DailyKaizen

Four years ago when I first began working in healthcare I was amazed how difficult it was to get work done outside of a functional area.  I worked at three different organizations during graduate school (internships) and then took a job with my current employer and all of them were completely siloed.  The first internship I worked with a team that had such a bad relationship with the teams up and down stream that they basically refused to even talk to their co-workers unless a problem got so bad it could not be ignored.  At a different organization I worked with a team where 50% of their work was sorting documents in a certain way so that they could be scanned by another team.  The team downstream changed their software and suddenly they did not need to have the documents sorted in the old way.  For some reason the message never got to the upstream team for almost three years, meaning that two full FTE’s worth of work was wasted for the entire time.  I could only shake my head. 

For some reason healthcare organizations really struggle with cross-functional management and improvement.  I am not sure the root cause for this challenge but I can guess it has to do with the following:

• A lack of clarity of who the customer is
• A lack of translation of customer requirements into work processes
• Lack of effective measurement systems
• Functional as opposed to cross-functional goals
• Budget > Strategy
• Specialization of work roles that set up long-standing hierarchy
• Antiquated structures and excess bureaucracy
• etc.

As you all know silos drive incredible amounts of waste and lead to all kinds of performance related issues.  As we began the Value Stream work this week that I discussed in my last post the team I am working with was quite literally blown away by the potential we found for improvement event though we just started.  Every team we visited was doing redundant work, over processing, missing opportunities to better serve their customers, had work processes that led to problems downstream, etc.  All of this because the teams were not connected to the teams either up or down stream from them. 

 The healthcare organizations that figure out how to overcome this issue will dominate over their competition.  One of the things that most excites me about Lean is that it provides a solution to this challenge.  There is evidence all over my organization that silos are in the early stages of breaking down.  The Value stream work is just one of many examples of how we are learning how to better understand our customers and then align our process across to better serve them.  Very exciting.

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