How Do We Change in Healthcare?

I have spent the last couple of months banging my head against a wall trying to figure out why one group of employees at one of my implementations just can’t align with a Lean way of life. Each time we 5S an area, it gets changed. Each time we try to implement standard work, it gets delayed by management. Each time we try to implement Kanban, we get no where. Why are these people fighting this implementation so much? Most importantly, why are they being allowed to resist this implementation? They seem to have a complete disregard for authority. Above all else, they can’t seem to wrap their minds around the fact that if we don’t cut costs and improve efficiency, we will cease to exist as a healthcare facility.

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I’ve been over it thousands of times, and I came to a realization just the other day – healthcare is made up of a myriad of individual thinkers. It makes sense, the culture of healthcare has allowed for autonomy to prevail for so many years. Caregivers are encouraged to “create the wheel” with each and every patient. Because an inidividual’s anatomy and physiology are so unique, it is sometimes necessary to treat using non-conventional ways. With that said, it makes sense to me that healthcare workers can’t grasp on to something as simple as Lean Thinking. It’s ironic that something so simple is so difficult. As someone pointed out to me the other day, “Lean just makes sense; it’s easy to do, and we probably do it already in our private lives.” I couldn’t agree more with this. Lean is simple, and that is why it is hard to accept in such a complex system. Simplifying our lives seems like an injustice to the patient. However, if we boil it down, it is what is best the patient. A process that operates free of variation does decrease error, which does increase the quality of care.

The problem is, how do I get the employees to realize this? You can give them real world examples and you can play little games to show them how efficient a process is when you cut the waste from it, but they still come back to the ideology that the real world is different than healthcare. “In healthcare, we’re different.” Really? If I were a patron of a fast food restaurant, I don’t want to wait for a burger with no pickles for 15 minutes and receive it cold. As a buyer of a new automobile, I don’t want to wait an extra six weeks to get leather seats instead of the standard fabric interior. As an airline passenger, I don’t want to pay for first class and have to sit in coach. As a patient, I don’t want to pay a premium to wait and ultimately receive poor care. That’s the point, it’s not about the employee, it’s about the patient. That is what everyone in healthcare must realize in order for Lean to sustain. Treat the patient like you were treating yourself. Would you feel comfortable walking into a treatment room that was filthy, unorganized, and where no two rooms looked alike? Would you want to sit and wait for 3 hours before you’re seen by anyone? When we realize this is when we begin to live in a Lean world.

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Unfortunately, the complexity of healthcare, combined with its autonomy is what is keeping healthcare from changing its attitude from “we’re as good as we can be” to “we must be even better.” Further, management must be willing to take a stand and promote continuous improvement as a way of life. The autonomy that healthcare workers have had for so long is just not going to work. As the saying goes, “if you do what you’ve always done, you’ll get what you’ve always got.” It’s time the delivery of care catches up to the 21st century.

Comments 6

  1. Meikah

    If healthcare is that bad there, just imagine how bad it is here in my end. I think you’re describing people who lack empathy. They cannot relate because they have not been in a situation where they received poor healthcare. Just wait till they are actually at the receiving end of a lousy healthcare service. The thing is, can you wait for that or do you need to wait for something like that to happen. As you carefully put it, these people should be proactive. Best of luck to you, anyway!

  2. Dr. Eugene Jacquescoley


    I understand your frustration. In particular with the “general” culture that plagues healthcare [as it relates to the adoption of standard operations]. Moreover, as a clinician, who embraces new technology, quality improvement and of course Six Sigma, for the sake of improved patient care, reduced variation and improved bottom line…it is unfortunate there are those individuals within my own community of providers, who are reluctant to embrace this sort of change.

    It has been considered by many in Six Sigma community that standard operations emcompass a fine mixture of technology, processes, and people (e.g., GE Healthcare). Efficiency in the healthcare community can mean many things. Especially, when is an accrediting body like(Joint Commission) is involved in grading a healthcare facility that is seeking distinction from other facilities. I refer to this particular example, because during this time of chaos, while a survey is being conducted by this particular accrediting body…a level of dysfunction ultimately reveals itself during this arduous process. Your comment “I’ve been over it thousands of times, and I came to a realization just the other day-healthcare is made up of a myriad of individual thinkers”; made me reflect on a recent survey. Whereas, the executive management were operating from a different set of priorities compared with the rest of the hospital staff.

    Overall, I agree with your observation. Think along the lines of innovation.

  3. Mark

    In addressing a problem, the fallback approach I’ve noticed in healthcare is to simply work harder and/or add more people to an already struggling process. Actually changing what you do is more difficult and more painful, and this is often resisted with surprising vigor. Complicate this with entitlement attitudes, professional pride and the tricky relationships between physicians and staff, and you’ve got a recipe for stagnation. You’re absolutely right — the patient is the common ground in all of this, often caught in the crossfire. Too often, I see staff and practitioners hiding behind "patient care" to protect the way they like to do things. I’ve even heard some bemoan the fact that we’re so busy. A key, I believe, is to start treating the whole patient experience as seriously as we do the clinical outcome. Then we can truly claim we have a customer-centered operation.

  4. Joel Gingery

    I recently asked a similar question of Michael Balle, one of the authors of THE GOLD MINE. His reply (edited):

    “To my mind, most of the misunderstandings arise from the notion that lean is simply a set of simple activities which, applied to one’s normal job, will make it marginally more efficient. So let’s have a few kaizen events, and business continues as usual.

    “This has not been our experience of successful lean implementation. What tends to happen is that as people change their perspective as they acquire “lean glasses” to see the waste, the overburden, and the stop-and-go they create, they also start making fundamental changes to the way they do their day to day jobs. And, to most of us past thirty, re-learning how to do what we’ve always done in a certain way does not come naturally, not surprisingly.

    “Bumping heads, as you put it, is the result of “lead, follow or get out the way”, and as lean is a system, sooner or the way, every one’s job will be touched, and every person will react very differently to the lean challenge, hence the specific path of each plant in the lean transformation.

    “… lean is not a “state”, it’s an attitude, a state of mind – it’s a constant challenging of current processes to reach the true north of better customer satisfaction.”

    Some will have to “get out of the way”! How to handle these people?

    I recommend reading THEGOLD MINE

  5. Andrew M. Hillig

    Thank you for the recommendation.

    My biggest concern is with getting people to see that "… lean is not a ’state,’ it’s an attitude, a state of mind." I see it, everyone close to me sees it, how can the employees not see it? I also think that this barrier has no age range. I have seen new careerist, such as myself, battling with the idea of making lean a way of life as well.

    To combat this reoccuring problem, we don’t do Kaizen events. We take our time with our implementations and make sure that all of our bases are covered and that the staff is fully understanding of what we are trying to accomplish. It’s at this point where the implementation breaks down. I am not sure if they don’t get it, or don’t want to get it.

  6. Capt.-Kaizen

    When trying to implement some new procedures or policies, very often this happens. What I might suggest you try doing is during the "define" stage communication with the people who will be actually performing the implementation is very important. During this time it is important that you discuss what their concerns are and address them at that time. Get their ideas as to how the new procedure(s) should be from their perspective and (you almost have to become an attorney who asks questions to "lead" the witness) you have them give "buy in" and then implementation becomes much easier.

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