DailyKaizen

I received a question from one of the blog readers yesterday that I thought would make a good entry. Also, I think there are others out there with far more experience then me that might be able to provide more thoughtful insight. Here is the question:
I would like to know to begin with how would you have a Lean transformation get started in a healthcare organization and to be successful will there be a particular area that we should first concentrate on, so we have buy-in with the management?
I am going to answer this question based on the approach that we took at Group Health and then reflect back on what has worked well and not so well. First, I would warn anyone against thinking that transformation is going to happen quickly, especially in the minds of management. Lean is all about embarking on a journey and the first couple of steps taken, unless you have a zealot CEO should be small and well thought out. To win over management you will need to show results which will lead to a pull for your support. Once this happens you will be able to contract with more leverage, which in turn will allow you to require leaders to invest more time in participation, which in turn will allow you to change the way they think–meaning “buy-in”. But first you need to get started.
There are two factors that we considered when we chose our first set of Lean “projects.” First, what leader would be open to new thinking and would be a good sponsor for this type of work. Second, what process is visible, has a big opportunity, but not overly complex. Based on this criteria we were able to find a couple of good areas to work with. We started in our laboratory service and pharmacy. Both these departments are led by strong leaders, they have processes that are easily made visible and there is always a big opportunity. I would caution anyone from trying to tackle a more complex healthcare process upfront like patient flow or OR scheduling. These types of processes will take a high level of technical sophistication, more advanced consulting skills and more importantly high levels of active sponsorship.
Once we had demonstrated success in lab and pharmacy we began to take on more complex, cross-functional work which has increased in complexity, scope and depth. Often we have made mistakes and gotten ahead of our leaders. I can think of one particular project that Ted and I worked on that took months to recover from, because we led our excitement get ahead of what the organization was ready to absorb. Management buy-in has quite literally come one RPIW or Value Stream event at a time, not as a big bang. The good news is that we have built a critical mass of supporters that is growing everyday.
So start small. Work with solid leaders that are open to new ideas and pick visible, easily scoped projects.

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