1. Enlightened Leadership
Treating lean transformation as an
During the Lean event rather than a mental, physical
Healthcare Journey and emotional process disregards the
emotional process of change and when
Leadership is the capacity to influence addressed, leadership underestimates
its depth.
others
Lean initiatives have failed to deliver The Emotional Cycle of Change has 5
significant value to customers when
the efforts are not aligned with the Optimism /
stages
Enthusiasm
organization’s strategy and fail to fully Rewarding
engage the workforce. Lean has to Uninformed Completion
Optimism (Satisfaction)
become more than a program or a (Hope) Informed
Optimism
series of events - it must become a Informed
(Confidence)
way of life which permeates all levels Pessimism
(Doubt) Hopeful
of the organization. Many Realism
(Hope)
organizations do a few Kaizen events
in selected areas to solve major
problems and consider the job done. Figure 1
Time
Yet, all that is created is initial
excitement with isolated Lean entails large-scale organizational
improvements not linked to the overall change triggering emotional reactions;
value stream or enterprise followed by denial, negativity, tentative
lack of sustainability. Lean is a acceptance, and commitment.
profoundly different way to think and Leadership can either facilitate this
to behave. emotional process or ignore it at the
risk of the transformation effort. The
Evidence of “Toolbox Lean” as difference in implementation of the
described above is all around; traditional “Toolbox Lean” and real
processes in waiting areas, labs, and transformational lean is leadership.
patient care units have been mapped
to death, events are run to Organizations must embrace lean as
demonstrate how much clutter can be an operations business system
removed from the workplace and supported by leadership and enabled
supply cabinets, case studies are by aligned, focused activities. To be
published, and best practices are successful, a lean framework must
shared. Yet seldom are these include; leaders who embrace the lean
accompanied by a change in behavior, philosophy and build accountability for
and thus the results of these well- sustainable improvement in key value
intentioned activities are little more streams, a dedication to developing
than fads or at best short-range lean talent competent in the lean
initiatives, with results that are tools, and supporting infrastructure
disappointing and not sustainable. that drives alignment and maximizes
Most lean occurrences have an
impact. Leaders, regardless of
overemphasis on tools, techniques and
seniority, title, or responsibilities are
technology versus the creation of
employees who influence others.
enablers such as; strategy alignment,
change leadership, organizational
development and critical thinking – All too often, change is announced in
which are vital in creating sustainable an enterprise vacuum, with little
lean transformations in healthcare. reason or rationale for what the

2. organization is trying to accomplish circumstance, challenges and
and how this change supports the opportunities; illogical demanding
vision; not appropriately "setting the people and organizations to change
stage" for change. To prepare when they are most successful. In
employees for success, leaders must many transformative changes the past
give them pertinent information about success is not a valid indicator of
the voice of the customer, as well as future success; in fact, past success
global, economic, technological, may be the greatest obstacle.
competitive, and industry trends. Transformation is a redefinition of who
Individuals need to know the vision, the organization is and what it does –
goals, and strategy of the Something Better, Something
organization. They need to understand Different.
the financial reality of the business
and how their actions impact that Research has clearly identified fifteen
reality. Everyone must understand leadership roles for a healthcare
what is waste, what is value and non- excellence journey (Casey, 2009):
value added as defined by the
customer and that waste must be • Establish the need for change
viewed as enemy #1 in order to be • Establish a sense of urgency
successful. Waste; waiting, concerning the need for
rework/defects, transporting, extra change
processing, over-production, • Have a clear vision for
inventory, or motion, is the enemy of
excellence and executable
value.
