The document discusses sustaining lean healthcare transformations. It notes that transformations require a culture change and developing management skills through coaching at all levels. Managers need to facilitate improvements by regularly observing work instead of just being on quality teams. Executives also need to evaluate their time to provide leadership presence. Training individuals without systems thinking can destroy value from poor coordination. There is no market discipline to encourage process excellence. Framing operations as a skilled trade can help realize benefits by directly involving senior management, working across divides, and nurturing long-term improvement focused on patient value. Success depends on intentionally developing people.

1. Lean In Health care – Crossing
the hurdles & The SRMC Story
Dr.Mahesh Vakamudi
Prof. & Head, Anesthesiology, Critical
Care, Pain Medicine

2. Let’s begin with the end in mind
Steven Covey
• What do you want to be in the transformed
state?
• What will a successful Lean Healthcare
transformation l k lik f you and when will
f i look like for d h ill
you get there?

3. If the answer to this question is
“Our quality department will have the skills to
apply Lean Healthcare tools and improve our
scorecard,”
…. you will find the journey very difficult if not
impossible

4. If, on the other hand, your answer to this
question is
“Every clinical service line and support area will
Every
be analyzing, improving and stabilizing their
work on a continuous basis to improve the
value we give to our patients and we will
achieve this state within the next five years ,
years”
……you may very well succeed
ll d

5. Lean in Healthcare must be
implemented as a system, not j a
i l d just
set of tools
f

6. Are the improvements achieved in Lean in
Healthcare activities are short lived?
“How do we sustain our improvements?”
• It involves the adaptive change in people’s work
and minds
……… a culture change
• True lean transformation involves change
management, which requires observation,
questioning, dialogue,
questioning dialogue design and coaching
…….. at all levels.

7. Sustaining Lean in Healthcare
• A common problem in healthcare is that we
don’t give managers the training and skill sets
to manage. We commonly assume that since
they are good clinicians they will make good
managers, and this is not so.
• Management skills can’t be assumed, they
need to be taught and these people need to
g p p
be developed intentionally

8. Sustaining Lean in Healthcare
g
• Managers need to be facilitating
improvements, not j members of the
i just b f h
quality or Lean department
• Managers are likely the busiest people in y
g y p p your
hospital and will be the first to tell you they
don’t have time to do these things because
g
they have so much on their plate. They’re
right.
g

9. “The currency of leadership is presence”
• This requires going to where the work is being
done regularly where they can see the work,
dialogue with staff, understand the i
di l i h ff d d h issues and d
provide support.
• It is likely that executives will also need to
critically evaluate how they are currently
spending their time and redesign their work such
that they have the presence required to lead the
transformation.
transformation

10. “It is easier to act your way into a new way of
thinking”
than
“To think your way into a new way of acting”
• The experience of solving problems and using
the Lean Healthcare tools will provide the
means for cultural development.

11. Internal Problem
Training in Functions without Systems Thinking
In practice, you have individuals working hard to
create value, with much of this value
destroyed in poor coordination and
communication

12. External Problem
No Market Discipline
No market benchmarks or standards to
k b h k d d
Encourage Process Excellence and to Punish
Process Laggards
P L d

13. Framing O excellence as a skilled trade, not a
i Ops ll kill d d
professional discipline

14. The Famous Five
• 1. Flavor‐of‐the‐Month Syndrome
• 2. Strong Leadership
• 3. Lean as a Headcount Reduction Tool
• 4.
4 You Need a Coach
• 5. Lean Is Easily Overblown

15. To better realize the potential benefits of Lean
Healthcare organizations need to
Directly involve senior management,
Work across functional divides
divides,
Pursue value creation for patients and
other customers
Nurture a long‐term view of continual
improvement.

16. The challenge is to revolutionise our
expectations of h l h
f healthcare
“To design a continuous flow of work for
clinicians and seamless experience of care for
patients”
Don Berwick, “Reducing Delays and Waiting Times Throughout the Healthcare System”

17. Trades person
d
Dir
Foreman
Prog Mgr
g g
Site Manager Site Manager
Foreman Prog Mgr
Support Dir Support
Trades person
TRADITIONAL LEAN

18. In the end your success will be determined by
end,
your people, your most important
asset.
asset Develop them intentionally and you
will succeed.