Next Level Leader Blog

Make Lean in healthcare more powerful by giving it a place to go.

A Powerful Formula

(Dialog with Jamie Flinchbaugh)

Bingo Jamie.

Healthcare has a big "me too" factor. Too often healthcare CEO's are looking to "install Lean" rather than looking for Lean to help them bring their organization to the next level. Articulating that next level is critical for focusing their Lean efforts.

That next level may be defined in a number of ways by the CEO:

• Becoming an ACO, Accountable Care Organization
• Accelerating product approval pipeline
• Dominating the X market by being THE physician practice "growth tool"
• Growing internationally in X markets
• Integrating primary care, specialty medicine, and hospital services
• Becoming dominant in-company health provider
• State-wide expansion for health policy influence
• Membership growth and service diversification

Lean needs a destination to maximize its contribution and your return on investment in building a Lean organization.

Lean is not a destination. It's a path to a destination. A powerful one.

One well known CEO MD announced to a large audience that "Lean" was his strategy, it being a comprehensive philosophy for guiding" his organization. He announced his first commitment: to train everyone in his organization in Lean. This is great for the consulting and training companies, but is it great for this CEO's healthcare organization?

 
I value continuous improvement in its various incarnations, Lean, Six Sigma, Six Sigma/Lean, TQM and the like, as powerful disciplines for managing work and organizational performance. Healthcare has picked up Continuous Improvement a number of times, only to discard it when the going got rough.  
 
Many leaders implemented the philosophy, methodology, and its tools poorly, never fully integrating them into how work was done at all levels, often leaving out the senior level's strategic work.

So when cost reduction and price competition hit the industry, executive teams relied on the old "fly by the seat of your pants" approach, or the old "roll up your sleeves and do the tough work of senior management" approach, rather than employing what they had learned from CI to tackle the pressing market challenges facing them.  
 
I observed this wholesale abandonment of this valuable CI system up close. I asked myself, "why would a previously committed senior management team abandon an approach that they had touted as the solution to their competitive advantage a decade earlier?
 
They abandoned Continuous Improvement in the past because:

• They saw it as a "good to have" not a "must have" approach to the business and senior level processes.  
• Those implementing it created a non-intuitive, cumbersome process that actually slowed organizational and team progress. 
• They put the CI expert over line management in running the business, creating resentment and control battles rather than employing CI experts as consultants to line management. 
• Many healthcare organizations created expensive CI infrastructures and internal consulting groups that were viewed as baggage when the cost cutting began. 
• CI was never employed as a strategy development and execution methodology so when the time came it was viewed as the wrong tool.
• Boards of Directors didn't have commitment to a CI approach as a selection criteria in recruiting new leadership when the time came.
• New leadership entering with a mandate to bring the organization through the next dire market challenge, saw Lean as a vestige of the old failed leadership and got rid of it first.

So, what should CEO's do to ensure that Lean is a powerful driver of competitive advantage, as Michael Porter speaks of this objective?

• Lean should be kept lean, first of all, so it doesn't become a major overhead burden in and of itself.
• It should be integrated into the core running of the business, not a special activity.
• It should be incorporated with strategic planning and execution
• It should be employed in the work of the executive team and board of directors.

When it is part of the strategic work and not treated as a program to observe, review, and "support" from above, it stands a chance of being a valuable lasting advancement in healthcare. Otherwise, it will be relegated to the dustbin of history where all the other CI approaches lie. It would be a tragedy to invest all over again in CI only to let it languish and fade away as it has before.

 
Jamie, I'm sure you and I agree on these issues. The work you and others are doing with Lean is vital for healthcare's success.

For my part, I will continue to work with CEO's and senior leaders to incorporate it as a powerful approach to helping healthcare organizations get to the next level, however they define that next level with their strategic vision.

For Your Team's Success, Remember the How ... & the What!

Response to HBR article: For Your Team's Success, Remember the How 

Linda and Kent,

Your emphasis on the How in this blog takes one side of the ongoing debate professional managers and experts have been batting around for years. What's more important, content or process, the What or the How. I have taken both sides in the course of my career working with senior leaders as a consultant and as a senior leader.