strategy
• Effectively communicate the
The patient and the organization’s
excellence vision so that it is
strategy need to be central to the lean
internalized at all levels
transformation. Lean strategy is new
for most healthcare leaders, therefore • Form cross functional
appropriate change management leadership teams to guide the
approaches should be applied to change for excellence
engage the entire organization on the • Ensure strategic initiatives are
journey from awareness through prioritized, focused and cross
adoption to overall sustainability. functionally owned. Creates
Lean always focuses on the value and alignment of functions within
the Gemba (where the work is done); the organization
the majority of the added value occurs • Guides actions to achieve
in the direct patient care and is often short term wins to build
driven by the nurses and doctors. commitment
• Sets expectations and re-
Lean competitive advantage is about enforce/reward desired
culture and development of outcomes
organizational competencies in a new • Effectively remove
enterprise business system; hence is implementation obstacles for
transformational. Transformation can action
not be managed with the same • Empower employees and
strategies used for incremental teams for action
change. Incremental change is linear, • Participate in and share
predictable, logical, and based on a ownership
progressive acceleration of past • Provide emphasis on training
performance. Transformation is none and development of individuals
of these things, often unpredictable
responding to unforeseen

3. • Drive the excellence change to The Healthcare House of Lean (Figure
include suppliers and 2), Healthcare Excellence Leadership
customers Roadmap (Figure 3A – E), and Lean
• Exemplify desired expectations Healthcare Transformation Model
and behaviors (Figure 4) give insight on how to
• Provide focus and structure to apply lean leadership principles as the
ensure sustainment of change organization processes mature. The
first phase of lean will focus on
Lean leadership in healthcare, as in stabilizing the physical environment in
any other industry, is dependent on preparation for effective evaluation
the transformation and behavior of and analysis.
individuals. If staff do not trust
leadership, do not share the CUSTOMER
SATISFACTION /
organization's vision, do not buy into QUALITY EXCELLENCE
the reason for change, and are not
Distinctive Competencies
ZERO DEFECT
Flexible, Capable, Reliable Resources
ZERO PPM
included in the planning, there will be
no successful change regardless of And
how brilliant the strategy. Effective
Action
Process
leadership is a critical success factor PROCESS PERFORMANCEDaily Management
Lean MONITOR
and plays a significant role in cultural SUPPLIER DEVELOPMENTStream Management
Value & MONITOR
transformation. Nothing has
CONTROL PLAN
Achieve Stability
DFMEA / PFMEA
highlighted this more than observing
Policy Deployment
Human Capital
APQP
lean transformations throughout
diverse industries and service areas Figure 2
since 1990.
Lean will succeed or fail based upon Facilitators must guide development of
the organizations leadership. Lean will the organization’s design for lean
highlight the strengths and deployment, which aligns and defines
weaknesses of leadership. Leaders executive-level ownership and
that are weak, can not make things accountability, identifies how many
happen, do not follow through in and which people to train for critical
execution, don’t communicate, or can roles, and outlines a communication
not accept change. This will become plan for the initiative.
more evident than ever during a lean
transformation. The good news is that
strong leaders and managers will come
to the surface; promote the strong.
Enlightened leadership position the
lean strategy for success through goal
alignment and building the necessary
infrastructure. They focus on process
improvement tied to organizational
development, individual growth and
value, performance reviews and
reward/recognition mechanisms.
Leaders leverage the organization
coupled with lean strategy to ensure
that they have a sustainable long term
approach that engages the entire
Figure 3
workforce.

4. not blame. Foster a deep
Phase 1: Learn (Organizational Understanding and
Readiness) understanding of the problem
by leading effective root cause
•Leadership understanding
•Create Steering Team
of organizational
•Leadership development
development and culture
•Change leadership training
change
analysis. Live to the principle
•Change Awareness and Readiness Forces of
Change •Situation Analysis
•Id and build infrastructure to support
Situation •Baseline assessment
the change Analysis •SWOT
•Develop communication Plan to
that it’s OK to make mistakes
•Customer Expectations
support organization and strategy
•Business Expectations
change Develop •Establish the need for
•Develop Boot camp/SME/LLDP Organizational change
as long as we learn from them.
Structure
•Establish Why change
•Establish sense of urgency
•Man
• Job Relations
• Support and recognition.
