Friday, August 07, 2015

Gene cites John: Makes great sense!

For some of us, one thing that makes Friday a great day is receiving Gene Lindsey's weekly email.  It's full of observations about the health care world, living in the woods of New Hampshire, and baseball--not to mention nostalgic visits to his childhood. (You can read previous editions here.)

Gene is a die-hard adherent of Lean, a process improvement and managerial philosophy that has both been used to great effect in the hospital world and has been an utter failure in the hospital world.  I am pleased that my hospital's experience fell into the former camp. In this week's edition, Gene reviews John Toussaint's latest book Management on the Mend, where he excerpts useful thoughts offered by one of the most successful employers of Lean.

Why has Lean succeeded in some places and failed in others? Gene summarizes the key lesson from the book:

"I think there is great evidence that John has walked the talk. Indeed the necessity that leaders be personally transformed if organizational transformation is to occur is a recurrent theme in the book which is really an open letter to healthcare leadership and their boards with the express purpose of convincing them that leadership is critical to Lean success. He introduces this idea on page three!

"The most common problem that I see [discussing the more than 145 organizations that he has personally visited that are in various stages of understanding Lean] is that leaders fail to recognize the magnitude of change that will be required and that change extends to leaders on a personal level."

I wrote back to Gene:

I went through it by osmosis, I guess, but as I look back on it later, I see a major maturation that took place in my leadership approach. 

Indeed, it was not until after I left my CEO post at BIDMC that I realized the extent of my own transformation and that I had adopted the mantra, "Lead as though you have no authority." Mark Graban interprets this:  "This doesn’t mean completely giving away your authority… it means not relying on that formal authority."  Or as W. Edwards Deming put it: "The leader is coach and counsel, not a judge."

As I meet with hospital clinical and administration leaders, I can quickly see which ones have reached this level of comfort in learning that their job is to work for the staff--not vice versa. And I can draw a quick correlation between their progress in doing so and the degree to which their institutions have become learning organizations.

If you are in a leadership position in a health care system, read John's book.  Then, lead or not.


Anonymous said...

Excellent article.

nonlocal MD said...

As I alluded to in a comment on a previous post, that one about the necessity for physicians' 'conversion', you are right - each and every person has to 'get it' on an individual level, or else you won't understand why you are doing what you are doing. (This is not confined to Lean, but applies to the entire safety and quality movement.) It really is transformative when you finally see the light.

If a CEO or physician chief wants to just implement this as the latest cool thing he's heard about, it will fail and s/he will have wasted his money. Unfortunately, that is exactly what I saw happening in my shop. Don't bother then, because the inevitable failure leaves a bad taste in everyone's mouth and sours them when you want to (or, God forbid, incentives and penalties force you unwillingly) to try again.

Carole said...

Nonlocal MD
I can imagine all your patients realizing that they are truly blessed and fortunate to have you by their side, with your strong views and opinions about patient safety and transparency. Lord knows what a better place this world would be with more "JUST LIKE YOU". I'd like to believe you are not an exception to the rule, but what you are, is a pleasant and happy surprise for me!!!