This week’s article was written by Michael Ballé. Michael is a highly respected leader and author in the world of Lean. He is the author of the well regarded book, The Gold Mine. Special thanks to Michael for submitting this article to us at HPP and Lean Healthcare Exchange for all in the Lean Healthcare community to read, and for leading the way in Europe for Lean in healthcare. Not long ago, Michael was visiting a hospital where the Lean Process Improvement team proudly showed him their 5S activities resulting from a recent Rapid Kaizen Event. In a nursing area, a garage-type shadow board (with missing “tools”) lorded over “overfull” shelves, untidy surfaces, and soiled linens on the floor. Altogether not very convincing, but we all know how hard it is to sustain 5S. The discussion led Michael to a troubling question. Enjoy the article:

What makes you think that techniques invented in a car factory could possibly apply to a hospital floor?

This is a real question. To all those who implement the tools of lean in healthcare, I ask the same question: what is your metaphor to transfer automotive techniques to healthcare: are patients parts? Physicians: operators? I don’t think so. There is real danger in applying a box of tricks devised elsewhere to a new setting because if we don’t start with an in-depth understanding of the real practice, we could end up giving plentiful but wrong advice.

Luckily, doctors and nurses being quite resilient, many lean efforts migrate toward support services such as improving the laundry delivery or records. This is much safer. But is this what lean teaches us? Aren’t we supposed to start at the customer first, and to improve customer satisfaction. Toyota’s message to its suppliers is explicit: safety and quality are the starting point of everything. A safe working environment for the employee will produce quality, which will satisfy the market and lead to volume, volume will lead to cost effectiveness and therefore to sustainable growth and profitability. In healthcare, the message is: start with patient and staff safety, improve patient care, and work from there.

How would Toyota then approach a new environment? Through kanban cards and yamazumi boards? Probably not. Toyota is currently driving a large effort on environmental management. Here are the three key messages:

Aim:
Zero emissions, zero waste

Kaizen:
Continuous improvement. As no process can ever be declared perfect, there is always room for improvement.

Genchi Genbutsu:
Going to the source to find the facts to make correct decisions, build consensus and achieve goals.

Of course the lean tools are important, but the lean tools are part of a system, which rests on a way of thinking. Before applying the tools in a non-automotive context, and all the more so in a non-industrial context, I believe it is worthwhile meditating on how the thinking applies to healthcare. On the nursing floor, for instance, one can start with the aim of zero patient (and staff) incidents, going and seeing the problems at the sources regularly, and involving staff teams to solve problems one at a time as part of their normal job. First and foremost, lean is about sharing a passion for quality.

Dr. Michael Ballé, business consultant and author, is President of ESG Consultants and co-founder of the Project Lean Enterprise (www.lean.enst.fr). This is France’’ leading lean initiative, conducted in collaboration with Telecom Paris, where Michael is associate researcher. For over a decade, he has focused on the human implications of lean implementation and has pioneered lean techniques such as Genchi Genbutsu, Standard Work and A3 problem solving in European hospitals. He is co-author of “The Gold Mine: a novel of lean turnaround” (www.lean.org/Library/), and has published extensively on organizational change. “The Gold Mine” has received the Shingo Prize for Excellence in Manufacturing Research.