Keen to Be Lean in Healthcare
Are you waiting with bated breath for Washington to fix healthcare? Me either. Regardless of your opinion on the pending legislation, there is still a problem. The soaring costs and staggering problems in healthcare still require us to fix the process. And that can’t be done from Washington.
CFO Magazine recently published Keen to Be Lean which chronicles a big of lean in healthcare. It does a nice job quoting LeanBlog.org’s Mark Graban. But it seems to focus lean in healthcare on cost reduction. It’s not the first time this mistake has been made, nor will it be the last.
Over 10 years ago, lean in healthcare got its real start when the Big 3 sent in continuous improvement experts to fix processes. Now their lean efforts were no prize, mostly because they missed the cultural changes in lean. But they were darn good at process improvement. One person they asked to help was my co-founder of the Lean Learning Center, Andy Carlino.
The argument was that healthcare was now the most expensive part of the car. It still is. And it’s worse in the U.S., as well articulated in John Shook’s column. So people went in to reduce costs. Unfortunately, costs were about 5th of people’s priority lists, because “we’re caregivers.” It’s very hard to get people’s attention to change their ways when your priorities aren’t matched.
The lesson learned – if you really wanted to get people’s attention, focus on what matters to them. That is delivering care. The Pittsburgh Regional Healthcare Initiative, which uses lean and we helped in their early days, calls their program Perfecting Patient Care. And it turns out that improved patient care quality actually reduces costs.
Didn’t we learn that lesson in manufacturing 20 years ago? I thought so.
I believe healthcare professionals are some of the most caring of any profession. I also believe, that with the exception of the military, they are the most highly trained. Good intentions + good training should equal great results, right?
But bad processes beat good people every single time.
Regardless of what happens in Washington, I know this. We have a lot of work to do to design, manage, and improve the work of the healthcare professionals. And Washington can’t do that for all the physicians, nurses, assistants, pharmacists, technicians, and administrators that suffer from bad processes.
I think it’s inevitable that CFO Mag would have a heavy cost angle. I certainly tried to make the case to the reporter that lean is about quality (and costs follows) and that lean can also lead to growth and revenue opportunities for a hospital.
We’re still on the long uphill battle to get healthcare to realize that better quality costs less. We need to say it over and over. Better process quality leads to better cost. If you define quality as newer technology, that’s going to cost more. But there’s a widespread assumption that healthcare is already efficient from an operations standpoint and that’s dead wrong.
Generally, I thought the writer did a great job for not being a lean guy. I’ll give him credit for being very inquisitive and at least mentioning quality.
I think it’s inevitable that CFO Mag would have a heavy cost angle. I certainly tried to make the case to the reporter that lean is about quality (and costs follows) and that lean can also lead to growth and revenue opportunities for a hospital.
We’re still on the long uphill battle to get healthcare to realize that better quality costs less. We need to say it over and over. Better process quality leads to better cost. If you define quality as newer technology, that’s going to cost more. But there’s a widespread assumption that healthcare is already efficient from an operations standpoint and that’s dead wrong.
Generally, I thought the writer did a great job for not being a lean guy. I’ll give him credit for being very inquisitive and at least mentioning quality.
I think it’s inevitable that CFO Mag would have a heavy cost angle. I certainly tried to make the case to the reporter that lean is about quality (and costs follows) and that lean can also lead to growth and revenue opportunities for a hospital.
We’re still on the long uphill battle to get healthcare to realize that better quality costs less. We need to say it over and over. Better process quality leads to better cost. If you define quality as newer technology, that’s going to cost more. But there’s a widespread assumption that healthcare is already efficient from an operations standpoint and that’s dead wrong.
Generally, I thought the writer did a great job for not being a lean guy. I’ll give him credit for being very inquisitive and at least mentioning quality.
Atul Gawande, with his high visibility from previous books and writing in the New Yorker, is drawing considerable attention to the lean practice of checklists in his new book. He’s been on numerous interview shows as part of the book tour I assume he’s making. He doesn’t use the “L” word, but does show a much wider audience that our healthcare systems are highly imperfect and can be improved with simple tools.
We probably need more formal and visible connections with him because of his wide credibility and his ability to reach a wide audience. I’m sure he’s aware of what some of the great hospitals are doing, and recognizes lean even if he doesn’t use our jargon.
