Our health care organizations are among the most complex businesses humankind has ever managed. They are buffeted by multiple factors, including governmental mandates and regulations, rapidly changing technology, a workforce that is stressed to the breaking point and disruptive innovators that eat away to the margins. All the while, the primary customer, the patient, is demanding service that is faster, better and cheaper.
Where is a health care leader to start? Hunkering down in the C-suite to develop game-changing plans that are driven down to the front lines has failed. A number of reasons are to blame — mismatched strategies, impossible tactics, and resistance from clinicians and employees. Many of these are avoidable by taking a calculated approach to leading and managing modern provider organizations.
Successful health care leaders work up front to develop a management system and culture that puts the patient first, values and engages front-line caregivers, pursues defect-free care, rapidly self-corrects when needed, and is capable of quickly and effectively adapting innovative approaches to care. The critical success factor is to transform the organization by adopting a management system that always strives to improve itself, such as Lean management.
Understanding the Collective Aim
For those who don’t know by now, Lean is the common name for the management system initially developed by Toyota. It is built on two key pillars: continuous improvement and respect for people. Continuous improvement is the more technical and scientific pillar. But respect for people is gaining recognition as potentially the more important pillar, because it accelerates the effectiveness of the first.
Lean principles dictate that we must begin with the customer, or in this case, the patient. The patient defines what he or she values from health care providers and, therefore, the patient is the most important person in the organization. Without patients, health care provider organizations would cease to exist. There would be no need for caregivers to come to work, nor for the buildings or the sophisticated technology they house; and there would be no revenue coming in to support infrastructure or pay salaries. Recognizing this, we must respect our patients (and their families), listen carefully to their needs and wants and keep a laserlike focus on what they value.
The caregivers are the second most important stakeholders in the organization. Every interaction between a caregiver — defined as anyone who talks to, escorts, comforts or treats a patient — has the potential to heal. Each interaction is a chance to relieve some anxiety, provide comfort, reduce pain, treat an illness, repair an injury or educate a person on how to live a healthier life. Collectively, these interactions amount to the health care industry’s whole reason for being.
Advancing Care while Controlling Cost
While patients are the focus of the value we provide, caregivers need the most support so they can provide the highest-quality healing interactions. Of course, those interactions ultimately enhance the patient experience and improve outcomes. But most caregivers are struggling. They feel increasing demands to juggle higher patient volumes while simultaneously improving performance on multiple metrics that are being reported with greater transparency.
It’s a lose-lose situation. The caregivers are burning out. Their reserves are at an all-time low, just when they need to be the most resilient.
Above all, a health care leader’s job is to ensure that caregivers have the tools they need to provide the best possible care to patients in a financially sustainable way. Lean management is a proven way to continually advance both objectives.
Getting Started with Lean Transformation
Become an active, visible leader and physically situate yourself where the work is done. Observe your staff as they work with patients. Stand in one place and watch as people race around. Follow a patient “door to floor,” or shadow a caregiver through part of his or her day. It will be surprisingly easy to see the inefficiencies, the wasted energy, the unacceptable delays and the unnecessary suffering. Then talk to the caregivers and listen to their perspectives on the current state. Such an experience will motivate you to personally commit to fixing the mess. This is the first step on the journey of Lean transformation.
As the journey progresses, your C-suite leaders will need to work side by side with caregivers. They will need to zero in on a location to analyze the patient experience from start to finish: tracking every step and identifying waste, defects and the small percentage of truly value-added work. This journey eventually will develop into long-term projects that address complex, deep-seeded issues; weeklong rapid improvement events that redesign workflows; and daily huddles to address smaller problems in real time.
Participation and ultimately leadership from front-line caregivers is paramount to this entire process. Chiefs, directors, managers and supervisors must be there to coach those who report to them on how to shift their routine — and to make them feel empowered as the organizations’ key problem-solvers.
Reinforcing Your Role as Leader
While this approach may seem to relinquish C-suite power, in fact, the role of the CEO and the C-suite leaders is indispensable. Executives are responsible for communicating the vision of this new approach, helping those resistant to change to get on board (or to get out of the way), and framing language that fosters understanding and motivates rather than blames. As waste and defects come to light, it’s critical for leaders to emphasize that a dysfunctional workflow process — not the caregiver — is at fault.
Imagine you are leading an organization that has the ability to effectively respond to the challenges it faces; has its entire workforce actively engaged in solving problems, removing waste and eliminating defects; and is able to focus its energy on maximizing the caring, healing interactions our patients crave. Such an organization will have gone through profound cultural change. This is the essence of Lean transformation, and change of this scope is possible only with strong, committed leadership.
Paul DeChant, M.D., is the executive director of clinical operations at Simpler Healthcare and the former CEO of Sutter Gould. He is based in San Francisco.
