Redesigning Clinical Workflows to Return Joy to Patient Care
Fighting Fires with Fire – Or with a Training Plan

I’ve started to notice a concerning trend in my Lean executive coaching work lately. Healthcare executives who are leading Lean transformations in their organizations are canceling or rescheduling our coaching sessions, often on short notice.

On one hand I fully understand why. There are always urgent issues that come up unexpectedly:

  • a “must see” conference or presentation,
  • a meeting called on short notice on a new strategic business opportunity,
  • a safety emergency, or
  • a directive from a superior who does not understand or support Lean.

On the other hand I find it curious that Lean coaching sessions are considered to be more expendable than other time demands that executives deal with on a daily basis. It speaks to the question of relative priorities.

When a healthcare leader commits to a Lean journey, they make a significant commitment of resources, time and money. There usually has been an ROI calculation that has been key to supporting the decision to start the journey.

firefightingAs the leadership team begins, they welcome the opportunity to change their daily experience of managing by heroic firefighting while rushing from one crisis to the next, to an experience of managing by developing their people into effective problem solvers aligned around the organization’s strategic plan.

We approach this new work with excitement and revel in early wins by:

  • identifying the high potential value streams,
  • planning and running rapid improvement events,
  • clarifying and deploying key strategies and tactics, and
  • developing the daily management system that stabilizes operations.

But then the real world rears its ugly head. Crises keep popping up, overwhelming the capacity of the leaders and the front line caregivers. In order to find time to put out the fires, less urgent commitments are rescheduled or canceled.

The Lean transformation slows as leadership’s attention is pulled away, as the leaders’ personal development slows, as the front line caregivers see their leaders in the gemba less often, as visual management boards are not updated or reviewed.

What is an effective countermeasure to this problem?

I’ve recently had success by inadvertently fighting fire with fire – creating a crisis by informing the leadership team that we need to stop our value stream work until we fix some basic problems by implementing daily management. Suddenly, I had everyone’s attention, and the leaders recommitted to doing their part, following their standard work, and going to gemba.

While I appreciate the recommitment, I’m concerned about how we achieved the outcome.

marathon-runnerWhat can I, as a Lean executive coach, do differently? Should I:

  • be more explicit up front about the level of commitment required of Lean leaders,
  • be more proscriptive about what leaders should be doing in each step of the transformation,
  • be more vigilant in ensuring that leadership is following through on their commitments.

A Lean transformation is like a marathon. Running a successful marathon requires sticking to a training regimen.

Rather than lighting a fire underneath those we coach, and forcing them to react, we would be better off being explicit about the process up front, closely track how well the leaders stick with their training regimen, and quickly develop counter measures when training goes off course.

What do you think? Is there a better approach to keeping Lean leaders tracking to leader standard work?

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