As you have seen in examples below, BIDMC is engaged in adopting the Lean philosophy to enhance our effectiveness in taking care of patients. An underlying premise of Lean is a respectful work environment for our staff, valuing each person and empowering him/her to call out problems and participate in improving things.
This approach raises a question, though. What leadership characteristics are appropriate to support the approach that characterizes a Lean company?
Yesterday, Gene Lindsey (CEO of Atrius Health) and I shared a podium in a session for human resource professionals, and he drew on the work of Robert Greenleaf to offer his view. Greenleaf set forth the concept of "servant leadership." Here's an excerpt:
"The servant-leader is servant first… It begins with the natural feeling that one wants to serve, to serve first. Then conscious choice brings one to aspire to lead. That person is sharply different from one who is leader first... The difference manifests itself in the care taken by the servant-first to make sure that other people’s highest priority needs are being served. The best test, and difficult to administer, is: Do those served grow as persons? Do they, while being served, become healthier, wiser, freer, more autonomous, more likely themselves to become servants?
Coincidentally, this kind of approach was recently reflected to a group of our senior leaders by Mike Hoseus, Executive Director of the Center for Quality People and Organizations. (Mike is the co-author of Toyota Culture.) He presented an inverted organizational pyramid. Instead of the usual pyramid showing the CEO atop, this one shows the CEO at the bottom, followed by the vice presidents, senior managers, and group leaders. At the very top are the suppliers, team members, and customers. Nonetheless, without the energy and commitment of the CEO to the Lean endeavor, it will fail.
An audience participant at yesterday's HR session skeptically raised the question of the sustainability of the Lean approach in a corporate setting. Citing previous management fads like re-engineering, six sigma, and the like, what assurance is there that the lessons of Lean will take hold and persist beyond the term of a given CEO? We answered that there is no concrete assurance. Each CEO employs his or her own management philosophy.
But I have a feeling that, properly implemented, Lean is remarkably subversive in this respect: Once you teach staff to be "wiser, freer, more autonomous," a successor CEO is going to find it pretty hard to undo those characteristics. Indeed, a Board of Directors would find itself compelled to search out candidates who have a similar underlying philosophy.
This is not to say that there is an inevitable persistence to the use of Lean in an organization. Like physical systems in which entropy takes over, consistently applied energy is necessary to maintain the process improvement system that we call Lean.