• Job Instructions
• Job Methods Achieve
•Machine Stability
• Maintenance Excellence
Encourage the use of a clear
• Capacity/Constraints/Demand Plan
• 6 Big Losses
•Material
• Inventory, BOM, routing, specification accuracy
escalation process to inspire
• Plan and Scheduling
• Handling methods
• Supply chain quality
•Methods
confidence that the work is
• Visual control, KPI tracking and countermeasures
• PSDM/PDCA, critical process audits, 7 quality tools
• COQ, cost system and standards
• Daily Management System in place
valued and that leadership
cares. Be available for people.
Figure 3A As a leader, direct all support
by yourself and others, towards
the point where value is added.
Additional development is needed to
Recognize individual and team
give senior leaders, directors and
efforts and achievements.
managers a high-level overview of key
lean concepts and how to apply them • Leadership commitment – lead
in a healthcare environment. These by example. Practice the “Go,
sessions also introduce change Look, See” method. Go to the
management tools and determine how point of cause of the problem
best to leverage them to support the as quickly as possible, while the
multiple process changes that will evidence is fresh. Be prepared
occur. This helps leaders at all levels to do and practically
understand their roles as sponsors, demonstrate what you expect
and the leadership behaviors they of others.
must employ in a lean-thinking • Deploy strategy and objectives.
empowered culture. Use and follow master
schedules. Keep them visible
Healthcare lean leadership behaviors and easy to interpret rather
include: than remote in an office. To be
useful, it must be reviewed
frequently and regularly. Guide
• Teach and engage the
and lead your people to
workforce. The leaders
understand their worth and
communicate with the team
their ideas to meet the wider
through systematic habitual
program objectives.
site visits and audits of the
process. They encourage • Commitment to standards.
people to challenge and be Understand and use standards
creative in their efforts to to define normal and abnormal
improve the process. (what should be happening
versus what actual is
• Respect for people. Others are
happening) conditions.
treated as they expect to be
Develop clear, user friendly,
treated. Leaders recognize that
visual controls at all levels to
communication is a two-way
help monitor and improve
process. Relationships in teams
standards. Maintain personal
are developed on the basis of
discipline, direct and coach
mutual trust and respect.
others to keep within standards
• Process focus. When problems and procedures. Always react
are investigated, tackle the to off-standard and off-target
process first not the people. Do situations with immediate

5. investigation and implement and achieve such
countermeasure. improvements. The strategic aim of
• Understand lean vision and any organization, therefore, should be
principles. Promote lean
Phase 2: Focus (Structure to Transform)
concepts and principles by •Create VSM
•Vision
•Long Range Strategic Plan
actions and decisions. In • Current •Strategy Deployment/BTO
• Future •Training to build leader change
• Ideal readiness and capacity
particular, promote
•Develop Implementation Plan – •Communication plan execution
(includes connecting with VSM and •Leadership commitment & trust
AOP’s) coaching
•Analyze for impact •Organizational structure,
visualization of information and • Translate insights to operational process, culture, people, and
terms measures/rewards refinement to
• Quality defect Pareto analysis / support strategy
•Performance and Reward
processes. Continually
Develop QCP
• Launch ongoing training program system alignment
• Benchmarking •Policies and Procedures
alignment
challenge the current care •Prepare organization to support execution
Define Strategy
and Vision
practices. Always relate and
•Focused initiatives and objectives/Priority
Matrix
•Structured reviews Identify Improvement Opportunities
confirm activities to the
•Leadership by example to demonstrate and Develop Plans
the old ways are gone
•Structured engagement events/RIE Enable Structured
•Timely specific training Action
achievement of a clearly
•Establish Teams
•Cross Functional Ownership
•Workplace organization/visual management
• LDMS
defined program and •Critical Thinking/A3/RCA
organization vision. Guide
others to understanding and
work towards a clearly defined Figure 3B
vision.
