These 5 Mistakes Can Kill Your Lean or Lean Six Sigma Program in Healthcare

Again, my guest for episode 274 of the Lean Blog Podcast was Jay Arthur, author of Lean Six Sigma for Hospitals: Simple Steps to Fast, Affordable, and Flawless Healthcare(now in its second edition) and Breakthrough Improvement with QI Macros and Excel: Finding the Invisible Low-Hanging Fruit.  

See Part 1 in this series: "We've trained a gazillion [Lean Sigma] belts in healthcare. Why aren't things any better?"​

Jay looked back at the phone company he had worked for, recalling, “We had led a team that saved $20 million in postage and $16 million in adjustments. Then, in 1995, our leadership team said, ‘Wait, we're not getting any return on investment (ROI) out of this total quality department,’” Jay said. “They shut us all down.”

Canceling TQM programs because of lack of ROI was, unfortunately, a common problem (see the book Why TQM Fails And What to Do About It from the 1990s). I see similar things happening today with Lean in healthcare, so I asked Jay about his thoughts around that failure rate and if there are common issues today that might lead to the cancelation of a Lean or Lean Six Sigma program. Jay outlined a number of mistakes some organizations make when adopting these approaches, including:

1) Too much mapping of processes and not enough fixing

"In our phone company, they got addicted to process mapping," Jay said. "We covered conference rooms' ginormous walls with flowcharts of how terrible it all was, but did we actually go out and start to say, 'What specific things do we need to fix?'" The answer, too often, was no.

2) Inconsistent commitment to performance improvement from leaders

"In healthcare, every couple years, they pick up performance improvement and they drop it, and pick it up, put it down, pick up and put it down."

“ I have this theory, because I've looked at a lot of healthcare organizations, where the new CEO comes in and either takes Lean and Six Sigma out or puts it in. They change about every three years. "

“The other thing they found is that if you want a culture to adopt a change, you need to get at least four percent [of employees] making improvements. At that level, it'll stick. At about 20 percent, it'll reach a critical mass and take off. It doesn't matter who the leadership team is. It is the informal leadership team inside that company, that hospital, whatever that is going to sustain the change. I'd love to have great leaders do this, but my observation is that doesn't happen.”

Jay also said that he believes the leadership team should identify pains for data collection and problem solving.

3) Not prioritizing and sustaining performance improvements that have been made

Jay often hears about great performance improvements made in the emergency department or about improvements in lab turnaround times, but these improvements often fizzle and lose momentum after a while.

“I essentially believe that nobody is doing the ‘C’ in DMAIC [Define, Measure, Analyze, Improve and Control] and putting in a control system to say, ‘Let's take this thing, and let's weave it into the very fabric of how we do business, and make that the way we do things, and put some control charts on it so we make sure it stays.’”

4) Training performed by the wrong professionals

"A lot of people I talk to in healthcare, they were trained by people who are manufacturing Six Sigma or manufacturing Lean people.” Jay explained. “They are not healthcare Lean people. The amount of tools you need in the healthcare environment is very small compared to what you might need if you wanted to go out and optimize a plant that makes carburetors. What happens is they have a disconnect about how to translate what they're being told or taught into, ‘How do I do that here?’”

5) Not implementing the training

“There was a recent article in the Harvard Business Review where they talked about ‘the great training robbery.’ They said, in the US, we spend $160 billion or something on training, and most of it's wasted. People go to class and learn all this stuff and then they go back and keep doing what they've always done. I see a lot of that as well.”

Thanks to Jay for sharing his thoughts. In my experience, I've seen organizations that train and certify belts, but don't have a culture and environment that allows them to use what they learned. At my last manufacturing company, the leaders were proud of all of the Lean Sigma Green Belts they had certified. They had lots of certificates hanging on the wall. But, if there had been 300 people certified, the number of completed projects over time was probably 302... one for each certification and not much else.

We need to avoid that same problem in healthcare today. Too many leaders think the problem in their organizations is, somehow, a lack of training for staff and front-line managers. As Dr. Deming said, quality starts at the top. We need a new management system, not just more belts and certificates.

If you want to find out more about Jay and his books, you can find him at qimacros.com. Jay also has a free Lean Six Sigma Yellow Belt training with healthcare examples. That address is lssyb.com.

To listen to the whole podcast and to read a PDF summary with this content and more, please click here.

Mark Graban (@MarkGraban) is a consultant, author, and speaker in the “Lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals (the 3rd edition was released in 2016)  and Healthcare Kaizen. He is also theVP of improvement and innovation services for the technology company KaiNexus and is a board member for the Louise M. Batz Patient Safety Foundation. Mark blogs most days at www.LeanBlog.org.