Lean Enterprise Academy > Healthcare > How Lean is Your Organisation ?
We are often asked to evaluate how lean a healthcare organisation is. How far it has progressed down its lean journey and what its next steps should be. As a result we have developed a formal Expert Healthcare Lean Audit.
The audit commences by taking a walk through its core activities to assess what they have actually done (activities and results). This quickly reveals whether they have been able to go beyond lean tools and point improvements to a value stream transition.
Looking at their visual management also reveals whether line managers are actually using this to manage progress, to respond to interruptions and to record persistent problems for root cause analysis later. As you talk to staff you also quickly discover how many lean seeds have been sown and how many lights have gone on in their heads. In other words how many employees have been infected with lean, process thinking and would not want to return to the "bad old days" before lean.
From experience we have learnt that the main problems and obstacles in going lean are rarely on the shop floor, but usually higher up the organisation in management. The shop floor is indeed a reflection of management. Here we assess whether top management just sees lean as a way of engaging employees in seeing and eliminating waste, by deploying lean tools right across operations. Or whether in fact lean improvement activities are being focused on closing the key performance gaps that are critical to the success of the organisation, by redesigning their processes that make and deliver value to the patient and the taxpayer.
Having defined the scope of the organisation's lean ambitions we then assess their approach to change management. In most cases this will be defined by which consulting approach they used to get started. Who they used will be a good indication of where they are likely to get stuck on their lean journey. The 16 week model line approach is unlikely to last long after the consultants have gone as the organisation will not have learnt enough to replicate it elsewhere. The ‘go to US’ trips to get religion and learn how to do Kaizen approach is also likely to run into the sand once the finance director begins to examine the costs. The repeat rapid improvement week model often goes hand in hand with an over reliance on outside experts so that the results are not always connected, sustainable or owned by the organisation.
We believe that healthcare organisations have to develop the ability to build their own lean knowledge and examples as opposed to scouring for lean knowledge from elsewhere. This means running controlled, scientific, experiments and then cross learning and building upon the lessons learnt.
These experiments, however, can only be conducted on a stable platform and this stability can only be provided through strong operational and process management. As a result we firstly assess the stability of a process.
Realising the full potential of lean means building a learning organisation on the one hand and a lean management system to drive it forward on the other. But again, it is not enough, for instance, for the organisation to be doing policy or strategy deployment or insisting that staff employ the A3 process. It is the quality of the analysis, the decisions and the learning that emerges that really counts.
Narrowing down the critical root causes of the broken processes that fail to deliver the required performance for the organisation is not easy. Deselecting the vast number of possible improvement activities in order to focus efforts on the vital few that will contribute to the biggest improvements is even harder. But without this a lot of effort is wasted and a lot of potential performance improvement is missed. The point of policy or strategy deployment is to align improvement activities across the organisation to solve the critical business problems facing the organisation. Again we assess the organisations ability to do this.
Making Hospitals Work describes how a top team in a hospital go through such an analysis. In their case discovering that streamlining the flow of emergency patients and reducing length of stay is the way to meet government waiting targets, improve infection rates and free up capacity to do more and more profitable elective operations with the same resources. This is precisely the area most outside consultants are reluctant to tackle.
In exactly the same way we look for evidence of similar thinking emerging from the policy or strategy deployment process. For example, if an organisation has a portfolio of around 500 improvement projects the alarm bells immediately begin to ring. This tells us that the organisation has batched up and released far too many projects in one go. This large volume of projects, all being worked on simultaneously, tells us that not only is each project actually contributing very little but also that the likelihood of these projects even delivering the desired output are extremely low.
We also assess whether someone has been given the responsibility of being the patient representative, who’s job is to improve the patient experience, horizontally through the, vertical, departmental and divisional silos. A person responsible for gathering the facts and gaining agreement from key parties. We assess whether the metrics driving behaviour also include the performance of the value stream as a whole and is there a mechanism for surfacing and resolving conflicts between departmental and value stream objectives.
Prior to the audit we will visit the organisation and help them to prepare for the audit. On completion of the audit we both present our findings and provide a formal written report along with suggestions as to how to close any gaps.
The Lean Enterprise Academy is a non-profit Academy established to develop knowledge of Lean Thinking and its implementation and to disseminate this knowledge through publications and workshops.
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