Role Of Change Leadership During Healthcare Excellence Journey 3
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. othersLean initiatives have failed to deliver The Emotional Cycle of Change has 5significant value to customers whenthe efforts are not aligned with the Optimism / stages Enthusiasmorganization’s strategy and fail to fully Rewardingengage the workforce. Lean has to Uninformed Completion Optimism (Satisfaction)become more than a program or a (Hope) Informed Optimismseries of events - it must become a Informed (Confidence)way of life which permeates all levels Pessimism (Doubt) Hopefulof the organization. Many Realism (Hope)organizations do a few Kaizen eventsin selected areas to solve majorproblems and consider the job done. Figure 1 TimeYet, all that is created is initialexcitement with isolated Lean entails large-scale organizationalimprovements not linked to the overall change triggering emotional reactions;value stream or enterprise followed by denial, negativity, tentativelack of sustainability. Lean is a acceptance, and commitment.profoundly different way to think and Leadership can either facilitate thisto behave. emotional process or ignore it at the risk of the transformation effort. TheEvidence of “Toolbox Lean” as difference in implementation of thedescribed above is all around; traditional “Toolbox Lean” and realprocesses in waiting areas, labs, and transformational lean is leadership.patient care units have been mappedto death, events are run to Organizations must embrace lean asdemonstrate how much clutter can be an operations business systemremoved from the workplace and supported by leadership and enabledsupply cabinets, case studies are by aligned, focused activities. To bepublished, and best practices are successful, a lean framework mustshared. Yet seldom are these include; leaders who embrace the leanaccompanied by a change in behavior, philosophy and build accountability forand thus the results of these well- sustainable improvement in key valueintentioned activities are little more streams, a dedication to developingthan fads or at best short-range lean talent competent in the leaninitiatives, with results that are tools, and supporting infrastructuredisappointing and not sustainable. that drives alignment and maximizesMost lean occurrences have an impact. Leaders, regardless ofoveremphasis on tools, techniques and seniority, title, or responsibilities aretechnology versus the creation of employees who influence others.enablers such as; strategy alignment,change leadership, organizationaldevelopment and critical thinking – All too often, change is announced inwhich are vital in creating sustainable an enterprise vacuum, with littlelean transformations in healthcare. reason or rationale for what the
organization is trying to accomplish circumstance, challenges andand how this change supports the opportunities; illogical demandingvision; not appropriately "setting the people and organizations to changestage" for change. To prepare when they are most successful. Inemployees for success, leaders must many transformative changes the pastgive them pertinent information about success is not a valid indicator ofthe voice of the customer, as well as future success; in fact, past successglobal, economic, technological, may be the greatest obstacle.competitive, and industry trends. Transformation is a redefinition of whoIndividuals need to know the vision, the organization is and what it does –goals, and strategy of the Something Better, Somethingorganization. They need to understand Different.the financial reality of the businessand how their actions impact that Research has clearly identified fifteenreality. Everyone must understand leadership roles for a healthcarewhat is waste, what is value and non- excellence journey (Casey, 2009):value added as defined by thecustomer and that waste must be • Establish the need for changeviewed as enemy #1 in order to be • Establish a sense of urgencysuccessful. Waste; waiting, concerning the need forrework/defects, transporting, extra changeprocessing, over-production, • Have a clear vision forinventory, or motion, is the enemy of excellence and executablevalue. strategy • Effectively communicate theThe patient and the organization’s excellence vision so that it isstrategy need to be central to the lean internalized at all levelstransformation. Lean strategy is newfor most healthcare leaders, therefore • Form cross functionalappropriate change management leadership teams to guide theapproaches should be applied to change for excellenceengage the entire organization on the • Ensure strategic initiatives arejourney from awareness through prioritized, focused and crossadoption to overall sustainability. functionally owned. CreatesLean always focuses on the value and alignment of functions withinthe Gemba (where the work is done); the organizationthe majority of the added value occurs • Guides actions to achievein the direct patient care and is often short term wins to builddriven by the nurses and doctors. commitment • Sets expectations and re-Lean competitive advantage is about enforce/reward desiredculture and development of outcomesorganizational competencies in a new • Effectively removeenterprise business system; hence is implementation obstacles fortransformational. Transformation can actionnot be managed with the same • Empower employees andstrategies used for incremental teams for actionchange. Incremental change is linear, • Participate in and sharepredictable, logical, and based on a ownershipprogressive acceleration of past • Provide emphasis on trainingperformance. Transformation is none and development of individualsof these things, often unpredictableresponding to unforeseen
• 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 onLean leadership in healthcare, as in stabilizing the physical environment inany other industry, is dependent on preparation for effective evaluationthe transformation and behavior of and analysis.individuals. If staff do not trustleadership, do not share the CUSTOMER SATISFACTION /organizations vision, do not buy into QUALITY EXCELLENCEthe reason for change, and are not Distinctive Competencies ZERO DEFECT Flexible, Capable, Reliable Resources ZERO PPMincluded in the planning, there will beno successful change regardless of Andhow brilliant the strategy. Effective Action Processleadership is a critical success factor PROCESS PERFORMANCEDaily Management Lean MONITORand plays a significant role in cultural SUPPLIER DEVELOPMENTStream Management Value & MONITORtransformation. Nothing has CONTROL PLAN Achieve Stability DFMEA / PFMEAhighlighted this more than observing Policy Deployment Human Capital APQPlean transformations throughoutdiverse industries and service areas Figure 2since 1990.Lean will succeed or fail based upon Facilitators must guide development ofthe organizations leadership. Lean will the organization’s design for leanhighlight the strengths and deployment, which aligns and definesweaknesses of leadership. Leaders executive-level ownership andthat are weak, can not make things accountability, identifies how manyhappen, do not follow through in and which people to train for criticalexecution, don’t communicate, or can roles, and outlines a communicationnot accept change. This will become plan for the initiative.more evident than ever during a leantransformation. The good news is thatstrong leaders and managers will cometo the surface; promote the strong.Enlightened leadership position thelean strategy for success through goalalignment and building the necessaryinfrastructure. They focus on processimprovement tied to organizationaldevelopment, individual growth andvalue, performance reviews andreward/recognition mechanisms.Leaders leverage the organizationcoupled with lean strategy to ensurethat they have a sustainable long termapproach that engages the entire Figure 3workforce.
