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The People Side of Lean in Health Care

By Trudy Lonegan

Diane Bock Ever think of interactions as waste? Lean recognizes eight forms of waste: defects, overproduction, downtime, underutilized skills, transportation, inventory, motion, and overprocessing. But we have identified a ninth form that is especially damaging in health care: ineffective and inefficient workplace interactions. Interactions are potential sources of waste that not only derail Lean initiatives but also hurt the patient experience.

Let’s look at two primary success factors in a Lean transformation: improved workplace interactions and the development of “Lean Leaders.”

The 9th form of waste:  workplace interactions

All interactions between managers, staff, and care teams are potential sources of waste. These include formal interactions (staff meetings, shift change meetings, coaching and performance discussions, etc.) and informal (hallway conversations, emails, instant messages, etc.). When these interactions are ineffective, the negative impact of the eight recognized forms of waste is compounded. In the study, Going Lean in Health Care, those forms translate directly or indirectly into lost time, money, supplies, good will, and slower care delivery. The end results can lead directly to patient safety issues, customer dissatisfaction, and staff disengagement.

Lean into the process

So how can we improve workplace interactions and eliminate the ninth form of waste? The first step is to treat an interaction as you would any other process: you must standardize it. The interaction can be systemized to reduce variability and create a repeatable and predictable process. Once the process is established, it can be applied to any type of interaction.

The Interaction EssentialsSM provide a framework for satisfying the two critical components of effective interactions: the practical and personal needs of the participating parties. This standardized approach includes the Interaction Guidelines—the five steps that target the practical needs of participants by guiding the structure of the conversation. These steps—Open, Clarify, Develop, Agree, and Close—form a process that progresses from the beginning of the interaction through the engagement of participants to the resolution.

Interaction Essentials

Personal needs, meanwhile, are met through the application of Key Principles. The Key Principles guide how participants interact with one another during the conversation and focus on fostering esteem, empathy, involvement, sharing, and support. Meeting personal needs addresses one of the foundational elements of Lean: respect for employees. And, the consistent and effective application of the Key Principles builds trust—another fundamental element of successful Lean operation.

The skinny on lean leadership

The health care industry is heavily invested in improving efficiency to reduce costs by decreasing waste, which can significantly impair operational and financial performance. Similarly, ineffective interactions between leaders and employees can also affect organizational performance. They create cost without adding any value. Worse, ineffective interactions generate confusion, conflict, and a lack of commitment to goals and change initiatives. The implications for patient safety and clinical outcomes are real. Health care organizations must build “Lean Leaders.”

DDI’s Global Leadership Forecast 2014|2015 shows that health care is neither making adequate progress improving leadership quality nor building a leadership bench.

This is a dangerous situation. Every health care organization is expending massive resources on programs to maximize efficiency, reduce costs, and improve patient safety and experience, but is not making successful improvements in leadership skills and quality. It is impossible to drive the type of transformational change that the industry requires without very agile, highly skilled leaders.

John Golding, my colleague, is an expert on Lean and has defined seven things lean leaders must do:

  • Ask the right questions: Enable others to think more deeply about what they are seeing and doing.
  • Consistently promote standardized work: Practice proven steps and measures designed to ensure predictable outcomes.
  • Identify problems vs. opportunities: Know the difference between a problem and an opportunity. Call out problems, and focus on quick resolutions.
  • Promote job ownership: Define and model ownership, establish boundaries, and constantly coach others to challenge their thinking and own their work.
  • Relentlessly drive out waste: Model effective interpersonal interactions. Focus on engagement and ownership of all involved.
  • Support experimentation and failure: Inspire curiosity, challenge current perspectives, create freedom for team leaders to experiment, and drive discipline for creating new ideas.
  • Accept responsibility for the team’s failures: Apply consequences for poor performance, but work in partnership with the individuals involved. Take direct responsibility to help them learn from their mistakes and ensure they can correct the causes.

Piling on

The chance to extract great benefits from small changes in human interactions is unprecedented. When interactions between leaders and staff are garbled and confusion ensues, safety is jeopardized, and productivity and the patient experience suffer. Ambiguity around responsibilities and expectations impacts every aspect of health care delivery. And without clear-cut feedback delivered with both practical and personal needs in mind, the ninth form of waste will likely compound all waste elimination efforts and impede continuous improvement.

When you consider the potential impact on productivity from ineffective interactions, tending to the “soft stuff” makes a lot of sense.

Trudy Lonegan, client executive, has worked with health care organizations to improve leadership and staff interaction skills to maximize organizational efficiency and customer experience and to drive more effective selection practices. 

James Clevenger's blog, which focused on this 9th form of waste in manufacturing, provided the source material for this health care blog.

Learn how DDI’s Manufacturing practice can help you optimize your talent for the success of your business.

Posted: 19 Dec, 2014,
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