Mark, do you know Dr. Gawande?
Atul Gawande, with his high visibility from previous books and writing in the New Yorker, is drawing considerable attention to the lean practice of checklists in his new book. He’s been on numerous interview shows as part of the book tour I assume he’s making. He doesn’t use the “L” word, but does show a much wider audience that our healthcare systems are highly imperfect and can be improved with simple tools.
We probably need more formal and visible connections with him because of his wide credibility and his ability to reach a wide audience. I’m sure he’s aware of what some of the great hospitals are doing, and recognizes lean even if he doesn’t use our jargon.
Mark, do you know Dr. Gawande?
Atul Gawande, with his high visibility from previous books and writing in the New Yorker, is drawing considerable attention to the lean practice of checklists in his new book. He’s been on numerous interview shows as part of the book tour I assume he’s making. He doesn’t use the “L” word, but does show a much wider audience that our healthcare systems are highly imperfect and can be improved with simple tools.
We probably need more formal and visible connections with him because of his wide credibility and his ability to reach a wide audience. I’m sure he’s aware of what some of the great hospitals are doing, and recognizes lean even if he doesn’t use our jargon.
Mark, do you know Dr. Gawande?
Here is a link to the book Karen is referring to, The Checklist Manifesto:
http://bit.ly/4v40Xw
Here is a link to the book Karen is referring to, The Checklist Manifesto:
http://bit.ly/4v40Xw
Here is a link to the book Karen is referring to, The Checklist Manifesto:
http://bit.ly/4v40Xw
On an aside, one of the challenges I face on a daily basis is trying to quickly describe what Lean is to someone who doesn’t know or thinks they know. Inevitably they pick out one or two points that appeal to them and focus on those factors (ie. better cost and quality results). The challenge for Lean in healthcare (like any field) is going to be to manage the perceptions.
Mark does a great job in describing Lean in healthcare with his book Lean hospitals (http://www.leanhospitalsbook.com/).
Ankit Patel
http://TheLeanWayConsulting.blogspot.com
On an aside, one of the challenges I face on a daily basis is trying to quickly describe what Lean is to someone who doesn’t know or thinks they know. Inevitably they pick out one or two points that appeal to them and focus on those factors (ie. better cost and quality results). The challenge for Lean in healthcare (like any field) is going to be to manage the perceptions.
Mark does a great job in describing Lean in healthcare with his book Lean hospitals (http://www.leanhospitalsbook.com/).
Ankit Patel
http://TheLeanWayConsulting.blogspot.com
On an aside, one of the challenges I face on a daily basis is trying to quickly describe what Lean is to someone who doesn’t know or thinks they know. Inevitably they pick out one or two points that appeal to them and focus on those factors (ie. better cost and quality results). The challenge for Lean in healthcare (like any field) is going to be to manage the perceptions.
Mark does a great job in describing Lean in healthcare with his book Lean hospitals (http://www.leanhospitalsbook.com/).
Ankit Patel
http://TheLeanWayConsulting.blogspot.com
Ankit – You gotta start somewhere. If initial focus is way too limited, you need to create the opportunity to expand the focus over time.
Ankit – You gotta start somewhere. If initial focus is way too limited, you need to create the opportunity to expand the focus over time.
Ankit – You gotta start somewhere. If initial focus is way too limited, you need to create the opportunity to expand the focus over time.
Karen,
I 100% agree but starting conditions are indicators of where you end up. If the cost is the sole focus on front end then it’s very difficult to get a true “Lean” organization. I’ve noticed that as long as the company who is implementing lean cares about something else besides just cost that can lead to growth.
This has just been my own personal experience. I’d love to hear your thoughts and experiences.
Ankit
Karen,
I 100% agree but starting conditions are indicators of where you end up. If the cost is the sole focus on front end then it’s very difficult to get a true “Lean” organization. I’ve noticed that as long as the company who is implementing lean cares about something else besides just cost that can lead to growth.
This has just been my own personal experience. I’d love to hear your thoughts and experiences.
Ankit
Karen,
I 100% agree but starting conditions are indicators of where you end up. If the cost is the sole focus on front end then it’s very difficult to get a true “Lean” organization. I’ve noticed that as long as the company who is implementing lean cares about something else besides just cost that can lead to growth.