As a young consultant, I emphasized the How, feeling that most executives bet on expertise when forming must-be-successful teams and in part because I didn't appreciate the content experts as much as I should have. After becoming a senior executive I became more and more frustrated with my consulting colleagues who undervalued expertise and over-estimated the magic of "teamwork" and "collaborative methodologies." Now I find myself encouraging line managers to think more about the process of getting to results and encouraging my consulting colleagues to invest more of their professional development time in business savvy and domain expertise.

I've concluded that if we could get senior executives to invest a bit more in strengthening collaborative processes and get consultants to invest more in knowledge and expertise, we'd have the perfect balance.

I'd love your thoughts on the professional debate. How far do you think collaborative and innovative processes gets a company team and where are the limits? Also, how far does domain expertise (including cross domain expertise) get us, and where are the limits?

I have found that teams comprised of superb communicators who lacked profound knowledge produced A+ esprit de corps but lack luster results, whereas teams with deep knowledge and expertise and a modest amount of collaborative capabilities produced more game-changing results.

Modest process + profound knowledge = potential for game-changing results

Great process + modest knowledge = modest results only.

Has your work taken you deeper into researching this balancing act?

Thanks,

Chris

Success FACTORS that seem to drive business and team success.

We've worked with many successful organizations. The best of them are always trying to improve their game. We've found that the ones that are successful in rapidly changing direction or accelerating their progress leverage some core organizational capabilities.

We've been taught by them to look for the following characteristics when assessing an organization's capacity for driving dramatic change: Focus or strategic direction that everyone understands, a commonly shared Approach or a model for dealing with problem-solving and key initiatives, an investment in hiring and developing leaders with solid Capabilities, an enabling Technology platform to support rapid collaboration and information sharing, Ownership as a core concept imbedded in the spirit of all levels of the organization, dedication of the right Resources needed to achieve the results decided upon, and finally Sponsorship at the highest levels of the organization for the change your organization is determined to achieve. Want to review your plan for change? Give us a call

This is what we've discovered as the map for senior level leaders and teams for achieving timely business results while engaging the people who will have to execute key decisions. Whatever name you use for the core components our successful clients have employed, each one is essential to enabling the kind of collaboration needed to making it all work.

Speed of that collaboration is critical to the success if a company is going to meet emerging market demands for responsiveness. Considering the increase in competition for meeting these market needs, time-to-market and speed of collaboration becomes even more vital if a company is intent on thriving.

There is an additional requirement of collaboration in an ever more competitive environment. It’s productivity. Companies these days must optimize the value produced in each of their core processes, in their investments in R&D, and in the utilization of their top talent.

The Collaboration to Results Model, gleaned from the successful, is designed to remove unnecessary steps in the process and reduce the demands on scarce resources that could be used for alternative purposes. Senior level talent is one of those valuable, scarce resources for which there is almost unlimited demand for attention. No one has time to re-play discussions, repair agreements, duplicate efforts, undo ill-considered actions, or engage in unproductive esoteric dialogue in the course of work.

The approach to collaboration recommended by The Holland Group is intended to streamline the collaborative process, surface conflict when resolving it can be most valuable, follow it through to resolution, definitive decisions, and accountable action. It’s designed to enable people to get to the heart of important business issues requiring the attention of top level talent.

We will review the most effective activities, interpersonal skills, tools, and organizational supports required by each phase of collaboration, the management of transitions between the phases to propel momentum, and the pitfalls that typically derail successful initiatives. Read the stories of our client's success.

There is one final component needed for success in achieving timely results that is often overlooked. That is the “Stance” or mindset of the leaders and participants involved in collaboration. The work of David C. McClelland of Harvard University established a clear link between leadership thoughts and attitudes, their behaviors, and their effectiveness in driving business results with their teams. We will provide tips for “Stance,” sometimes thought of as self-talk, that you may find helpful as you engage your team in the work at hand.

Leaders, like scientists, need to brand their vital initiatives.