• Support the change process.
Phase 3: Align (Implement and Execution)
Understand and know what the
changes are and take an active
• Extending the VS to suppliers
• FMEA’s performed on existing critical
processes
• Modular Design
part in the change, • Value Stream Accounting
• Consolidate and lessons learned
•Center for Healthcare Excellence with
demonstrating positive change
institutionalized patient experience focus
• Transition of Care
actions yourself. Lead change,
• Capacity flexing to Demand Takt
• Process Capability initiatives
• Line Stop
identify and remove roadblocks,
Institutionalized • Escalation Review process
Operations
Excellence
• Empowered Teams
checking that all the factors for • Standard Work
• Skills Versatility
• Pull/1 for 1
change are in place. Stimulate
Continuous
improvement
• Quick Change Over
• Quality at Source
• TPM
others and inspire actions
• Ergonomics Improvement Plan
• Visual Leadership and
Implement communication
For
• Kaizen (5-day change event)
towards the future state vision.
Short Wins
• Create value stream aligned
management structure
Identify your own inhibitors, be
honest and communicate to
help evolve methods to Figure 3C
overcome lack of knowledge
and confidence. Work one step
at a time, check, confirm and Phase 4: Institutionalized
then move on. (Continuous Competitive Advantage)
• Center of Excellence (COE)
• Zero New Product Launch issues
• World Class Benchmarking
In this new approach governance and Achieve
Competitive
Advantage
• Customer Directly linked to Order Process
• Integrated VOC
• Sustained practices and behaviors
leadership support at all organizational
•Build system of refinement and continuous
improvement
Six Sigma Product
& Processes
levels is critical to achieving successful
and sustainable improvements. Feedback
Integration
• Institutionalized Six Sigma across
functions
Leaders should inspire people to adopt
• Supplier Performance Management
• Build to end-customer demand
• Early Supplier NPD Involvement
• Value Added services to Customers –
change and not leave them feeling
•Communication Plan Total Solutions
•Best practice/lessons learned
reviews
compelled to implement concepts that
•Extended value chain
engagement
•Re-assessment
•Feedback integration
have been defined solely by senior •Self directed work teams
•Enlightened leadership
•Expectation reinforcement
management. Employees and
physicians need to see the benefits
Figure 3D
and are enabled and actively engaged
in improving the workplace for
themselves, their patients and the to empower appropriate staff and
organization. These individuals are in physicians and ensure that they have
the best positions to initiate, the appropriate knowledge, expertise
and time to be successful. True

6. competitive advantage resides in the the enterprise is to survive. The
creation of a distinctive competency potential of the work force really is the
founded in the organization’s culture enterprise’s greatest asset.
of; critical thinking, problem solving, Developing organizational competence
change, innovation, and healthcare requires education and training at all
excellence. levels. This is designed with a change
Healthcare Excellence Leadership Roadmap
Learn Focus Align Institutionalize
Continuous
Organizational Structure to Competitive
Transformation
Understanding Engage Advantage
•Understand Organizational •Communicate •Communicate •Communicate
Development and Change •Establish credibility •Coaches Empowered Teams •Champions Best practice &
•Lean change awareness & •Interpersonal savvy •Facilitates RIEs Lessons Learned
readiness •Resolving conflict •Conducts Structured Reviews •Engages Extended Value
•Lead with purpose •Learning to delegate of Initiatives Chain ownership
•Conduct HCX assessment •Benchmarks •Leadership by Example •Integrates Feedback
•Establish Why change •Create Training Plan •Coaches others on Improvement •Mentors Self Directed
•Establish Vision & Urgency •Builds leadership Tools & Techniques Work Teams
•Complete OEL training commitment •Operations Champion on Waste •Monitors Supplier
•Establish Communication •Assist Strategy Deployment •Champions OpX to Extended Performance
plan •Establish Teams Value Stream •Conducts VOC
•Create Infrastructure for Change •Facilitates change efforts •Performs FMEAs •Enlightened Leadership of COE
•Establish ELT •Policy and procedures •Lean Certification •Strategic thinking
•Ensure CAP is in place •Organizational structure •Conduct Strategy Deployment •Champions Strategy Deployment
•Establish Customer for Value Streams •Build relationships •Identify innovation and new
expectations •Facilitates VSM •Think and act systematically business
