Tuesday, March 14, 2017

I believe in miracles but in the proper context

We have all heard of miracles. Someone’s cancer miraculously regresses, a child is found alive in a collapsed building after 3 days with no food or water, or someone blind hits their head and can suddenly see. Merriam Webster dictionary defines a miracle as: An unusual or wonderful event that is believed to be caused by the power of God. A very amazing or unusual event, thing, or achievement.
A majority of Americans think miracles happen and according to several polls on the topic, a majority of physicians who are overall a skeptical and science oriented group, believe that miracles happen.  Given this wide-spread belief I think us “believers” would agree that the following are true about miracles: They are fairly rare, they almost always involves one person, they cannot be explained by science, and most are related to a person’s health or well-being.
Over the last 10 years the amount of Hospitals that say they utilize process improvement and/or have a process improvement staff have expanded rapidly, estimates vary but it’s likely that at least 45% - 60% of our 5,000 Hospitals are utilizing some process improvement methodology. In terms of my experience I see a majority of Hospitals practicing LEAN methodology or some similar variation. There is huge difference in the results of such programs, many Hospitals are practicing LEAN but only a small minority are truly embracing LEAN and in effect being LEAN.
This is where the miracle connection comes in. From my many interactions with Healthcare executives I suspect a good portion of them consciously or subconsciously believe in process improvement miracles.  Why do I say this? Because many believe that without much intervention and time from themselves, without sacrifice and hard work from staff, without generating any internal conflict, and without much program funding Process Improvement miracles will occur.  They believe that if they talk about LEAN, understand some of the lingo, hire or train some black belts or a Lean Sensei they will have created a LEAN acting and LEAN thinking operation.  That is not how it works. If the proper planning and attention is not applied to the Process Improvement program it will not be successful. Hoping, praying, and wishing that the organization will become LEAN does not work. 
I have been practicing Lean methodology for 25 years and I have never seen a LEAN organization transformation miracle. I have seen LEAN organizational transformations but they came about gradually over many years of focused dedication to the concepts and principals.  You can’t dip your toe into the LEAN process, you can’t do it sometimes, only in some areas, or only when it is focused on some financial or safety crises. It involves significant behavior changes that eventually lead you to the cultural change you need. 
For a LEAN program to be successful it needs to be well structured and thought out. This requires both significant strategic planning as well as a financial and emotional investment.  If JACO or some other certifying body came into a Hospital and found significant and reportable problems the Hospital administration and the Board would not hesitate to spend whatever money and time it took to fix the problem(s); we all know this happens practically every day.  The reason for the focus is obvious: The problem is real, it is very tangible and it has the potential to harm the hospital’s reputation and in turn, its viability.
The difficulty of investing properly in a LEAN or Process Improvement program is that the problems are usually not so tangible and often not “top on the radar screen”. Instead of one or two big problems LEAN is focused on all daily problems, separately these problems do not usually account for much in terms of patient safety or financial cost but together, they are significant, enough to take away at least 2-4% of margin and likely to eventually lead to patient safety issues or staffing issues that will be extremely costly. Many of the problems in daily work are hidden, they don’t show up as an item on the P&L, they don’t make headlines but like a small snowball travelling down a mountain, more and more snow will be added and eventually it can become a very large object or an avalanche that cannot be stopped and it will cause much destruction. It’s always the problems you don’t see or perceive that eventually cause the most damage.
Most CEO’s feel that developing a great work culture is very important.  There is no better vehicle to do this than by implementing a complete and fully supported LEAN program but it needs to be done correctly and that takes hard work, professional help, some up front financial cost, and super-intense executive focus. When done correctly the results are truly “miraculous” but don’t expect those results to occur via a miracle, it just will not happen.  

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