Proponents of lean management argue that whether or not healthcare providers realize it yet, there is a major demand within their organizations for the model because, they will tell you, lean improves patient safety and reimbursement rates, and creates new standards around transparency. But getting healthcare organizations on the lean bandwagon takes leadership.
Healthcare Finance News talked to Ted Stiles, director of Stiles Associates, a lean-focused executive search firm, about lean management and leadership.
"In the manufacturing world, lean needs a 'burning platform' to motivate leadership in the middle of organizations to do something significant... and significantly different," said Stiles. And healthcare is more than a burning platform – it's a raging inferno.
Because of the value it returns to the patient, lean is experiencing a huge demand within the healthcare industry, Stiles said.
“One large organization I worked with, in five years, has seen financial results with lean leadership that were roughly worth over $100 million. The numbers are real. And the amount of opportunity is really kind of boundless at this point," Stiles said.
But many healthcare organizations have departments that are not functioning at the level they need to. The fastest way to get a lean program highly operational is to bring in someone who's been through multiple cycles of transformation before, Stiles said. Unlike quality initiatives where a person can receive a certificate saying they've passed some test now making them a qualified leader, lean is very experiential, he explained. The most effective classroom is in the environment itself, trying the work hands-on and accumulating scars because of it.
You need people leading this kind of work who've actually done it before. "You can't be an effective lean leader by simply staying one chapter ahead of class. This mode has failed in other industries. Lean looks very basic and simple – but the magic is in the execution," said Stiles. A qualified leader knows where pitfalls are and can help an organization navigate away from them. Transformational experience is critical.
2. Process-oriented thinking
The classic American industrial management theory is based on result-oriented thinking. Lean is the opposite. A good lean leader needs to be almost obsessive about processes – dismantling the techniques a healthcare organization uses to figure out if they're the cleanest methods to deliver the highest level of value. If organizations can have faith in this style of thinking, results do happen over time.
3. Ability to slow down
Hospitals have much more red tape to go through than manufacturing companies, and sometimes they lack clarity and alignment, Stiles noted. "So people who are transferring from a different type of lean to healthcare lean need to realize that moving things forward can take much more time. There's more listening and learning involved. Seeking to understand the complexity of the healthcare industry is integral before jumping in and changing the world," Stiles said.
4. Brutal honesty
Lean work is hard. At its most basic level, deploying a successful lean program means people need to talk honestly about what they do well and what they don't. Organizations need to be open about their shortcomings, too. In a lot of management cultures, the key to success is hiding or deflecting that. A good lean leader is going to push the organization to be more transparent. Once problems are visible then, and only then, can you dig in and fix whatever needs fixing.
5. Exceptional relationship-building skills
If you have someone that's built a career in manufacturing on results, those skills won't necessarily translate well into the healthcare space. "Candidates in healthcare won't lead with results, they'll lead with relationship- and trust-building, which is really the only way to get physicians or high-ranking clinical leaders – even nurses on the frontline – to talk to you about what their hopes and fears are, or where they believe the biggest amount of improvement needs to be done," said Stiles.
Lean is about change. It's about pushing people out of their comfort zones. Lean leaders ask aggressive questions that challenge why things are done the way they are within an organization, especially when the topic of transparency arises. Lean leaders need to motivate people to be able to take that step out of their box. "If you can get someone who can tap into various different levels within organizations to find out what the hope is, what the optimism can be, that's very powerful stuff," Stiles said.
7. Operational management experience
There needs to be some level of operational management thinking. That operations leadership piece is where you get into good sustainable, repeatable management systems, Stiles said. Setting up some kind of tracking board helps measure the right signals within key performance indicators (KPI), and once you develop that – you have those visual controls within a lean organization – you can begin the practice of daily "huddles" where leadership and other frontline supervisors can look at these boards to see whether the things that needed to happen happened. And if they didn't, they can begin to spot any abnormalities developing where a process redesign is needed so that it can be attacked and rooted out with good cause analysis, nipping problems in the bud before it's too late.