Adopting a Lean approach to health care can be likened to going on a diet or weight loss plan. Lost on the analogy? Well, let’s think about it…
First, no one can lose weight for you. They simply can’t do the exercise or count the calories for you. There comes a point at which you have to stop listening to advice or simply thinking about exercise and actually get going. Others can only teach you what you need to know and coach you through the necessary changes. But even then, outcomes can be limited if the focus is too narrow and immediate.
Second, everyone knows that the effort isn’t simply about losing weight. The weight is often just a symptom of deeper and more complex issues – just as it is with Lean. This approach frequently uncovers other, deep-rooted issues holding your community hospital back from achieving the highest patient care goals and maximum efficiency.
And, finally, the process of getting healthier doesn’t typically apply to just one part of the body. Sure, you can target particular systems or muscle groups, but essentially, the whole body is involved in one way or another. So it is with Lean healthcare. It can’t be done in isolation. There’s no way to exercise effectively with one leg still on the couch.
It may be time to ask, then: How engaged is your whole organization in improving its operational health? In this article, we’ll take a look at 11 simple parameters to gauge how far off the couch your community hospital is.
Lean Implementation Assessment: 11 Scoring Factors
Use the following self-assessment for your management teams to gauge the level of growth within your organization. Start by having each participant score a 1 to 5 on each of the following parameters:
- Leadership Engagement
- 1 = Lean methods are used by a select few. It is viewed as a program. There is little or no visible support (gemba activity) from senior leadership.
- 2 = Most leaders participate in an A3 in their own department at least once a month. Senior leaders begin to lead, coach and sponsor projects.
- 3 = Leaders initiate improvements without prompting. They begin to demonstrate and articulate how Lean has improved performance for their department and organization.
- 4 = Lean competence is seen as essential to being in a leadership role. Leaders frequently collaborate with other departments to improve customer value streams.
- 5 = All decisions are supported using Lean thinking. Over 10% of leadership time (at all levels) is spent at the gemba or on improvement activity.
- Leadership Coaching Skills
- 1 = Most leaders don’t understand enough about Lean to introduce it to staff.
- 2 = There is some activity with leader involvement. Staff members are not allowed to improve processes on their own.
- 3 = Leaders begin to develop Lean skills in staff members. They are seen as coaches and mentors.
- 4 = The staff is encouraged to work on improvements. Leaders can train staff on most Lean concepts.
- 5 = The department can function for long periods with the leader absent, with no noticeable effects.
- Staff Involvement
- 1 = A few staff members have participated in project team improvements – less than 10% were involved in the last month.
- 2 = Some staff have been involved in departmental and project team improvements – less than 25% were involved in the last month.
- 3 = Many staff-driven improvements have been initiated – less than 50% were involved in the last month.
- 4 = Staff members are initiating improvements to achieve daily targets – less than 75% were involved in the last month.
- 5 = All staff know how to address abnormalities and achieve targeted results – 100% were involved in the last month.
- Improvement Activity
- 1 = One to five A3s are started each month with various levels of execution.
- 2 = Over 50% of departments have multiple A3s active.
- 3 = A3s are actively used in a majority of departments. Any employee can initiate A3s.
- 4 = There’s activity in every department having a positive impact on driving measures. Most staff members have some level of Lean experience.
- 5 = Every staff member has been involved in an A3 activity at some point in the past year.
- 1 = Strategic or tactical plans don’t exist.
- 2 = Plans exist but are not shared with all staff members. No review activity takes place.
- 3 = Department plans tie to the organizational plan. Plans are reviewed quarterly.
- 4 = True North is identified. All plans (departmental and organizational) are reviewed quarterly. Measures are physically posted for staff viewing.
- 5 = From reviews, goals are adjusted and corrective actions are created. Progress is communicated to all staff members at least quarterly.
- Customer Value Streams
- 1 = No one knows what a customer value stream is.
- 2 = Value stream maps are done with most A3s.
- 3 = Most departments have a value stream posted for a major patient process.
- 4 = All major value streams are identified and posted for staff view.
- 5 = Quarterly reviews of major value streams drive A3 improvements.
- Customer Service (Quality)
- 1 = There is no action for or reaction to errors in care.
- 2 = Errors are measured. Trends create actions based on A3 thinking.
- 3 = Staff is involved with root cause analysis. Error-proofing skills are taught.
- 4 = Root causes are sought for every error. All corrective actions are documented.
- 5 = Year-upon-year improved results are realized.
- Patient Satisfaction
- 1 = Patient surveys are done but create little action.
- 2 = Patient survey trends are analyzed for trends. There is some A3 activity from negative trends.
- 3 = Patient experience is the focus of most A3s. Some leading measures are being established.
- 4 = Voice of the Customer (VOC) is included in many A3s. Improvements are employee-driven.
- 5 = A system of collecting the VOC is proactively used to meet patient needs, and patient satisfaction scores are improving.
- 1 = Some driving measures are used to highlight progress.
- 2 = Organizational measures with goals exist. Some leading measures are being developed.
- 3 = Departmental measures are tied to and support the organizational measures and goals.
- 4 = Measures are posted for all staff members and reviewed on a regular basis. Staff can articulate what the organization’s driving measures are.
- 5 = Leadership has systems in place to review all measures. Gemba walks are used to review department measures.
- 1 = There is little or no organization-wide communication about Lean activity or results. Department improvement needs are addressed at a monthly staff meeting.
- 2 = There is some evidence of Improvement activity, such as newsletters or posted A3s in departments. Activities are mentioned in staff meetings.
- 3 = At least 50% of departments practice a daily huddle to review leading measures with improvement plans and activity.
- 4 = All departments practice a daily huddle to review leading measures with improvement plans and activity.
- 5 = Organizational driving measures and strategic plans are reviewed with the staff at least quarterly. Staff members can articulate their role in achieving organizational driving measures.
- 1 = Lean has only been introduced to a handful of people in the organization.
- 2 = Most staff members have heard about Lean activity. Lean is still seen as a program.
- 3 = Lean becomes part of the organizational framework. Customers/patients begin to notice a change in the organization. There is a noticeable reduction in staff turnover.
- 4 = Lean is widely recognized as having moved the organization forward. Leadership members collaborate with other organizations to learn more.
- 5 = All activity has been highly influenced by Lean methods and principles. Other organizations seek our expertise.
Once all categories are scored, participants should calculate their total at the end (to be used as a comparison for future assessments). More importantly, for each parameter, make sure they write one step needed to get your organization to the next level.
The Assessment Is Only The Beginning
While the score is important to show progress, the most critical outcome of this assessment should be your effort to create an action plan that takes everyone in your community hospital to the next level in terms of Lean healthcare implementation.
So, when everyone is done, have the facilitator gather and summarize the scores. Discuss one parameter at a time, as each participant shares their score and next step. As a group, summarize the list of next steps into tasks and use them to formulate an action plan.
Once the plan’s framework is established, add names and due dates to each of the plan’s tasks, and be sure to set quarterly dates to review.
How did your organization do? For additional guidance on navigating your ongoing Lean healthcare journey, schedule a free consultation with ICE Technology Lean Coach Dan Nikkel.