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 teamgive senior leaders, directors and efforts and achievements.managers a high-level overview of keylean concepts and how to apply them • Leadership commitment – leadin a healthcare environment. These by example. Practice the “Go,sessions also introduce change Look, See” method. Go to themanagement tools and determine how point of cause of the problembest to leverage them to support the as quickly as possible, while themultiple process changes that will evidence is fresh. Be preparedoccur. This helps leaders at all levels to do and practicallyunderstand their roles as sponsors, demonstrate what you expectand 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 visibleHealthcare lean leadership behaviors and easy to interpret ratherinclude: 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
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 BenchmarkingIn this new approach governance and Achieve Competitive Advantage • Customer Directly linked to Order Process • Integrated VOC • Sustained practices and behaviorsleadership support at all organizational •Build system of refinement and continuous improvement Six Sigma Product & Processeslevels is critical to achieving successfuland sustainable improvements. Feedback Integration • Institutionalized Six Sigma across functionsLeaders 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 reviewscompelled to implement concepts that •Extended value chain engagement •Re-assessment •Feedback integrationhave been defined solely by senior •Self directed work teams •Enlightened leadership •Expectation reinforcementmanagement. Employees andphysicians need to see the benefits Figure 3Dand are enabled and actively engagedin improving the workplace forthemselves, their patients and the to empower appropriate staff andorganization. These individuals are in physicians and ensure that they havethe best positions to initiate, the appropriate knowledge, expertise and time to be successful. True
competitive advantage resides in the the enterprise is to survive. Thecreation of a distinctive competency potential of the work force really is thefounded in the organization’s culture enterprise’s greatest asset.of; critical thinking, problem solving, Developing organizational competencechange, innovation, and healthcare requires education and training at allexcellence. 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 4Trust in the intelligence, capability, management model in mind - knowingand creativity of employees and people which stakeholders in the organizationwill astound you. In the Industrial Age, need awareness level training andcompanies squandered immense those that need deep levels ofamounts of human potential on expertise. An assessment via a leanmindless, repetitive tasks and Value Stream Analysis can help themeaningless paper work. It never organization measure where it standsoccurred to leaders in those days that on the road to lean awareness,their assembly-line workers had the readiness, and sustainability. Suchknow-how to rebuild entire car diagnostics helps establish what isengines, negotiated complicated bank required to develop and maintainloans, managing household budgets, those that can sustain gains and buildorganizing charity drives, or run on existing strength and capacity.complex volunteer organizations intheir spare time. Today, no A communication strategy that is notorganization can afford to waste congruent with organizational systemshuman capital; every talent, every and the actions of leadership isidea, every skill is needed urgently if useless. Corporate leaders are
beginning to learn the importance of accountability, organizations need tobehavior-based communication as a become true learning organizations.requirement for leading discontinuous Leaders need to adopt lean thinkingchange. Organizations send two methodologies as a way of life in theconcurrent sets of messages about organization. Leadership and strategychange. One set of messages goes alignment are key to a betterthrough formal channels of performing delivery system. Leaders,communications -- speeches, need to champion this development ofnewsletters, corporate videos, values organizational competency in leanstatements, and so forth. The other thinking in a strategic and alignedset of messages is delivered informally way. The right steps taken now andthrough a combination of "off the applied consistently throughout therecord" remarks and daily activities. organization will not only bring aboutFor todays skeptical employees, savings, but also help reduce therhetoric without action quickly frustrations that leave dedicateddisintegrates into empty slogans and professionals questioning the loftycompany propaganda. Ongoing and rhetoric.honest communication is both crucialand a must. You can not communicate The root cause of initiative failure in aenough throughout the process, traditionally managed organizationespecially in the early days of the stems from the fundamental lack oftransformation. Communication must change leadership. Lack of a clearbe honest, providing a vision of what understanding that implementation ofis to be accomplished. sustainable operations excellence is not simply about deploying techniquesLack of timely action or follow-through of lean, but about the creation ofwill cause the process to fail. Nothing distinctive competencies in thewill kill buy-in and commitment from organization resources. Organizationalthe front line individuals faster than resources should be built uponleadership and management not knowledge, establishment of newfollowing through on commitments to values, expectations, behaviors andthe transformation, including action standards of performance, as well asitems, metrics, Gemba Walks, etc. To alignment of the organization structurenot follow through or stall coupled with process improvement toimprovements due to lack of attention support the new strategy. The realand commitment will be the death of bottom line is that sustainablethe transformation and destroy critical competitive advantage throughbuy-in at all levels of the organization. healthcare excellence is only achievable through organizationalLeadership’s commitment will be transformation.tested early and often. Leadershipmust walk the talk, only paying lipservice to the philosophy of lean willbe discovered quickly. Leadership willbe watched closely so look foropportunities to make believers out ofthose on the fence. This does notmean everything must be warm andfuzzy, but it does mean staying true tothe lean philosophy and purpose.In the complex environment with theevolution of new healthcare