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Lean In Health care – Crossing
the hurdles & The SRMC Story



         Dr.Mahesh Vakamudi
 Prof. & Head, Anesthesiology, Critical
          Care, Pain Medicine
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?
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
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
Lean in Healthcare must be
implemented as a system, not j a
i l          d               just
set of tools
     f
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.
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
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
“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
“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.
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
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
Framing O excellence as a skilled trade, not a
    i Ops     ll           kill d d
          professional discipline
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
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.
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”
Trades person
                         d
    Dir
                            Foreman
  Prog Mgr
     g g

Site Manager              Site Manager

  Foreman                   Prog Mgr

                Support       Dir        Support
Trades person



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

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Lean in health_care___crossing_the_hurdles final part 1

  • 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.