(response to a terrific blog post "Why Science Depends On Good Branding" by John Pavlus whose writting has appeared in Wired, New York, Scientific American, Technology Review http://bit.ly/swTcds )

John's premise is that people need enticing names for important scientific investments in order to understand them and to advocate for government funding. Even though the technical experts think it's all smoke and mirrors, they, most of all need the results of widespread understanding and support.

I would add, we all need good branding for the things leadership wants us to invest our time and engergy in.

A leader who can do that while genuinely laying out organization's competitive options is a good catch for any organization.

My response:

Great point John. Even the Patagonian Tooth Fish needed a new name more acceptable to the public, Chilean Sea Bass. Aren't we all more comfortable ordering an Orange Roughy rather than the ole Slime Head?

Let the scientists do science and the marketers do marketing.

I kinda like "The God Particle," (still can't write the word without caps, but the caps might make the scientific research even MORE "user friendly and interest more constituencies?)

That said, I'd like to push the marketing one step further and get to the ole "Value Proposition." How about a marketing slogan that lets us know what we might get from the research and the ultimate answer. How about "The God Blog" or "The Eternity Door" or "God's Well of Unlimited Inexpensive Energy" or "The Existential Angst Removal Formula."

Will the scientific discovery give us "Night Baseball" even in the arctic circle? Will the research lead to a more eco-friendly paint removal solvent? Will we be able to get a job with the "God Project?"

I do think if the project "only" solves the puzzle of how the universe began many would vote to delay it a few more years.

What we need is a leader who understands the value proposition of the investment and can compare it with the value proposition of investing in alternative energy, highways and bridges, natural gas, and healthcare.

Now that leader would be a "whore's egg*" worth catching!

 

*  http://bit.ly/rRXNR3

Humble Advice for Leadership of Lean Healthcare

response to a Mark Graban blog on Lean ( http://bit.ly/qB8ref )

Nice article Mark. Your comments and those of John Toussaint, Conal, and Al are apropos of the ongoing challenges we in healthcare face in adopting and even more importantly, sustaining Lean principles within our organizations and within the industry as a whole.

They can all be summed up in the word "Leadership."

The challenges of Leadership in Healthcare becomes the challenge to Lean:

1. Constancy of Purpose and Profound Knowledge (two of Deming's favorites) is often lost in the cacophony of marketing and branding terms designed to sell improvement methodologies and techniques.

We are all here to bring value to people's lives around their health and wellbeing. When the language, tools, methodologies and overarching brand of improvement becomes more dominant, the core purpose gets pushed off center stage.

As a result, when the environment demands a dramatic shift in strategy and healthcare model, top leadership looses connection to the Lean tools and methods that they come to see as "not up to the task" of mastering the new challenge.

2. Strategic Imperatives: Engagement of the people closest to the work and the service, likewise begins to be treated by leadership as a "nice-to-have" component of survival rather than a "must have" of the new solution. Continuous Quality Improvement got thrown overboard in the past when leaders began to see it as the method for the middle or front line of the organization, not for the senior level challenges of competitive positioning, capital investment, payor management, profitability, and more.

Lean gives us another chance as an industry to infuse our organizations with the core improvement principles articulated by Deming, Drucker, Berwick, Womack, and others, and by companies like Toyota, GE, Ford, Intermountain Health, Harvard Community Health Plan, JCAHO, and ThedaCare.  

My concern is not "can we adopt it?" I know we are and will continue to do so. My concern is "will we sustain it?" and "will we continually improve its effectiveness" in staying on top in the never ending leadership challenge of improving the value created by our healthcare institutions.

My humble hard-earned wisdom: Lean (like "a rose, by any other name") must be infused into the fabric of the work of Boards of Directors, Executive Teams, and Medical Leadership in our healthcare institutions and small businesses if we are to build value and maintain steady momentum as an industry.

Required Blog Tips:

1. Infuse Lean into the fabric of the work of Boards of Directors, Executive Teams, and MEdical Leadership.

2. Lean is here to support the success of the institution, its customers and its Executive Leadership, not the other way around.

