A Lean Management System Starts with Senior Leaders

by Steve Leuschel
September 4, 2014
A Lean Management System Starts with Senior Leaders
by Steve Leuschel
September 4, 2014 | Comments (0)
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When it comes to getting started with Lean, best practices have been changing,
especially in healthcare. From events, projects, and A3s to focusing on the development
of a lean management system, we're discovering a new way to run and lead our
healthcare organizations, or any organization for that matter. When it comes to changing
things, the question is where should we start? Do I believe we should experiment with a
lean management system at a model line level? Yes, without a doubt. Do I believe this
is where we should start? No, absolutely not. Here's why.

Many organizations start with a

 
handful of traditional lean tools. They
focus on value stream mapping and try
"Before our senior team huddle, I didn't
to improve processes while neglecting
realize the extent of the problems that were
to update leadership and management
happening on a daily basis. When the
systems. Just re-read Dr. Toussaint's
Department of Health was here with five
story in On the Mend. An employee
complaints, I already knew about all five,
asked him, "How are we supposed to
which is rare... Shortly after implementing
change when you keep managing the
this senior team daily huddle, I began
same way?" (p. 1207 kindle version).
another huddle with my operational direct
In her book, Beyond Heroes, Kim
reports. At first many individuals were
Barnas, describes the problem as
skeptical because we had started and
"Every manager at ThedaCare
stopped huddles in the past. After several
manages his or her own way. There is
weeks of this more structured, integrated
no one system." (p. 11). We've learned
approach, when I asked if the huddle was
a great deal from Dr. Toussaint, Kim
helpful, the operations team unanimously
Barnas, and ThedaCare. Why repeat
said yes."
the same mistakes?
- Dominic Paccapaniccia, Chief Operating
Yet, as I speak with colleagues, I hear
Officer, Indiana Regional Medical Center
the same mistakes being repeated day
in, day out as healthcare organizations
 
continue down a pathway of an event
based system with leadership
championing events, but leading the same way they have led for many years. Guess
what happens eventually? A courageous employee is going to speak up and say, "How
are we supposed to change when you keep leading and managing the same way?"

If your organization has concluded that Lean is the way forward, be sure to grasp past
mistakes and current best practices on developing a lean management system in the
most efficient and effective way possible – because healthcare does not have time to
repeat mistakes that can be avoided.
If we know the best way to learn is through experience, and senior leaders are expected
to be teacher-coaches in this new lean management system – we need to start by having
leaders change their daily experience and response to problems. It's a very different
experience to coach a lean management system than it is to participate in one as a team
member. That is why I am proposing that we start with senior leadership as we strive to
be lean, adapting and experimenting with our own lean management systems. They are
the core team members we need place focus to create a common language and a
common system they can both articulate, coach, and lead.

Here is what you and your organization can do:

1. Get a coach who knows and has implemented lean management systems from the
top down (internal or external).

2. Start a daily leadership huddle using standardized, but flexible questions to spark
problem identification. For example, were there any employee injuries/accidents
yesterday? Any reported patient safety events? Any actionable patient complaints?

3. Teach a simple problem solving system and have senior leaders to start problem
sheets and begin the problem solving process based on problems articulated at the
huddle. (You'll need some support from the CEO with this).

4. Establish a balanced scoreboard with the organization's most important metrics

in a balanced way such as employee safety rate; patient safety rate; overall satisfaction;
operating margin; and growth metrics. Focus on the long term and highest priority
metrics – not 40 measures around finance. Keep it simple!

5. Establish a monthly cycle to ensure senior leaders are selecting and helping to
solve problems to drive the top metrics, again coaching the problem solving system.
Make sure problem statements are articulated clearly and are based on high priority
problems (from the problem-sheets created during the daily senior leader huddle).
6. Establish leading process indicators (related to high priority problems) and ensure
planned countermeasures are happening and being improved. Start new problem sheets
if necessary.

7. Coach and learn.

Once senior leadership understands these components, next it's time to expand into a
model line, develop standard work, and cascade/align activities throughout the rest of
the organization. The idea is to develop and build upon the senior leaders' foundation
for a lean management system, keeping senior leaders a step in front of the model line,
and the model line at least a step in front of the rest of the organization. This is what
enables senior leaders to lead. First, learn by doing, then coaching. Then you can lead
the rest of the organization through a lean transformation.

The views expressed in this post do not necessarily represent the views or policies of
The Lean Enterprise Institute.
Keywords:  coaching,  healthcare,  lean leadership,  lean management
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