Like many performance improvement programs, the road to Lean typically begins as a series of projects.
However, these will at best involve a small proportion of hospital staff, so the majority remains unaware of the principles of Lean and the benefits derived from these projects.
Once the project has finished, the impetus to carry on the good work often stalls, as the team is diverted to other initiatives or simply caught up in daily firefighting. If the organization is to move away from projects and towards a continuous improvement culture, it has to involve all staff in developing and actioning new ideas.
An environment dedicated to results and creativity
This is where the classic elements of Lean emerge, through a series of structured daily, weekly and monthly sessions involving teams of nurses, managers and clinicians. At the core are daily huddle meetings – often lasting 10-15 minutes maximum – where people review progress and also have the freedom to raise issues and come up with ways of addressing challenges.
These huddles must be built into the daily work and occur consistently, with the most successful exponents of Lean addressing smaller daily improvements as well as larger, unit-level goals.
Daily improvement ideas come from frontline staff and are quickly prioritized (often on a whiteboard, where they are graded according to ease of implementation and degree of impact). Staff can then collectively agree which ideas should move forward or be dropped, and flag those larger ideas requiring additional support. During this selection process, the team is frequently asked how their solutions relate to wider strategic objectives, which reinforces corporate goals and ensures staff are aware how they are contributing to these goals.
Surprisingly, most staff quickly warm to the task of leading small improvement efforts, happy in the knowledge that they will not face a bureaucratic committee. Typically a solution is expected to be implemented within a week and, importantly, must address the root cause. Such enthusiasm spreads fast, helping to bring on board even those more skeptical people that have seen many previous improvement efforts fail to stay the course.
Instead of responding to instructions from above, doctors, nurses and managers will now be responsible for building and continually refining the patient experience. These individuals have the greatest knowledge of the critical issues facing the hospital and are best-positioned to address challenges such as waste, flow and variability.
Staff are far more likely to be enthusiastic about and compliant with new processes that they have helped to create themselves, confident that their solutions will result in better patient outcomes and greater efficiency for the hospital.
Financial or non-financial rewards can stimulate creativity; celebrating successes reinforces the new culture of change and lets everyone know that their ideas can be translated into visible, measurable improvements.
While gaining buy-in from clinicians can sometimes be a challenge, the data driven approach and sheer pace of Lean improvements at the frontline often wins over and engages this key group. Having been frustrated at the slow pace of change in the past, clinicians are attracted by the close involvement in the solution, where there is a clear and tangible link to patient quality and safety; the issues closest to their hearts.