| I want you to think about the term Leadership | | | | problem would be largely obviated. |
| for a moment. If I asked several of you to give | | | | A fourth skill very necessary for strong quality |
| your definitions I bet there would be many | | | | improvement leadership is analytical skills. A leader |
| different points of view, some similar, perhaps, | | | | should be able to weigh the cost of a quality |
| but most quite different. Do you envision | | | | improvement effort versus the return on |
| someone who is strong and demanding with rigid | | | | investment. Rarely are the success or failure of a |
| concepts about getting things done? Do you | | | | quality improvement effort tracked in terms of |
| envision someone who is a good listener, who | | | | cost and savings. Focusing only on patient health |
| leads by example? I think there are many valid | | | | means that sustainability is ignored. With the |
| ideas about leadership, and each probably has its | | | | increase of competition in health care and the |
| place depending on the situation. I want to focus | | | | advent of bundling of payment for services in |
| on what kind of leadership is necessary for | | | | Medicare the financial factor cannot be ignored. |
| changing an organization into a Lean organization | | | | Besides these four characteristics the leader |
| or maintaining a Lean organization. The reason I | | | | guiding the Lean transformation must also |
| choose to do so is that I am a member of a | | | | understand some of the basic tools of |
| committee that is charged with developing a | | | | Lean-process mapping, kaizen events, 5S and |
| program to assist local physicians and physician | | | | voice of the customer, among others. I don't |
| organizations incorporate Lean healthcare with the | | | | think that the leader needs to be the master of |
| Wagner Chronic Care Model. One of the | | | | these; rather she should be able to recognize their |
| milestones is to develop leadership locally; | | | | correct application and through her vision of a |
| leadership in quality also came up as the primary | | | | quality organization see that these tools are |
| identified need in a survey of the local physician | | | | implemented and the results communicated |
| organizations. | | | | throughout the organization. One situation, for |
| When changing an organization into a Lean one, | | | | instance, in which the leader makes sure the tools |
| the first thing I consider is the person at the top | | | | are implemented correctly is by appointing people |
| and his characteristics. Without firm support from | | | | with Lean skills to teams; this team might be |
| this person the transformation will not be | | | | defining new processes to handle diabetes |
| successful and will not endure. In a hospital this | | | | patients in a primary care setting. She should be |
| would be the CEO and in a primary care setting, | | | | able to select an able leader for this team and |
| the person making the major management | | | | see that the ideas generated are sorted and |
| decisions, whether the office manager of a | | | | disseminated with the best ones implemented. |
| physician. One characteristic of this leader should | | | | Once the process is implemented the leader |
| be persistence. Why? Changing the way an | | | | should have the impact measured and if the |
| organization approaches quality requires a cultural | | | | impact is positive have the process maintained in |
| change. Such change will encounter resistance; | | | | spite of common roadblocks such as resistance |
| people tend to resist change because maintaining | | | | from those who want to maintain the status quo, |
| the status quo is comfortable. A leader at a | | | | as mentioned above. |
| hospital, for instance, might after much staff | | | | In order for a leader to become familiar (not an |
| training in Lean tools succeed in getting the front | | | | expert though) with these tools several |
| line workers-the nurses, the aides and the | | | | approaches are possible. There are many |
| doctors--to change only to have middle | | | | conferences and trainings for lean management |
| management sabotage the efforts. Only with | | | | available in healthcare. The American Society of |
| persistence can this roadblock be overcome. | | | | Quality offers such. Another approach is to |
| Persistence mixed with patience and high | | | | contract with a consultant who is familiar with |
| standards will be necessary because the changes | | | | both healthcare and Lean techniques. Whatever |
| will take a considerable amount of time too. One | | | | the approach-workshops, conferences, online |
| year for a primary care office to embrace | | | | training or hiring of a consultant--I think it a good |
| continuous quality improvement would not be | | | | idea to follow up these with a reference text |
| unusual, whether the leader starts small by | | | | such as A Lean Guide to Transforming Healthcare |
| changing one part of the office at a time or | | | | by Thomas Zidel. |
| whether the staff as a whole is trained and asked | | | | Lest you think that I miss the mark with my |
| to change. By the way, in a November 19, 2007 | | | | characterization of a Lean leader, let me relate |
| article in the Wall Street Journal persistence along | | | | one last story. Jaimie Houghton was the CEO of |
| with attention to detail, efficiency, and analytical | | | | Corning Glass and implemented Total Quality |
| skills were named as the most important skills of | | | | Management in the early 90's to Corning. He spent |
| successful CEOs. | | | | a great deal of time traveling to Corning's units |
| Attention to detail means recognizing and | | | | worldwide to drive his vision of a quality |
| understanding how the parts work together. In | | | | organization. In 1995 one of Corning's units |
| order to lead change successfully this would mean | | | | received the Malcolm Baldrige National Quality |
| understanding how different members of a quality | | | | Award. Mr. Houghton retired the next year after |
| improvement team work together. Do they | | | | successfully imbedding TQM in Corning. His |
| complement each other? Do they clash? The | | | | successor, however, did not have the passion for |
| leader is responsible for integrating such a team. | | | | quality that Mr. Houghton had. The programs were |
| Besides understanding team dynamics, a leader | | | | not abandoned but other priorities and visions |
| must understand how the different parts of the | | | | preempted Mr. Houghton's legacy. The result was |
| healthcare site function. Does the support staff or | | | | that sales dropped dramatically and the stock |
| administration complement the clinical? For | | | | price fell from $113 to as low as $1.10. In 2002 Mr. |
| instance, is billing efficient? If not, this has negative | | | | Houghton was coaxed out of retirement to |
| consequences in providing clinical care. | | | | rescue this failing giant. This time, Mr. Houghton |
| Efficiency in quality improvement cycles means | | | | instituted quality using Lean and Six Sigma. He |
| understanding where waste exits in an | | | | made sure that the programs would endure after |
| organization and also understanding how to utilize | | | | he left again. Although the share price is |
| staff ideas to eliminate these wastes. For | | | | considerably below the high of $113 of previous |
| example, in a primary care site a leader should | | | | years, the company leads its competitors |
| have a clear picture of how to reduce the time | | | | considerably in market value. Much of this is |
| spent looking for misplaced patient histories, if | | | | attributable to the persistence of Mr. Houghton in |
| paper histories are still being used. Of course, if | | | | ingraining recognized quality approaches into the |
| electronic health records are being used, this | | | | company. |