3. Make sure Lean Sensei's understand the business of healthcare.

4. The biggest waste is created by leadership. Eliminate Strategic Waste (ill conceived acquisitions and mergers, poorly planned investments, reactive strategic distractions, and more)

5. Don't just study Lean. Profound Knowledge and Sound Judgement, critical for success includes business, strategy, economics, demographics, science, and more, is built continually by leadership not crammed like the preparation for senior finals.

1 Big Tip on Running a Creative, Productive Meeting

Response to article in LeaderLab http://bit.ly/oSID0B

Nice article David. Like Michael I always loved meetings. I never tired of the exchange and the challenge of figuring our what makes conversations flow the way they do. But that's my business. And it's my life's passion, understanding the dynamics that move discussions forward or into the pit and out again.

The book's been written on how to run them, how to make them creative, and how to move them to productive decision-making. Why each generation of leaders needs to learn it all over again is beyond me.

I've worked for years to create and refine the flow of a productive conversation amongst colleagues.

1. There is a natural flow model
2. A baseline level of interpersonal capabilities of participants,
3. A commitment to a Focus, and
4. Something that everyone brings to the table in terms of knowledge, expertise, and
5. A penchant for learning, getting closure, and getting important things done.

Other than that, meetings are simple! :-)  

Now here's the 1 Big Tip for Running a Creative, Productive, Meeting:

1. Make sure the right people are working on something really important that's needed by someone really important to everyone.

If this condition doesn't exist, go out for a relaxing lunch!

For more than one tip, click on the button to the right ... that's right, this one ...

12 Lessons from an Undercover Leadership Consultant

After 7 years consulting with the senior leadership teams of Baptist Health System, Daughters of Charity National Health System, Humana, JCAHO, and many more as the Managing Director for Healthcare, ODi one of the top 3 consulting firms in Healthcare Continuous Improvement at that time, as well as working with the top leadership teams in AT&T, Procter & Gamble, NYNEX, Harte Hanks, and many more, I went "Dark."

That's it. I went undercover. On the inside. I became a senior manager inside of a 6,000 employee, $2B managed healthcare company and then went in deeper, as the SVP for Corporate Services in a fast growth, national, for-profit behavioral health company with 6,000 employees and contractors, growing from $50m to $500m in 6 years and lead executive for Parent Company Relations, with our $10B parent.

I was in so deep, I wasn't sure I'd ever get back, like Johnny Depp in Donnie Brasco .

I spent 8 years on the inside, barely holding on to my identity as the ruff and tumble of organizational politics at the senior level knocked me around, toughened me up, and taught me lessons I could never have learned as an external consultant.

These hard earned 12 lessons have never left me:

1. While you may think you're doing the right thing, others will undoubtedly perceive you as having ulterior motives.

2. There are two types of people in corporations, a. Those confident they can work anywhere and unintimidated by the dangers of getting fired, thus mostly doing the right thing regardless of the consequences, b. Those who decide to retire from the company in which they work (regardless of their age)  - these people will do the most unintelligible things just to survive, even to the point of looking incompetent.

3. There's no end to what you can get accomplished as long as you are willing to not take the credit.

4. There are some people who spend their entire careers studying politics and therefore will rarely be undone by amatures. You would be astounded by their creativity if you ever got the chance to be close to one of them.

5. You only get 6 months to a year to act like an impartial, curious, executive. After that, you're part of the political soup. Even your "oh shucks, it's hard to figure out why we do it this way" questions are taken as focused attacks on colleagues.

6. Well intending leaders who don't take heed of politics soon find themselves dropping through the open manhole, stunned, confused, and determined to get even, only afterwards realizing that they're wiser for the eye opening mugging. 

7. It's better to align yourself with the influential positive forces and take your chances as an upstanding corporate citizen, but always keep the destructive elements in your rear view mirror.

8. Better to invite parent company execs. in for tours, meetings, and special projects to actively draw their attention to things you want and away from the things you want them to stay out of.

9. Nothing big is achieved without a collaborative alliance working day and night to get it done.

10. Never, never, never lose sight of how the CFO views the world. It's his or her voice the CEO listens to before going to sleep every night.

11. There's no such thing as a non-political environment. If you think you're in one that is creative, open, and trusting, wait around to see what it's like after the financials tank.

