Lean transformation ….all that glitters is not gold!
It is often said by cynics that Lean applied in healthcare will be consigned to the scrap heap along with other approaches to reform before it.
This is almost certainly true unless we as believers in the power of Lean promote the difference between transactional change and transformational change.
Transformational change is what the NHS desperately needs (and the rhetoric is replete with the word ‘transformation’) yet many organisations (public sector, commercial and academic alike) misguidedly pursue what they believe to be transformational change, but is in fact transactional change.
Transactional change in my view, even if it is combined with tools lifted from the Lean toolbox, will ultimately fail to deliver.
How does this happen? I think it is because transactional change is comforting to executive and non executive boards. Proposals from advisors often contain Lean / Sigma models, jargon and concepts that are technically correct and sound appealing.
The ‘Transformation’ promised takes the form of a project or a programme, it will follow a single and comprehensive approach and it emphasises clear structure, control and governance measures. Strategic choice will be on offer. The plan may include time for mapping the whole organisation, gathering all manner of data, visioning and planning in the board room through workshops.
By contrast real transformation: Starts at the frontline with those who work closest to the patient, it seeks to give ownership to staff and align system forces by consent, persuading staff with believable and locally collected data and with fact based argument.
The design is owned locally and there is room for innovation, learning and discovery.
Resources such as outside experts help and techniques such as lean models are used to enable change, not to control it.
Small and frequent steps are taken, rarely wholesale redesign or complete change in the operating model. Transformation is never a project; it is part of the ‘day job’.
Transformation is messy, different operating environments will demand different solutions, some interventions will take straight away, others will take longer.
Impact on the cost / quality profile of the organisation certainly comes but is not always easy to explain by deductive reasoning. For executives the process will be uncomfortable.
So what am I proposing to those who may be thinking, what part do the executive play? Will I be unleashing chaos in my organisation and abdicating control?
My response would be, make enabling change part of the executive’s ‘day job’, there is plenty to do:
Make sure you have a planning process that sets out unified strategic direction, not a strategy for transformation, just one for commercial and service operations, one which gives your department’s bold clear missions which they in turn can in turn interpret and pass down. Objectives must be bold and leave room for local interpretation and adaptation.
Is your model of clinical governance integrated and enabling of frontline led care, while giving the necessary demonstrable safeguards required by regulators?
Are you managing the organisation’s human resources well, spotting and developing talent (the talent to transform and manage services)?
Are your Informatics team enabling change, facilitating rapid system improvements as the staff transforming services require them?
Are you promoting a customer service culture that positions frontline staff as the customer of the corporate centre?
Are you visible at the frontline, building your understanding and reinforcing and nurturing success wherever it breaks out.
Make sure it is transformation that you have got, it may use Lean tools, but all that glitters is not gold!