Applying Lean techniques to improvement work is not rocket science. I’ve seen teams who produce significant change after reading a book and applying what they learn. Most improvement events using Lean result in measureable improvement, and teams usually apply the techniques they have learnt to make further improvements. Despite this, the use of Lean in organisations often remains an isolated improvement attempt, with limited impact on the wider organisation – good for a team, a service and a group of patients, but not more than that.
Moving improvement from well-meaning projects to widespread and continuous change is the step at which Lean implementations often falter. Getting beyond the technical application of Lean tools to wider change is the topic of A Leadership Journey in Health Care: Virginia Mason’s Story by Charles Kenney. This is the newest of three books now available on Virgina Mason. I discussed one of the previous books in an earlier post.
Virginia Mason in Seattle is one of the best known success stories of the use of Lean in health care. They have been using the system for well over a decade, and have achieved convincing results. They have also talked and written about Lean, and established a training arm, the Virgina Mason Institute.
Earlier books on Virgina Mason dealt with the use of Lean as an improvement tool. This book spends more time on the use of Lean as a management system, and discusses the key role of leadership. As with previous books, it is an easy read. Charles Kenney, the author, is an experienced writer, and focuses on personal stories and experiences, rather than data and methods.
If you want to read about Lean techniques to apply in health care, this is not the book with which to start. For that, try something by Mark Graban – Lean Hospitals would be a good choice. It’s probably not even the best book to inspire you on the use of Lean in health care – Transforming Health Care is a better option. What it does do well is look at the place of Lean as a management system.
Some of this relates to hoshin kanri, and the hard work of aligning an organisation and its staff around key priorities and actions – but it is also good on the ‘soft’ side, on the role of values and of respect for staff.
On hoshin kanri, or what Virginia Mason refer to as World Class Management, the book distinguishes between management by policy, cross-functional management and daily management. The book is good on the importance of daily management, an area in which Virginia Mason have drawn heavily on the work of David Mann, and his excellent book Creating a Lean Culture.
The willingness of Virginia Mason to search out people who are expert in a area, and to learn from them, is one of the most appealing characteristics of the organisation. There is a similar example in the book of their use of the work of Lucian Leape.
The text is also informative on the work to put daily management into place. They describe daily management as,
‘the daily routines and behaviors of leaders from a frontline supervisor to an executive that create the environment and ensure reliability of processes day in and day out‘ (Kenney 2015: pg 43)
A leader’s role, in this model, is to ‘teach, guide, coach and improve daily work‘. This requires an understanding of what standard work is, and a willingness to observe and engage. This, the book explains, has to also include a set of behaviours, in which staff are treated with respect and their role in improving their own work recognised and expected.
Other important aspects of Lean implementation stressed in the book are continuity and committment. When leadership teams change very quickly, it is difficult to stick with any approach. The temptation to change horse in mid-stream must be great. The striking continuity in the Virigina Mason management team, and their talent development pipeline, is well described.
The book is a case study, but the evidence for wider application is supported by accounts from other organisations who have gone to Virginia Mason for support and learning (the case study that begs to be written is on health care organisations who have tried Lean and dropped it).
The main argument in the book is that to improve quality at scale takes commitment over time; a willingness to identify and change unhelpful behaviours; the gradual movement to a whole management approach, and an unrelenting willingness to put patients first. It’s not a recipe book, but it does help to identify some of the building blocks that have been helpful to Virgina Mason. Given their track record and demonstrable success, their message deserves attention.