12. There's always someone everyone loves to hate or mistrust who is in a position of power. Don't pay attention to what they're doing, pay attention to the person who's behind him or her.

13. (Bakers dozen) If no one's commenting on an obvious important issue, chances are they're well informed about what's out of bounds for discussion. Proceed with caution.

There's much more but blogs are supposed to present a discrete number of points if you intend them to be read. It's good to know the rules first before you ignore one that's actually good for you.

Tips on how to speed collaboration and get great results

I was having coffee with a colleague talking about speed, she was working on speeding up the sales cycle for her clients, I speeding up collaboration at senior levels of leadership.

Speed was the goal, regardless of what we were discussing. Why? No one has enough time in this connected world in which we are all bombarded with thousands of messages each day from somewhere in the universe. It's hard to think straight let alone get the important things accomplished.

So, what's the secret to speed? It's not moving faster!

That only gets more irrelevant things done, perhaps 10% more in any given day. We need breakthrough. We need to cut out things, not add more.

Story of slow:

One of my clients was frustrated with their continuous improvement process. The CEO wanted business results fast. Great business results! Most of the teams in his organization were taking 18 months to arrive at a solid recomendation for improvement of whatever they were working on.

I took a deep dive to find out why?

This is what I found.

1. Teams required a facilitator who was trained to be an expert in problem solving
2. They were using a methodology that had 14 steps for designing a new process
3. They had 7 steps if they were improving a current process
4. Many teams spend 4-6 months deciding which path to take
5. Most teams had been working on their challenge for at least 8 months

My CEO client was shocked and needless to say intent on doing something about it. At first, he wanted all teams stopped fully believing that a monster was created that had to be killed.

He asked me what I advised.

He had a real dilemna. His organization had launched a continuous improvement process for all the good reasons. His people were the brightest in their industry. All were delighted to have passed the rigorous requirements for getting hired by this well respected company. And, this CEO's employees were dedicated to the mission of this organization and committed to doing the right thing for their patients and other customers.

I could see that this CEO was between a rock and a hard place. Stop all efforts and he would demoralize everyone who had dedicated their time and energy to contribute their best. Let them continue would be to ignore a terrible waste of talent and resources. Waste was not something this healthcare organization could afford given the competition over price in the market place.

So, what did we do to speed the collaborative problem-solving process for achieving the most needed breakthroughs?

1. Reinstituted senior leadership reviews of all major initiatives
2. Required leaders to present their progress in measurable terms
3. Made decisions to accelerate and re-invest in the most important initiatives
4. Established a designated percent of budget for strategically vital initiatives
5. Conducted a rigourous executive level review of improvement priorities and committed targetd funds for the top 5
6. Established an accountability structure and process for each

These six steps eliminated waste by creating focus. Now, the top talent in this organization dedicated their time to the most important initiatives. They closed our their involvement with those initiatives which were not top on the list.

But what about speed? Did the top initiatives go faster? Yes, and here's how:

1. The laser beam of executive commitment got focused on the most important projects
2. The leader of each was held accountable for results and required to present progress reviews
3. No requirement was placed on methodology
4. Requirements for reviews were made perfectly clear
5. Recources were focused on these top initiatives and removed from the least important ones

This great organization re-discovered that focus created speed.

That's it. What about the process that was slowing them down? Did these leaders change their approach?

They most certainly did. Here's what this organization changed in process:

1. Achieving vital business / clinical results became the focus
2. Recognition shined the light on sound thinking, progress, and measurable results, regardless of the process used
3. Process improvement experts focused their consultation on achieving results rather than on conducting the perfect process
4. Expert internal consultants reported to the leader of the initiative, not the other way around
5. This organization simplified the imporvement process that was driving theoretical debate
6. Continuous improvement consultants were challenged to be useful in the eyes of each team
7. Teams were no longer accountable to the internal consultants but rather accountable to senior leadership

In summary: This CEO challenged his organization to achieve the results required for successful execution of their strategy. Speed and improved results were achieved through the following.

