Various models have been created to share key steps in a successful Lean transformation, whether in healthcare or other industries. In my career, and as President of Lean East, I have been a leader in multiple transformations but am always searching for ways to continually improve my coaching and teaching. This post provides an overview of two transformation models I have researched and five thoughts on the models based on my personal experience.
The Lean Enterprise Institute (LEI) has created a very nice framework or model describing the required steps for a Lean transformation within an organization. Their graphic is below and you can click this link to see further details about their model.
LEI’s model was developed for any Lean transformation, be it for a small team or organizational-wide, and simplifies the change into five questions, summarized as:
- What is the purpose of the change–what true north and value are we providing, or simply: what problem are we trying to solve?
- How are we improving the actual work?
- How are we building capability?
- What leadership behaviors and management systems are required to support this new way of working?
- What basic thinking, mindset, or assumptions comprise the existing culture, and are driving this transformation?
For LEI, process improvement and people capability are the pillars, with leadership behaviors in the middle. Now look at a model created by the ThedaCare Center for Healthcare Value, after their ten years of experience transforming a hospital system.
ThedaCare places customer value at the pinnacle, with organizational purpose, values, and principles as the foundation. They then focus on systems – a new operations system with scientific problem solving and integrated support systems. This allows and is supported by a new management system and new leadership behaviors. Note that ThedaCare’s model is meant to be built slowly, over many years, unlike the LEI model for transformation.
Lean East Thought 1: Customer value is the key
In both these models and my own thinking, customer value is the end goal. LEI begins with identifying your value-driven purpose and ThedaCare puts organizational purpose, values and principles at the foundation of the transformation and customer value at the top. None of this is a surprise, but be skeptical of a model that doesn’t include results valued by your customer as the objective. Lean Healthcare East also recommends an organization begin a transformation effort by examining the business case for Lean – why is a Lean transformation important to the organization right now?
Lean East Thought 2: Application of Lean tools is not enough
While many equate Lean with the application of improvement tools (value stream mapping, 5S, root cause analysis, 5 whys, poka-yoke, etc.), neither model stresses these tools. In my experience, organizations that wield these tools effectively can achieve results, but not a cultural transformation. Every organization applying Lean thinking will have (at least some) engaged employees and some with expertise in applying the tools. Positive results can be achieved for a time, but is the organization truly undergoing a Lean transformation? It is the leadership behaviors and management system that will ultimately need to change to sustain a transformation. Both models stress behavior change and leadership change, and ThedaCare also emphasizes system change. This is well beyond the application of tools.
Lean East Thought 3: Must focus on building capability in the people
Lean is not about doing the things you do today faster; rather it is about examining your processes and identifying the things you “must” do today . . .. and changing the process so that you no longer have to do them. The process of successful lean transformation rests on applying PDCA (scientific method) cycles of experimentation at every level, everywhere, all the time. Process improvement is based upon tests of change. This continuous improvement application develops new habits in each and every employee of the organization. Habits change the mindset over time, and eventually the culture.
Lean East Thought 4: Leadership behaviors make or break the transformation
If you are a leader who prides yourself on your ability to make quick decisions and set people straight, you better be prepared to change. Don’t expect to delegate the work of change to middle management either; you must build your personal capability. Find a coach and teacher who can help you learn and change. Plan to spend much more of your time where the value is created. Become a coach and teacher yourself and model the new behaviors you expect.
Respect for people is paramount. Management by objective should be replaced with management by process. Answers are replaced by questions. Benchmarking is replaced by striving for perfection. And directing staff is replaced by enabling and supporting staff.
ThedaCare suggests leaders ask themselves these three questions every day:
- Are my staff and doctors treated with dignity and respect by everyone in the organization?
- Do my staff and doctors have the training and encouragement to do work that gives their life meaning?
- Have I recognized my staff and doctors for what they do?
Lean East Thought 5: One size does not fit all
Different organizations will succeed with different models based on their culture and past experiences. Customer value differs, even within the same industry, and existing mindsets and organizational values matter. Eventually in order to give your processes a chance to produce good results you will need to switch the organizational focus from results to methods. Every organization will have different lessons and experiences on their journey, even if they are striving for similar goals. Lean is all about “learning by doing,” with knowledge transfer and scalability the key to sustaining a transformation.
Agree or disagree? Please let me know any of your key learnings from these models and check back for a follow-up post with additional thoughts.