Comments on: Keen to Be Lean in Healthcare

By: Dave Scottow

Dave Scottow — Sat, 16 Jan 2010 19:38:58 +0000

Jamie, you are right on — however there is a twin headed dragon of a problem. If you are introduced as a lean implementation specialist by a department (ED, Lab, OR) and don’t deliver cost improvements the CFO will grow cold to the initiative, if you are brought in by the CFO with a cost focus the departments will resist based upon their care focus. What really is needed is focused and determined C level leadership to take the long view and improve care and processes to the point that costs are reduced. I’ve been consulting hospitals, labs and clinics for 5 years and what is lacking is the kind of leadership (check their leadership profiles) that enables that to occur.

By: Mark Graban

Mark Graban — Wed, 13 Jan 2010 15:42:01 +0000

Hi Karen – I don’t “know” Gawande, although he’s right here in Boston. I saw him speak at a book tour event in Cambridge last week and got to say hi during the signing.

He’s certainly aware of Lean and even of LEI and our push into healthcare. Gawande gave a quick shout out to Toyota in his 2nd book, “Better.”

http://lnbg.us/z

I’d be curious to talk with him and ask if he avoids playing up the Toyota angle too much because it runs the risk of turning of healthcare people (two degrees of difference – Japanese and manufacturing)?

My ideal state would be for Gawande to devote a New Yorker article to what’s going on with lean in healthcare. I’d love to see how he would write it. If he can connecting Farming to healthcare (his last New Yorker piece), he could do a similar interesting connection to manufacturing I bet.

http://lnbg.us/0

@Ankit – thanks for the shout out of my book!

By: Ankit Patel

Ankit Patel — Wed, 13 Jan 2010 15:39:38 +0000

Karen,
I 100% agree but starting conditions are indicators of where you end up. If the cost is the sole focus on front end then it’s very difficult to get a true “Lean” organization. I’ve noticed that as long as the company who is implementing lean cares about something else besides just cost that can lead to growth.

This has just been my own personal experience. I’d love to hear your thoughts and experiences.

Ankit

By: Karen Wilhelm

Karen Wilhelm — Wed, 13 Jan 2010 15:34:43 +0000

Ankit – You gotta start somewhere. If initial focus is way too limited, you need to create the opportunity to expand the focus over time.

By: Ankit Patel

Ankit Patel — Wed, 13 Jan 2010 15:20:42 +0000

On an aside, one of the challenges I face on a daily basis is trying to quickly describe what Lean is to someone who doesn’t know or thinks they know. Inevitably they pick out one or two points that appeal to them and focus on those factors (ie. better cost and quality results). The challenge for Lean in healthcare (like any field) is going to be to manage the perceptions.

Mark does a great job in describing Lean in healthcare with his book Lean hospitals (http://www.leanhospitalsbook.com/).

Ankit Patel
http://TheLeanWayConsulting.blogspot.com

By: Jamie Flinchbaugh

Jamie Flinchbaugh — Wed, 13 Jan 2010 15:19:54 +0000

Here is a link to the book Karen is referring to, The Checklist Manifesto:
http://bit.ly/4v40Xw

By: Karen Wilhelm

Karen Wilhelm — Wed, 13 Jan 2010 14:57:32 +0000

Atul Gawande, with his high visibility from previous books and writing in the New Yorker, is drawing considerable attention to the lean practice of checklists in his new book. He’s been on numerous interview shows as part of the book tour I assume he’s making. He doesn’t use the “L” word, but does show a much wider audience that our healthcare systems are highly imperfect and can be improved with simple tools.

We probably need more formal and visible connections with him because of his wide credibility and his ability to reach a wide audience. I’m sure he’s aware of what some of the great hospitals are doing, and recognizes lean even if he doesn’t use our jargon.

Mark, do you know Dr. Gawande?

By: Mark

Mark — Wed, 13 Jan 2010 14:36:12 +0000

I think it’s inevitable that CFO Mag would have a heavy cost angle. I certainly tried to make the case to the reporter that lean is about quality (and costs follows) and that lean can also lead to growth and revenue opportunities for a hospital.

We’re still on the long uphill battle to get healthcare to realize that better quality costs less. We need to say it over and over. Better process quality leads to better cost. If you define quality as newer technology, that’s going to cost more. But there’s a widespread assumption that healthcare is already efficient from an operations standpoint and that’s dead wrong.

Generally, I thought the writer did a great job for not being a lean guy. I’ll give him credit for being very inquisitive and at least mentioning quality.