1. Focus
2. Simplified process (evaluated on ease-of-use)
3. Accountability (for business results)
4. Commitment of resources for achieving sound results (not for following a proscribed process

10 Point Checklist: Does your improvement model make sense?

This blog is a response to a LinkedIn discussion. Kwong-Chi's LinkedIn Discussion Question:

How can you deal with a group of people who doesn't want to improve any processes?

My response: ( http://linkd.in/qfnsq1 )

Kwong-Chi, I would have to see what you're presenting to this resistant group to advise. Sometimes we are inadvertently enrolling people in things that don'e make sense to them.

Does Your Model do the Following, Checklist:

1. Is it in every day language? (Japanese is not everyday language in the US)
2. Is the methodology intuitive? (or do people have to be trained in what it means first?)
3. Is your model aimed at achieving what they want to achieve? (Lean is not a destination)
4. Do you understand their world first? (do they believe you do?)
5. Is their current approach failing? (And are they aware of this?)
6. Have they gone through other "movements" that didn't make sense, & that were abandoned? (must explain why this one is different)
7. Are they resisting Lean or resisting improving the business? (if latter, they're gone)
8. Does their boss expect solutions to be presented in your format? (if no, forget it!)
9. Have you given them something small that worked?(IE better, faster solution)
10. Do they think you're a Lean zealot or a business success zealot? (if the former, change!)

 

Conclusion:

If you have dealt with the above checklist and they still are not engaged, you've got the wrong people.

 KEEP YOUR EYE ON THE BALL, BUSINESS SUCCESS. Click on pic

If Lean can't pass the checklist, it will go the way ot TQM, Reengineering, and the Dodo Bird!

10 Leadership Lessons of "W.A.S.P Lean 6 Sigma"

 

Lean has been around since the founding of this country.

 (America is where I'm sitting right now. - For those of you from Astonia, I would love to have you respond below with your own list.) 

In fact, Lean concepts are as old as time. The tools and methods continuously change, hopefully improving. We could go back to Leonardo da Vinci, Socrates, or Moses, but let's see what Ben Franklin et al had to say about Lean.

 

W.A.S.P Lean-six sigma principles for Leaders

1. Eliminate Waste "Waste not want not"

2. Quality "Anything worth doing is worth doing right"

3. Clean work space "Keep thy shop and thy shop will keep thee." 

4. Principles "A Lie stands on one leg, the truth on two." 

5. Respect "Do unto others as you would have them do unto you"

6. Systems thinking "Blame-all and Praise-all are two blockheads."

7. Continuous improvement "Look before, or you’ll find yourself behind."

8. Pull "Necessity is the mother of invention."

9. 5 Why's "Weighty Questions ask for deliberate Answers."

10. Feedback "If you do what you should not, you must hear what you would not."

And one for good measure, my favorite:

Profound Wisdom "Where sense is wanting, everything is wanting."

Clould have been said by Deming

In this age of rapid change we prey for progress, and sometimes get it. In some areas we seem to require learning the same thing over and over again.

Leadership of organizational excellence, is one such arena that never tires new branding for tried and true disscoveries of Peter Drucker, Edwards Deming, Margaret Mead, and Dale Carnegie.

Each new generation of leaders, now lasting about 5-10 years, has to learn some things over and over again. They're being encouraged by consulting firms eager to market the new breakthrough leadership brand. They start with a clean slate, Tabula Rosa. (No, not the video game, the Aristotelian one. )

(Remember the .com era leaders who insisted that the old business models are irrelevant only to re-discover that cash is king?)

Why do we all have to learn it again? What happened to what we spent so much money, time, and talent on learning years ago? To top it off, once again, healthcare is following 5-10 years behind private industry.

Don't get me started!

___________________________

On the other hand ... most of us learn best from experience.

"One thorn of experience is worth a whole wilderness of warning."

James Russell Lowell, an early American Romantic poet, critic, editor, and diplomat is quoted as saying,

So ... Let's get to it, re-learning leadership of organizational excellence.

"Never put off till tomorrow what you can do today."

But this time, please, let's avoid the Muda!

and, let's make Lean worth the investment!

Don't just teach Lean - Teach them business!