) to teamwork, respect, and real process improvement.

How can Lean be used in conjunction with other work methodologies?

Many organizations in healthcare use “Lean” as their primary improvement methodology and management system. But, many use a broader, more general term like “Operational Excellence” or “Performance Improvement” as a banner for any combination of methodologies like Six Sigma, TeamSTEPPS (a patient safety improvement method), Studer Group methods (a popular consulting firm), and Agile (in the health system’s I.S. department). In software, there are different “flavors” of approach, including Agile, Kanban, Scrum, Lean Startup, etc.

Rather than arguing over competing approaches, I’d suggest using methods that make sense and prove effective for you and your organization. My hope for the Lean Startup movement, in particular, is that it shifts from too much of a focus on starting companies and more toward building a new type of company over time, as author and Lean pioneer Eric Ries [2] advocates for. Lean or other related methods should be more than a set of tools and tactics – there really needs to be that deeper, broader element of a Lean philosophy and culture, which has to include ongoing continuous improvement and “respect for people” (the dual pillars of the “Toyota Way” management approach).

What advice can you give the interface team on “managing up” to their supervisors and encourage them to install a Lean workplace?

This can be a difficult sell upward in an organization. In too many organizations, supervisors or executives just aren’t accustomed to taking suggestions from employees about relatively trivial things, yet alone a big idea like changing the culture. This is, perhaps, why so many technical people flee established organizations to start their own companies in an attempt to start anew with a fresh culture. That said, I’d suggest focusing on the expected benefits of Lean that would resonate most with leaders – on time delivery to the customer, quality, improved productivity, and reduced cost.

Lean should lead to a more successful organization which, for many good reasons, makes the supervisor or executive look good. That said, people are complicated and it might be a tougher sell to get managers to give up some of the control and traditional authority they are used to. If they like “being the boss” and enjoy the superficial power that comes with that, they might likely resist the idea of culture change, even if it promises better results for all.

My general advice – easier said than done – is that sometimes you have to just find a better job in a better organization if you can’t change the organization you work for. The best time to look for a job is, of course, when you already have one… and you can try to intentionally seek out an organization that has at least some semblance of a “Lean culture” in place (or one with humble leaders who are trying to move in that direction).