Redesigning Clinical Workflows to Return Joy to Patient Care
Everything Has to Change
Everything Has to Change

“If you want things to stay the same around here, everything has to change.”

Richard Carr, an HR expert and Simpler colleague, shared this quote from The Leopard, written by Giuseppe Tomasi di Lampedusa. As described in this Wikipedia post, as the mid-19th Century Italian historical novel progresses, a prince is forced to choose between upholding the continuity of his upper class values, and breaking tradition to secure continuity of his family’s influence in society. Read on to learn how health care shares much in common with this prince, and “Everything has to change.”

Richard shared this quote while we were preparing a summary presentation following a two-day status review of a client regarding the progress of their Lean transformation.

This client has been on its Lean journey for about two years, and has the usual mix of pockets of great progress, areas of moderate adoption, and some significant gaps.  This includes the senior leaders, who are mixed in their commitment to Lean and to their success at designing and following Leader Standard Work.

Why Everything Has to Change in Order to Stay the Same

This client has a great history of caring for its community for over 100 years. It is well-regarded and provides outstanding care. It is also at risk of losing its market share leading to significant financial instability.

Do you know which health care system I’m talking about? Since this describes many systems these days, you can only guess.  There are many hospitals, medical groups, and systems with strong reputations who are at risk.

If they want things to stay the same – reputation, patient-focused culture, strong financial performance, ability to adapt to changing market forces – they have to change. A lot.

This client made the choice two years ago to pursue a Lean approach as a key strategic initiative.  Their strengths include a couple of value streams that have made some progress and widespread adoption of a daily management system that includes tiered huddles escalating problems quickly to the level at which they can be resolved.

Their weaknesses include minimal work on strategy deployment and slow change in leadership behaviors.

What Changes are Needed?

So what has to change for “things to stay the same”?

  • It starts at the top. The C-suite have to change.  The CEO needs to actively, visually, continuously lead the transformation by being present at events, going to the gemba, and communicating to the physicians and staff regularly.
  • The VPs and Chief X Officers need to do the same, actively sponsoring value streams, leading their executive steering teams.
  • The middle managers need help.  Most of them have been successful solving problems and telling others what to do to ensure the solution works.
  • Now they need to learn to be mentors and coaches to those reporting up to them.  They need to learn how to manage based on the prinicple of “Respect for People.”
  • They need more robust clinical business intelligence – giving access to data and key metrics needed to rationally manage the business.
  • And they need to further enhance relationships with physicians.  The physicians are starting to get involved, and have opportunity to do much more.

They asked what we thought were the most important strategic moves they should make.  My first recommendation was to implement the Lean management system thoroughly across the enterprise. If your operations are still functioning as many health care systems do, with lack of direction, inadequate information, low employee morale, and poorly defined workflow processes, investing in new programs or acquisitions makes little sense. You will simply add more to the chaos and dysfunction.

If, on the other hand, you first invest in developing effective operations, any new programs you develop, or entities you acquire, will thrive.  The investments needed to reach this level are more than financial.  The most important are the leaders themselves investing their time at the gemba, and investing their hearts and minds in developing as a Lean leader.  As Gandhi said, “Be the change you wish to see in the world.”

I have great hopes for them, but I’m not sure that they are ready for that level of deep change.

I sincerely hope that they are up to the task. Their community derives so much benefit from their good work. It would be tragic for their services to falter.

Are You Ready to Change Everything?

So what about you and your organization? Would you say that “Everything has to change” to preserve your heritage, your great quality care and patient service?

If you are, please share your insights.  If you are not, please share your concerns.

I hope we can help you to see things differently.

One Response to Everything Has to Change

  1. Thanks for this great explanation of the paradoxical quote at the beginning. With the seismic shifts in health care today, organizations that have survived on primarily on reputation are now needing to improve. That can only help the ultimate customer: patients and their families.

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