As the healthcare delivery system transitions from volume to value, hospitals are looking for new ways to cut costs and improve quality. To accomplish these dual goals, many hospitals employ Lean manufacturing techniques, which involve examining processes end to end, and identifying and eliminating waste.
The more progressive hospitals and those whose programs are accelerating the fastest are those that have recruited Lean leaders from the manufacturing industry — where Lean was born as the Toyota Production System — to guide Lean initiatives. Most systems have been a little reluctant to do this in the past, according to Ted Stiles, a partner and vice president of executive search for Stiles Associates, a retained Lean executive search firm. "There is still some resistance around believing that someone could come in from outside and understand [healthcare] and be effective. This view is changing though. As more hospitals look at what systems like ThedaCare, Cleveland Clinic, and Group Health Cooperative have achieved with manufacturing executives, it’s becoming clear that the right leaders from manufacturing can really make a difference." he says.
Slowing down
One major challenge is the difference in pace between manufacturing and healthcare, with manufacturing drastically outpacing healthcare in its ability to make system-wide changes. This faster pace is due in part to the different structures of management in healthcare and manufacturing, according to Mr. Stiles. "Manufacturing organizations tend to be more aligned at the strategic level than healthcare organizations, so there is a higher level of understanding from top to bottom of the goal. They tend to move faster — everyone knows their part and they get out and do it," he says.
In addition, manufacturing organizations tend to be more hierarchical than hospitals, which affects the speed of decision making and implementation of decisions. Whereas a manager of a plant may make a decision and it is implemented directly, hospitals may gather stakeholders in meetings to discuss the costs and benefits to all parties. "Healthcare organizations are far more consensus oriented. Decisions are not necessarily made very quickly because there are a lot of considerations that need to be in the mix," Mr. Stiles says.
Although hospitals' slower pace may require Lean leaders to adjust, it does not mean lean techniques cannot be used to full effect. Lean leaders need to slow down, learn about the environment first, build trust and relationships and then move forward with process improvement. "Lead with humility, lead with relationship building," Mr. Stiles says, "because a highly educated clinical leader isn't going to necessarily care that you're the best at TPS [Toyota Production System] work. And they're probably not going to trust you right away."
Positioning Lean leaders for success
To integrate a Lean philosophy and approach into a hospital's culture, it is helpful to have Lean leaders report to someone as high in the leadership hierarchy as possible — if reporting to the CEO is unfeasible, they should report to the COO or other C-suite executive, according to Mr. Stiles. By having Lean leaders report directly to the operations decision makers, process improvements can be made quicker and more easily.
Including a Lean leader on the executive team is still new to hospitals, so the position title varies by organization. Mr. Stiles says some common titles are Director of Lean Transformation and Director or Vice President of Process Improvement, Business Excellence or Process Excellence. Under the Lean director hospitals typically have "anywhere from two to 20 Lean experts and process excellence coaches," Mr. Stiles says.
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The more progressive hospitals and those whose programs are accelerating the fastest are those that have recruited Lean leaders from the manufacturing industry — where Lean was born as the Toyota Production System — to guide Lean initiatives. Most systems have been a little reluctant to do this in the past, according to Ted Stiles, a partner and vice president of executive search for Stiles Associates, a retained Lean executive search firm. "There is still some resistance around believing that someone could come in from outside and understand [healthcare] and be effective. This view is changing though. As more hospitals look at what systems like ThedaCare, Cleveland Clinic, and Group Health Cooperative have achieved with manufacturing executives, it’s becoming clear that the right leaders from manufacturing can really make a difference." he says.
Making the leap
While the involvement of manufacturing experts in healthcare has become more accepted, there are still challenges for Lean leaders transitioning between these two industries. Mr. Stiles describes what Lean leaders need to cross these industries' boundaries.Slowing down
One major challenge is the difference in pace between manufacturing and healthcare, with manufacturing drastically outpacing healthcare in its ability to make system-wide changes. This faster pace is due in part to the different structures of management in healthcare and manufacturing, according to Mr. Stiles. "Manufacturing organizations tend to be more aligned at the strategic level than healthcare organizations, so there is a higher level of understanding from top to bottom of the goal. They tend to move faster — everyone knows their part and they get out and do it," he says.
In addition, manufacturing organizations tend to be more hierarchical than hospitals, which affects the speed of decision making and implementation of decisions. Whereas a manager of a plant may make a decision and it is implemented directly, hospitals may gather stakeholders in meetings to discuss the costs and benefits to all parties. "Healthcare organizations are far more consensus oriented. Decisions are not necessarily made very quickly because there are a lot of considerations that need to be in the mix," Mr. Stiles says.
Although hospitals' slower pace may require Lean leaders to adjust, it does not mean lean techniques cannot be used to full effect. Lean leaders need to slow down, learn about the environment first, build trust and relationships and then move forward with process improvement. "Lead with humility, lead with relationship building," Mr. Stiles says, "because a highly educated clinical leader isn't going to necessarily care that you're the best at TPS [Toyota Production System] work. And they're probably not going to trust you right away."
Positioning Lean leaders for success
To integrate a Lean philosophy and approach into a hospital's culture, it is helpful to have Lean leaders report to someone as high in the leadership hierarchy as possible — if reporting to the CEO is unfeasible, they should report to the COO or other C-suite executive, according to Mr. Stiles. By having Lean leaders report directly to the operations decision makers, process improvements can be made quicker and more easily.
Including a Lean leader on the executive team is still new to hospitals, so the position title varies by organization. Mr. Stiles says some common titles are Director of Lean Transformation and Director or Vice President of Process Improvement, Business Excellence or Process Excellence. Under the Lean director hospitals typically have "anywhere from two to 20 Lean experts and process excellence coaches," Mr. Stiles says.
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