Lean is about helping organisations and individuals to learn to do things they could not previously do in order to meet the business challenges they face. The more problems they learn to solve the better they get at problem solving. This in turn triggers a virtuous circle of never ending improvement. The common ingredient of a lean transformation is engaging everyone, not just a few experts, in this activity of learning. It is not the solutions they come up with, because these will always depend on the specific situation. The leadership challenge is to trigger and support the conditions that enable this accelerated learning to take place. In my travels I came across two very different examples of how leaders are doing just that.
One of the most inspiring is the 433 bed public hospital Consorci Santiari del Garraf just outside Barcelona in Spain. Walking round this hospital I was struck by the enthusiasm of the doctors and nurses describing the many problems they had solved and how this had made things so much better for them and their patients. It was also clear they are on a roll and are very actively supported by the CEO and the senior nurse leading lean. Nothing is going to stop them finding and solving the next set of problems. They had not only closed the original 20% budget shortfall but had just been awarded the prize for the best-managed hospital in Spain. The full story is told in two articles on Planet Lean, which I urge you to read, A Healing Organisation and My Lean Story #3.
What is telling about this example is not lots of perfect visual management boards or extensive lean training, but the engagement and enthusiasm of the staff. This is no accident, but the result of working with a very experienced mentor and team (leading our Spanish Instituto Lean Management) able to keep asking the right questions to challenge teams to diagnose their situation and find their own answers and teaching them to stabilise their work to create a baseline for making improvements using PDCA. It is a great example of an experienced Sensei (trained directly by one of the best Toyota Senseis) working with a hands-on leader at every stage to create the front-line capabilities that ultimately drive accelerating and sustained improvement.
This is a very similar story to the work Dave Brunt has been doing with the Halfway Toyota Dealer Group in South Africa, whose COO will speak at our UK Lean Summit. Again asking questions strongly supported by leaders. But in this case also doing different experiments in different locations to discover the most effective ways of helping front-line staff learn how to make improvements. For me these two examples embody the original spirit of the Toyota Production System (TPS).
After a decade of lean in healthcare it is striking that there only two whole hospital examples, namely Thedacare and Virginia Mason in the USA. Both of these pioneers had extensive outside consulting support, including numerous study trips to Japan and strong determined leaders. Another keynote speaker at our UK Lean Summit is Dan Florizone, former hospital CEO and early visitor to Virginia Mason, who went on to establish a Province wide lean healthcare initiative and is now Deputy Minister (top civil servant) for Education and Lean Across the Provincial Government of Saskatchewan, Canada. He will talk about this bold, sometimes controversial and pioneering experiment that I saw for myself last year.
While the reach and scope of these initiatives are impressive (850 improvement events since 2012 and training 800 lean leaders) what makes this really work is the state-wide Hoshin planning process now in its fourth year. This engages literally everyone from the front-line to Provincial leadership in listening to the needs of service providers and prioritising the vital few initiatives that everyone can then focus on. There is even a Hoshin wall in the Parliament building showing cross-ministerial priorities.
Again strong hands-on leadership and clear focus better leverages and links all the improvement activities together. What is also striking is their engagement of front-line staff and patients who understand the flows of work in designing several new hospitals, using the 3P process. The net result is a new hospital with a much smaller footprint and lower capital cost, as well as significantly reduced running costs over the life of the building. What makes this 3P exercise so significant is that it is not lead by outside experts, indeed the architects and contractors are only allowed to observe until the front-line staff and patients have completed their mock-ups of the overall layout around the workflows and the room layouts. This 3P process is now being used in redesigning the delivery of all kinds of services
Here we have two very different approaches to developing capabilities in very different circumstances. Lots to learn from both of them. We will be discussing these examples at the UK Lean Summit in Kenilworth on 18-19 November, join us there. I will also bring these two hospital examples with me for a workshop for top hospital CEOs in Greece later that week.