This has just been my own personal experience. I’d love to hear your thoughts and experiences.
Ankit
Hi Karen – I don’t “know” Gawande, although he’s right here in Boston. I saw him speak at a book tour event in Cambridge last week and got to say hi during the signing.
He’s certainly aware of Lean and even of LEI and our push into healthcare. Gawande gave a quick shout out to Toyota in his 2nd book, “Better.”
http://lnbg.us/z
I’d be curious to talk with him and ask if he avoids playing up the Toyota angle too much because it runs the risk of turning of healthcare people (two degrees of difference – Japanese and manufacturing)?
My ideal state would be for Gawande to devote a New Yorker article to what’s going on with lean in healthcare. I’d love to see how he would write it. If he can connecting Farming to healthcare (his last New Yorker piece), he could do a similar interesting connection to manufacturing I bet.
http://lnbg.us/0
@Ankit – thanks for the shout out of my book!
Hi Karen – I don’t “know” Gawande, although he’s right here in Boston. I saw him speak at a book tour event in Cambridge last week and got to say hi during the signing.
He’s certainly aware of Lean and even of LEI and our push into healthcare. Gawande gave a quick shout out to Toyota in his 2nd book, “Better.”
http://lnbg.us/z
I’d be curious to talk with him and ask if he avoids playing up the Toyota angle too much because it runs the risk of turning of healthcare people (two degrees of difference – Japanese and manufacturing)?
My ideal state would be for Gawande to devote a New Yorker article to what’s going on with lean in healthcare. I’d love to see how he would write it. If he can connecting Farming to healthcare (his last New Yorker piece), he could do a similar interesting connection to manufacturing I bet.
http://lnbg.us/0
@Ankit – thanks for the shout out of my book!
Hi Karen – I don’t “know” Gawande, although he’s right here in Boston. I saw him speak at a book tour event in Cambridge last week and got to say hi during the signing.
He’s certainly aware of Lean and even of LEI and our push into healthcare. Gawande gave a quick shout out to Toyota in his 2nd book, “Better.”
http://lnbg.us/z
I’d be curious to talk with him and ask if he avoids playing up the Toyota angle too much because it runs the risk of turning of healthcare people (two degrees of difference – Japanese and manufacturing)?
My ideal state would be for Gawande to devote a New Yorker article to what’s going on with lean in healthcare. I’d love to see how he would write it. If he can connecting Farming to healthcare (his last New Yorker piece), he could do a similar interesting connection to manufacturing I bet.
http://lnbg.us/0
@Ankit – thanks for the shout out of my book!
Jamie, you are right on — however there is a twin headed dragon of a problem. If you are introduced as a lean implementation specialist by a department (ED, Lab, OR) and don’t deliver cost improvements the CFO will grow cold to the initiative, if you are brought in by the CFO with a cost focus the departments will resist based upon their care focus. What really is needed is focused and determined C level leadership to take the long view and improve care and processes to the point that costs are reduced. I’ve been consulting hospitals, labs and clinics for 5 years and what is lacking is the kind of leadership (check their leadership profiles) that enables that to occur.
Jamie, you are right on — however there is a twin headed dragon of a problem. If you are introduced as a lean implementation specialist by a department (ED, Lab, OR) and don’t deliver cost improvements the CFO will grow cold to the initiative, if you are brought in by the CFO with a cost focus the departments will resist based upon their care focus. What really is needed is focused and determined C level leadership to take the long view and improve care and processes to the point that costs are reduced. I’ve been consulting hospitals, labs and clinics for 5 years and what is lacking is the kind of leadership (check their leadership profiles) that enables that to occur.
Jamie, you are right on — however there is a twin headed dragon of a problem. If you are introduced as a lean implementation specialist by a department (ED, Lab, OR) and don’t deliver cost improvements the CFO will grow cold to the initiative, if you are brought in by the CFO with a cost focus the departments will resist based upon their care focus. What really is needed is focused and determined C level leadership to take the long view and improve care and processes to the point that costs are reduced. I’ve been consulting hospitals, labs and clinics for 5 years and what is lacking is the kind of leadership (check their leadership profiles) that enables that to occur.