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Steven Spear

Steve Spear: Healthcare is least likely to benefit from lean or any other operational excellence approach because healthcare professionals are not trained to think systematically about systems

By Steven Spear, - Last updated: vendredi, juin 17, 2011 - Save & Share - Leave a comment

Healthcare is the sector least likely to achieve process excellence with any meaningful breadth or speed because of three key impediments, one internal to healthcare,  one about the environment in which healthcare organizations operate, and one about the way in which ideas about process excellence are presented.

Internal Problem: Training in Functions without Systems Thinking

The internal problem is that healthcare professionals are trained, promoted, and evaluated in narrowly defined functional specialties–specialties within imagining, within surgery, within medicine, within nursing, etc.  There is good reason for this focus within specialties–mastery of the advanced science and technology requires time, practice, and effort.

However, missing from this is any training on the construction, operation, and improvement of systems–how to integrate the various specialties into a well functioning, coherent, whole.  Therefore, in practice, you have individuals working hard to create value, with much value destroyed in poor coordination and communication.  Hence, time and effort are spent recreating lost value, rather than adding new.

In contrast and for example, a professional engineer receives extensive training within a specialty; however, they learn–from early on–that their professional expertise will be expressed through systems much larger than themselves, by the integration of narrow specialties into a comprehensive project.

External Problem: No Market Discipline to Encourage Process Excellence and to Punish Process Laggards

On average, healthcare providers suffer terribly in their capacity to delivery high quality services, affordability, to a broad market.  In most other sectors (education being another obvious exception), market forces–customers making informed purchase decisions on the basis of reliable functionality, reliability, and cost data–would reward the standouts and punish the less capable.

Healthcare doesn’t operate that way.  Performance information is not available to decisions makers so we make arbitrary choices–I picked an emergency department based on the quality of the coffee shop adjacent to the waiting room–because I couldn’t know costs, complication rates, inconveniences in follow up appointment scheduling etc.  Friends have chosen treatment from institutions famous for their research and teaching only to suffer horrible complications.

Therefore, even if some healthcare professionals overcame their blindsidedness to system thinking, they would be poorly rewarded for their success.  Meanwhile, those who remained myopic don’t suffer the consequences of diminished business.

Framing Ops Excellence as a Skilled Trade, Not a Professional Discipline

There is a third obstacle to elevating operational excellence as a concern within healthcare (and within myriad other organizations as well).  Large organizations are run (more often than not) by people who have proven expertise within a professional discipline.  A professional discipline is one in which there is some core ‘theory,’ in which expertise is demonstrated by the iterative application of that theory onto situations of ever greater complexity.

For instance, mechanical engineers master a few principles in Newtonian mechanics, heat transfer, fluid dynamics (a variation on Newtonian dynamics), and system dynamics and prove themselves out by applying those ‘simple’ principles onto ever more complex structures.  Electrical engineers start with simple principles and prove expertise by application onto evermore challenging situations.  So too financial people, doctors, and so forth.

In contrast to professionals are skilled trades, the crafts in which expertise is demonstrated by the skillful application of tools onto problems–electricians, carpenters, plumbers, technicians, etc.

Skilled tradespeople rarely run organizations.

Operational excellence suffers from being presented as a skilled trade, not a profession grounded in sound theory about system design and improvement.

Lean experts master tools–value stream maps, standardized work, 5S, etc.  Six sigma experts master tool–DMAIC, etc.

Not grounded and able to speak in a ‘theory’ of systems–how to construct them to minimize complexity, how to operate them to maximize feedback for stability, how to improve them to maximize learning–ops excellence people are disadvantaged in talking to professionals running organizations because they talk as if they are coming from the skilled crafts, not from another important profession.

In short, healthcare is least likely to benefit from lean or any other operational excellence approach.  Healthcare professionals are not trained to think systematically about systems.  They are not rewarded for doing so well anyway (nor punished for not). Finally, as experts within a profession, they are not likely to be open to a field presented as a skilled trade, and not as another professional discipline.

We may not be able to fix 1 and 2, but for 3, we have both responsibility and opportunity.

Steve Spear

Sr. Lecturer, MIT Sloan School of Management
Sr. Fellow, Institute for Healthcare Improvement
Author: The High Velocity Edge
Twitter @StevenJSpear

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