It is a long-term, comprehensive strategy

 Continuous incremental improvement

“Once leaders start spending more of their time out where the work is being done in their organization watching what is going on, they will be surprised what they learn.”

Sarah Patterson, Executive Vice President and Chief Operating Officer

Sarah Patterson

Paul Levy’s blog, Not Running a Hospital, is one of the best in health care. Paul was formerly CEO at Beth Israel Deaconess Medical Center in Boston and now does a good deal of teaching and speaking around the world in addition to writing his blog (every day!).

He recently hit on something that is of fundamental importance for anyone on or contemplating a lean journey. In his pull-no-punches style, Paul recently wrote:

“If there were a form of medical malpractice lawsuit that I would like to encourage, it would be against those consulting firms that promise hospitals that they will teach them how to ‘do Lean.’”

Paul continued with the observation that

“You don’t ‘do Lean.’” Lean is not a program. It is a long-term philosophy of corporate leadership and organization that is based, above all, on respect shown to front-line staff. There are two essential aspects, training front-line workers to be empowered and encouraged to call out problems on the ‘factory floor,’ and training managers to understand that their job is to serve those front-line workers by knowing what is going on on the front lines and responding in real time (when problems are fresh) to the call-outs.”

I asked Sarah Patterson, Virginia Mason Executive Vice President and COO, for some additional thoughts on this topic. She offered the following thoughts, which get directly to the heart of the issue:

Virginia Mason has been on its journey to implement a new management system based on the Toyota Production System for over 10 years. We have learned a lot during that time by trying things, making mistakes, learning from our mistakes and trying different approaches. Over that time, we have learned that:

This is not a “quick fix” for every problem in your organization.  It is a long term, comprehensive strategy and requires changing the work of leaders from the top to the front lines of the organization to be effective. The results need to be measured over the long run or you risk giving up or moving onto some other method too soon. In our early years, some of our staff told us that they were going to “wait us out” before they started using the tools and methods as they believed, from their past experience, that we (the leaders) didn’t have the patience to stick with it for very long. It has sent a strong message in the organization that we have “stuck with it” for more than 10 years.

It requires that the organization’s leadership, starting with the C-suite, be actively engaged in leading the initial training in the methods and tools, creating the infrastructure that will support ongoing education, as well as ensuring that the tools are being used effectively and, finally, holding everyone in the organization accountable for using the principles and tools on an ongoing basis.

Consultants can be used to jumpstart some of the specific training and development of the roll-out strategy, but they are never a substitute for the active and ongoing engagement of the organization’s leaders in leading the change. Using consultants may give leaders the false sense of security that they are “doing something” to help their organization be more effective but they can miss the insight that the problems in their organization may be the result of or at a minimum, not being helped by how the leaders are doing their work.

We have learned that workshops to train lean tools and methods are not where the real learning occurs. It is in the application of the tools in the workplace where the real learning takes place. Acquiring a new competency requires practice. Asking our very experienced leaders to “go back to school” and learn these new competencies means that they will have to be willing to be vulnerable in front of their peers and their boss. If the executives aren’t role modeling these behaviors, it isn’t going to happen with the rest of your leaders.

Once leaders start spending more of their time out where the work is being done in their organization watching what is going on, they will be surprised what they learn. We have learned that much of what we think is happening is not what is actually happening. We have learned that the jobs we are asking our staff to do every day are oftentimes not doable because there are not stable and reliable processes to support them. It helps us as leaders to know what the problems are every day that are preventing our staff from delivering waste-free care because then we can prioritize our improvement work.

How are the leaders in your organization learning about the work that is happening on the front lines?