I am borrowing some slides recently presented by James Womack, of the Lean Enterprise Institute, as a follow-up to my previous post about adoption of the Lean philosophy in an organization. If the description there was Lean 101, this is Lean 404.
It is one thing to talk about reducing waste in a process and to learn techniques for doing so. It is another thing altogether to create the management competencies that permit this kind of process improvement to take place on a sustained basis. As Womack notes in the first slide above, most organizations do not have the competencies in place to do that.
In the slides below, he sets forth the difference in management approaches between the traditional view and the Lean environments. (Here is a similar oral description from a thoughtful doctor.)
How do you get there? The key is to have the nerve to experiment. Instead of thinking in traditional vertical silos and reporting relationships, you need to have enough confidence in people to let them think along the entire value stream of a given process. This empowers them to redesign the way work is done, extracting waste, improving worker satisfaction, and delivering more value to customers. In a hospital, where the customers are patients, "more value" can actually mean avoiding life-threatening errors and omissions. It can also "simply" mean a more pleasant experience; e.g., less time spent waiting to be seen in an ambulatory clinic.
Think about the organizational and leadership issue in soccer terms. Imagine that, as a coach, you try to improve your team by thinking separately about the forwards and how they will play and be evaluated; and then the midfielders; and then the defense; and then the goaltenders. Of course, that would be silly. The game is played horizontally -- not only across a field, but also across the various position players. As you reduce waste -- mishandled balls, poorly directed passes, and other miscues -- it is the interaction of the entire team, irrespective of vertical definitions, that leads to success. Your job as leader (coach) is to promote those interactions and engage all participants in process improvement. Yes, those goaltenders need their own specialized training, too; but your job as coach is the one Womack ends with below -- helping people figure out how to integrate the horizontal process improvement approach with the vertical organizational needs.
This is where LEAN meets naive, where the most exquisite design meets a primate. As finely tuned as we hone the machine, every human interface remains a gaping fault line for failure. This is never more obvious than healthcare. Behavior - its variation and determinants - of in situ life is just too messy for most disciplines (we like a lab), and our efforts are blindly stuck in assumptions of rationality. As you say, culture eats strategy for lunch. But what about culture? What behavior? And why?
ReplyDeleteHorizontal organization is really difficult not just because systems are not designed that way. It is really difficult because the benefits of hierarchy are so strong. And humans are designed to create them and take great advantage of them when they can. This demands a different ecological, rather than just operational, design. I'd like to see LEAN data on human failure as well studied as the easier links in the chain. But I don't think that we are even asking the right questions yet.