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Five Reasons That Lean Thinking is Difficult in Hospitals

December 17, 2015

139911315Many of our healthcare clients are on their “lean journey” which means we have long discussions about their culture, and what behavioral competencies are important in their workforce. Lean behavioral competencies and culture, both on the front line and in leadership, could not be more different from traditional hospital culture and behavioral expectations.

Hospitals are traditionally organized around silos, and value professional autonomy and hierarchies. There is usually a culture of expertise and authoritarian leadership style. Hospitals have only in recent history even defined what “success” is and what the relevant performance metrics are. Many hospitals still tend to focus on short term problems and solutions, rather than long term continuous improvement.

Lean, on the other hand, requires a culture that values respect for colleagues, collaboration, humility, empowerment, innovation and constant improvement as part of every team member’s daily function. Hospitals seem to struggle in five areas:

1) Lean projects vs. a lean culture

Many organizations claim to “use lean”. Few really have a “lean culture”. Many hospitals have lean or six sigma process experts who work on individual projects to improve specific operational functions. Recall, hospitals tend to focus on short term solutions so this approach fits. It takes a serious commitment and several years to really implement a lean culture.

2) Clinging to a traditional leadership style

Part of the problem with truly adopting a lean culture is finding senior leaders who either come from a lean organization or who are able to change from a traditional leadership style. We perform executive assessments for lean organizations when they are looking for that rare individual. Someone who can be metrics driven, more coach than dictator, comfortable with delegating innovation and decision-making down through the ranks, and willing to take the organization through this change at a time when healthcare organizations are under real pressure for immediate results.

3) Comfort with ambiguity

Healthcare is, to a large degree, prescriptive in nature. Evidence based practice, treatment protocols, policies and procedures. Every healthcare profession is schooled in the “accepted” way of operating, clear rules and clear directions. These approaches are designed to ensure patient safety. In a true lean culture, you are asking a nurse manager to go off script, find new solutions – but still ensure patient safety! There may be several ways to solve a problem, remove waste and improve outcomes. The answers may not be online or in the text book.

4) Willingness to make mistakes

Now this seems entirely inconsistent with the traditional provision of healthcare. We aren’t saying be willing to make mistakes with regard to patient care, but be willing to try solutions to complex problems. Hospitals often suffer from “analysis paralysis” – taking 18 months to evaluate potential solutions and then choosing none of them because they couldn’t gain consensus that it was the “ideal” solution! In those 18 months, they could have implemented 3 potential solutions and found the one that worked. We had a discussion with a senior team this week, looking to fill some leadership positions and this was their focus. They want people who are willing to go out on a limb, willing to share a potential idea, even if it’s wrong – to have faith in themselves and each other, and a willingness to be vulnerable within the team.

I read a great quote by Brene Brown on this last topic, “Vulnerability is the birthplace of innovation, creativity and change.” Brown speaks about the idea that we need to accept and embrace the concept of failure, not because failure is a good thing but because it’s a natural part of the path of progress.

5) Missing one of the two lean pillars!

Finally, Toyota will tell you that lean is built on two pillars. One is process. The other is people. Most health systems miss the second pillar entirely. As Mike Hoseus says in, Toyota Culture, The Heart and Soul of the Toyota Way, “Most companies miss seeing the blood flow of TPS – the human resources philosophies and strategies that make it work at Toyota.”

This last piece means hospitals need to take the same, progressive, lean-focused, approach to talent as companies like Toyota. Define these requisite behavioral skills, and build a selection system around them. To learn more, see our free white paper:

Bryan Warren Bryan Warren is the President of J3 Personica, a consulting, assessment, training, and coaching firm, and a guest blogger for PSI. Bryan is an expert in progressive talent strategies, with a particular focus on leader and physician selection and development.