•Business knowledge •Creates Implementation •Manage organizational complexity •Creating and articulating vision
Plan •Implementing change •Creating strategic alignment
•LDMS Established •Taking risk •Leading culture
•Embraces change •Visionary •Catalyzing change
•Developing value in others
Figure 4
Trust in the intelligence, capability, management model in mind - knowing
and creativity of employees and people which stakeholders in the organization
will astound you. In the Industrial Age, need awareness level training and
companies squandered immense those that need deep levels of
amounts of human potential on expertise. An assessment via a lean
mindless, repetitive tasks and Value Stream Analysis can help the
meaningless paper work. It never organization measure where it stands
occurred to leaders in those days that on the road to lean awareness,
their assembly-line workers had the readiness, and sustainability. Such
know-how to rebuild entire car diagnostics helps establish what is
engines, negotiated complicated bank required to develop and maintain
loans, managing household budgets, those that can sustain gains and build
organizing charity drives, or run on existing strength and capacity.
complex volunteer organizations in
their spare time. Today, no A communication strategy that is not
organization can afford to waste congruent with organizational systems
human capital; every talent, every and the actions of leadership is
idea, every skill is needed urgently if useless. Corporate leaders are

7. beginning to learn the importance of accountability, organizations need to
behavior-based communication as a become true learning organizations.
requirement for leading discontinuous Leaders need to adopt lean thinking
change. Organizations send two methodologies as a way of life in the
concurrent sets of messages about organization. Leadership and strategy
change. One set of messages goes alignment are key to a better
through formal channels of performing delivery system. Leaders,
communications -- speeches, need to champion this development of
newsletters, corporate videos, values organizational competency in lean
statements, and so forth. The other thinking in a strategic and aligned
set of messages is delivered informally way. The right steps taken now and
through a combination of "off the applied consistently throughout the
record" remarks and daily activities. organization will not only bring about
For today's skeptical employees, savings, but also help reduce the
rhetoric without action quickly frustrations that leave dedicated
disintegrates into empty slogans and professionals questioning the lofty
company propaganda. Ongoing and rhetoric.
honest communication is both crucial
and a must. You can not communicate The root cause of initiative failure in a
enough throughout the process, traditionally managed organization
especially in the early days of the stems from the fundamental lack of
transformation. Communication must change leadership. Lack of a clear
be honest, providing a vision of what understanding that implementation of
is to be accomplished. sustainable operations excellence is
not simply about deploying techniques
Lack of timely action or follow-through of lean, but about the creation of
will cause the process to fail. Nothing distinctive competencies in the
will kill buy-in and commitment from organization resources. Organizational
the front line individuals faster than resources should be built upon
leadership and management not knowledge, establishment of new
following through on commitments to values, expectations, behaviors and
the transformation, including action standards of performance, as well as
items, metrics, Gemba Walks, etc. To alignment of the organization structure
not follow through or stall coupled with process improvement to
improvements due to lack of attention support the new strategy. The real
and commitment will be the death of bottom line is that sustainable
the transformation and destroy critical competitive advantage through
buy-in at all levels of the organization. healthcare excellence is only
achievable through organizational
Leadership’s commitment will be transformation.
tested early and often. Leadership
must walk the talk, only paying lip
service to the philosophy of lean will
be discovered quickly. Leadership will
be watched closely so look for
opportunities to make believers out of
those on the fence. This does not
mean everything must be warm and
fuzzy, but it does mean staying true to
the lean philosophy and purpose.
In the complex environment with the
evolution of new healthcare