Sustaining
and spreading the gains in lean Hospitals: Role of Leadership
Edly Ferdin Ramly
ABSTRACT
Whether you follow
Lean, Six Sigma, or an internal methodology, one of the biggest challenges of
process improvement is ensuring that process changes are adopted
consistently—and sustained— and spread by your organization. How can you
measure how well your process improvements have been adopted? And how can you
monitor activity to ensure process improvements are sustained while identifying
new best practices for continuous improvement. The success factors of lean lies
on lean leadership.
Keywords: Lean Health care, Lean
Leadership
INTRODUCTION
People often equate “Lean” with the tools that are
used to create efficiencies and standardize processes. However, implementing
tools represents at most 20 percent of the effort in Lean transformations. The
other 80 percent of the effort is expended on changing leaders’ practices and
behaviors, and ultimately their mindset. Senior management has an essential
role in establishing conditions that enable that 80 percent of the effort to
succeed. Their involvement includes establishing governance arrangements that
cross divisional boundaries, supporting a thorough, long-term vision of the
organization’s value-producing processes, and holding everyone accountable for meeting
Lean commitments. This is accomplished through regular, direct involvement.
When upper management sets the example, durable Lean success and an
increasingly Lean leadership mindset follow.
Most of the literature on Lean conversions has
focused on implementing the Lean tools (to create flow, establish pull, support just-in-time production, etc.) in
manufacturing (Womack and Jones 1996; Rother and Shook 1998). Some of the
literature has explored Lean tools in healthcare, office settings, or product development
processes (Graban 2008); Critiques of
the tools only focus note that even brilliant use of tools without changes in
culture rarely produces lasting change, or even lasting .There is a missing link in Lean. This missing link
is the set of leadership behaviors and structures that make up a Lean
management system.Lean management bridges a critical divide: the gap between
Lean tools and Lean thinking. Systematic Lean management separates Lean
initiatives that start well but falter from those that sustain initial gains
and deliver further improvement.
In
this paper, we examines the key reasons why process changes often fail to be
sustained in the long term. Explore DIET techniques on how you can track
whether your organization is
really sustaining and spread the lean thinking
and continuous improvement.
FAILURE OF LEAN
IMPLEMENTATION
The lean effort
is consider failed once the organization stop their effort in waste elimination
stop. Stop mean the gain not been sustain and the implementation not been
spread. The main reason of failure are due to:
1. Purpose – The purpose of lean initiative have not been
clearly defined. In many cases, the organization adopted the lean just because
it is “the best menu of the day”.
2.
Process – The
process of the lean implementation not been plan, do, check and action. Yet, my own observations say this is
precisely the thing that most companies can’t seem to do. Why? Surely one major
reason for this is the way we lead and;
3. People – Employees didn’t buy in the initiative.
THE ROLES OF THE LEAN
LEADER
For hospital-wide Lean initiative to succeed, leaders at three
organizational levels must play complementary roles. This overlap reinforces
continuity of support for new practices throughout the organization, e.g.,
disciplined adherence, attention to process performance at intersections, and
gemba walking (which takes managers to the front lines to look for improvement
opportunities). This continuity maintains the internal integrity of Lean tool
implementations and the Lean management system.
Senior leaders play a central role in Lean
management. Their contributions are essential in:
1. Developing and implementing structures and
processes that anticipate and respond to the difficulties of a Lean initiative
that crosses internal boundaries;
2. Increasing the odds that process improvements
survive the transition from project mode to ongoing process and Creating
conditions in which a sustainable Lean culture of continuous improvement can
develop.;
3. Establishing and maintaining new,
process-focused measures along side conventional measures of results;
4. Transforming commitments to change into actual
change, supporting and sustaining new behaviors and practices;
The leader’s job at Toyota get each person to take initiative to solve problems and improve
his or her job. The Leader’s job is to
develop his or her people
spirit of Lean Mentorship. “If the learner hasn’t learned, the teacher hasn’t
taught”
Figure 1: Example of leadership model at
Toyota
Leadership at Toyota change from managing numbers to managing the process.Leaders at Toyota, like leaders anywhere,
want to see measurable results. But they know that the financial result is a result
of a process. They also realize that the financial results reflect
the past performance of that process. Far better is to create a process
that can be managed right NOW.
Leadership at Toyota also change from Problem-hiding to Problem-solving. All actions at Toyota revolve around planning
and problemsolving. It is assumed that there will be problems, that everything
will not go according to plan. “No problem is problem.” For the system to work,
problems must be exposed and dealt with forthrightly. Hiding problems will
undermine the system. Leadership at
Toyota utilised P-D-C-A. Toyota would say this is essentially the
P-D-C-A management cycle they learned from Dr. Deming.
Chairman Cho of Toyota:
Three Keys to Lean Leadership
- Go See - “Sr. Mgmt. must spend time on the plant floor.
- Ask Why - “Use the “Why?” technique daily.
- Show Respect. “Respect your people.”
In the early days of lean
implementation, the leader should allowed to just try things, to make mistakes and
learn from them. That’s the spirit that required in lean. “Continuous
improvement comes from making mistakes and learning from them." “It is a
mistake to suppose that men succeed through success; they much oftener succeed through
failures. Precept, study, advice, and example could never have taught them so
well as failure has done.”
CONCLUSIONS
Lean leadership is the key toward lean success.
The leader need to define the clear purpose of lean and ensure the first
project is the successful by giving full support and resources. Focus on
measure should be established based on process and transformed the commitment
in term coaching, education and respects.
ACKNOWLEDGEMENTS
The author would like to thank EFR
Management, Malaysia Productivity Corporation, National Iranian Productivity
Organization, Asia Productivity Organization, and management and staff of
Hospital A, Hasheminijad Kidney Centre, Tehran, Moheb Hospital, Tehran that provide the financial and resources
support in this research.
REFERENCES
Rother M and Shock J (1999),
“Learning to See”, Lean Enterprise
Institute
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