Lean in light of the postmodern challenges of healthcare Dr Stefan Metzker CEO Hospital Maennedorf, Switzerland

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Healthcare in Switzerland

• Population: 8.4 Mio

• Hospitals: 288 (52 beds/10’000 SA: 28, Ger: 86, UK: 33, US: 30)

• Health insurance compulsory foremployees (free choice ofhospital), extra private coverage(free choice of doctor + comfort)

• Introduction of DRGs 2012

Welcome to the Games

Best possible health care at the lowest cost!

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Hospital in Trouble….

Hospital in Trouble (continued)

• Medical Doctor (Emergency Physician) – trained in Switzerland and South Africa (ICU Tygerberg Hospital)

• EMBA (UCT): Prof. Tom Ryan and Prof. Norman Faull

• Experience in other industries: Capestorm and hospitalproducts and services provider PrionTex Micronclean –first Steps with Lean

• Director Clinics of Valens in Switzerland

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New CEO….(No 4 in 3 years)

First Experiences with Lean Toyota Production System

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Toyota Mantra Mass production & and forced processing vs. continuous flow “make one – move one”

We were Heroes

?How the hell is Lean going to

help US?

Achetypes of beliefs in the past centuries:

• Middle Age: Dictate of strength

• Age of Enlightenment: Dictate of reason

• Age of Industrialization: Dictate of productivity

• Age of Communication: Dictate of networking

• Postmodern Age: Dictate of multidimensionality (and the end ofreason….. )

How did we get here? A few steps back in History

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Postmodernism

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Definition:Postmodernism is described in literature, architecture, art, philosophy but also in socio-economy as a reaction to the failure of rationalism*

*Karl E Weick: Scholar in organizational behaviorand psychology –Ross School of Business, University of Michigan:Making sense of the organization – a postmodernorganization theory:Managing becomes the managing of sense,sharing of meaning, of diversity and oppositions.

Strategies of Organisations in Postmodern Times*

Application of Systems Thinking* in order to be able toadapt better in a rapdidly changing environment by• building structures that promote autonomy and the

capability to solve problems (heterarchic networks andthe use of diversity nn !)

• transforming of the culture of organisations to moreopenness, participation, the abilty of self-organisation and cohesion (gravity) by sharing a common vision.

• creating conditions for the development of the peoplein organisations (generation Y!) that allow them tocreate solutions and to participate in the developmentof the organisation (= empowerment)

• allowing structures that support reflection

*Management Model of the University of St. Gallen, Switzerland

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If a Lion could talk….*

13*Ludwig Wittgenstein

Who is the boss?Balancing Act between Hippocratic Oath and Economy

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Prof. Luc Hoebeke: Making work systems better (expert organisation)Prof. Karl E Weick: Strategic thinking is an activity of the right hemisphere and often leads to a social swamp with a tendency to push ones own view!

High Complexity

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Visual Diagnosis: Broken processes due to duplication, non functioning interfaces, poorly assigned responsibilities (structures) and poor leadership…

Incompatibility of a Patient centered clinical Path with hierarchical and departementalizedStructures of Hospitals

Difficult ‘value stream for patients’ - their journey is horizontal

but hospital structures are often vertical

Purpose, Process, People?*

«The failures to adopt value as the central goal in health care and to measure value are arguably the most serious failures of the medical community. Setting the goal as cost containment, rather than value improvement, has been devastating to health care reform efforts.»Prof. Michael Porter: What is value in health care? N Engl J Med 2010; 363:2477-81

«We permanently try to improve the organisation but tend to forget thetreatment of our patients….we still have not realised that the ‘True North’ of theLean Transformation primarily serves the purpose of improving the quality of thetreatment»John Toussaint, CEO ThedaCare Center for Healthcare Value, Presentation, Lean Health-Care Transformation Summit, Brussels Oct 2015

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*Jim Womack

Lean Hospital v 1.0

Lean Hospital v 3.0 Following the True North: Management on the Mend

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Lean and Leadership: Lead with Respect*Principals drive Behaviour: Balancing Principals, Results, Tools and Systems

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*Michael Ballé

Lean and Leadership: Management on the Mend*Lean Healthcare ist NOT an improvement program. It is a operative system within a management system that presupposes a radical transformation of the culture in the organisation.

In a ‘Lean Hospital’ it is the job of every worker at the front topractice medicine and to solve the problems of our patients; it is the job of every superior and manager to be there to supportthe work of the front-line workers. There are therfore only two kinds of jobs in a ‘Lean Organization’:

1. Problem solver2. Supporter of the problem solver

The CEO, the members of the board, management and superiorsare supporters of the problem solvers.

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Lean and LeadershipBottom up vs. Top down

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Five Changes Great Leaders Make toDevelop an Improvement CultureNEJM April 27, 2017John S. Toussain, MD & Susan Ehrlich, MD, MPP (Zuckerberg San Francisco General Hospital andTrauma Center)

1.Willingness2.Humility3.Curiosity4.Perseverance5.Self-discipline

‘Align, enable and improve’

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From KPIs to KBIs: Leadership Competence Model SMA

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Four core competencies:

1. Employee-oriented leadership: Soft skills , know yourselfand others

2. Employee promotion and development: Coaching

3. Client orientation: Quality

4. Result orientation: Lean tools, research, finances and control

Lean Hospital Maturity ModelReceipe for a Lean Hospital – Revolution in 7 steps:John Toussaint, Lean Healthcare Transformation Summit Brüssel, 2015 und ‘Management on the Mend’

1. Leadership - Willingness for ‘Change’ - ‘True North’ commitment -patient and their security come first with quality of their treatmentalways in mind

2. Create a Lean cell – 3-dimensional working model

3. Establishment of values and principals (culture!) for a climate thatencourages problem identification and solutions thereof

4. Build a central ‘Improvement Office’

5. Redesign the Frontline Management Systems (Empowerment, KVP, Gemba etc.)

6. Rollout in the entire organisation

7. Realignment of the organizantion politics, most importantly in the HR-, finance- and IT-departments

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And if Lean doesn’t work?

http://www.youtube.com/watch?v=Wdroj6F3VlQ

Lean Hospital v 3.0 is a response to thepostmodern challenges by becoming a Learning Organisation* with Systems Approach and Empowerment

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*Peter Senge: Author of ‘The Fifth Discipline’

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Taiichi Ohno: «Let the flow manage the process, and let management manage the flow»

Dannel P. Malloy: «By empowering our people toimprove the processes that define theirworkplace, we can tap a powerful force that will lead the way to a stronger, more prosperousworld.»

Lead with Respect* and beLean with your Heart!

*Michael Ballé: Lead with Respect

SYSTEMS THINKING

System thinking is a method of critical thinking by which you analyze the relationships between the system's parts in order to understand a situation for better decision-making. In simple terms, you look at a lot of the trees, other plants and critters living around the trees, the weather and how all these parts fit together in order to figure out the forest.

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