The Harvard Business Review published an article called "4 Steps to Sustaining Improvement in Health Care" last week that walks through what exactly makes some organizations successful in long-term improvement initiatives. The information in this article is based on research done by the Institute for Healthcare Improvement on organizations that not only achieved significant results through continuous improvement but were also able to sustain them. In short, they learned that the key is to find a way to engage and standardize the processes of managers on the front lines.

Lean in the healthcare industry is comparatively new, having first made an appearance in 1995 (over 50 years after Toyota began using it in manufacturing automobiles). Hundreds of hospitals and healthcare systems are now recognizing that they can reduce cost, increase safety, and improve patient and staff satisfaction using the Lean improvement methodology, but many still find it difficult to transform their organizations in this way.

The "stickiness" of a cultural transformation depends on your ability to get started, spread it throughout the organization, and sustain your efforts. This HBR article focuses exclusively on healthcare, but the principles it outlines apply to any company, in any industry. Lean is universal, folks. Let's walk through the article and talk about how it applies to your business.

Pilot the Change

The first step to sustaining improvement is to pick a location from which to pilot the change. In this pilot location, you'll want to standardize the work of managers at every level. This "model cell" approach allows you to experiment on a small scale so that you can adapt and improve your method with low cost and low risk. Find what works for your specific organization, drive success in this one area, and then use this area as a model to teach and inspire the rest of the organization. 

This is the approach we encourage new customers to use when rolling out KaiNexus, working closely with leadership to identify which area is an ideal pilot location. Our criteria match those identified in this HBR article, and you should follow these same criteria when picking a model cell for your own Lean transformation. They are: 

1. The pilot area should be stable with a low turnover rate, making it easier to train staff in their new roles. 
2. Managers here should understand the WHAT, HOW, and WHY of your transformation: what their role will be, how their behavior needs to change, and why this is important for achieving the organization's strategic goals.
3. There should already be strong and stable leadership in place in your pilot area. Managers should be confident and effective in their daily tasks and should have time that they'll be able to reallocate toward supporting and spreading improvement.
4. Your model cell should have at least one champion of improvement on-site; someone who understands the importance of the change and is able to motivate others to contribute.
   
   
   

Engage Lower Levels of Leadership

If you're this far into planning your Lean transformation, you probably know already that you need to engage front line leaders in the process. A common mistake, however, is to think that starts at the director level. Instead, you should be focusing on managers that are the first point of contact for your front line staff. By coaching these people in improvement and standardizing their processes to avoid reverting back to old habits, you will have a direct, daily impact on staff.

The managers who lead the daily huddles, help staff solve problems, and decide which issues to escalate are the ones who will truly be driving your improvement culture. Focus on them so that they can spread improvement down the chain of command. Use their success to spread improvement up the chain in the other direction, to more senior leaders.

Incorporate Lean into standard, well-defined work that people are already doing to avoid the trap of falling back into old habits. Such regression causes managers who should be focusing on improvement to have to get involved in fixing the daily processes of the team. This micromanagement makes staff resentful of the change, as they feel scrutinized and criticized in their daily work rather than empowered and intrinsically motivated to improve. By choosing processes that are well-defined and standardized from the start, staff will be excited about the opportunity to improve something they're proud of rather than feeling forced to improve something they're struggling with. That nuanced difference is huge in attaining a sticky culture of continuous improvement.

Shoot for Quick Wins

We advise all of our customers to start off their Lean journey by looking for the low-hanging fruit, so I was excited to see this on the list in this article. These are the improvements that everyone knows need to be made and just haven't taken the initiative yet to make. They're quick and easy, and success here gives the team a success to rally around right from the start. Look for improvements that are easily measured and can be accomplished in the near future to increase the stickiness of the initiative.

Celebrating these early wins increases enthusiasm for improvement. One of our customers goes so far as to actually give an actual watermelon to staff as recognition and celebration for their low-hanging fruit.

Once these early wins have increased buy-in for improvement, it will be much easier for managers to engage their staff in tougher improvements down the road.

Ask "What Bugs You?"

If you ask a group of people to improve their daily work to attain the organization's strategic goals, you're going to have a hard time convincing them that a) they know what to improve (even though they likely do), and b) they have time to do it. A better, easier way to go about engaging people in improvement is to ask questions like

• What bugs you?
• What is the most annoying part of your job?
• What is something that takes too long and should be made more efficient?
• What can you do to make your customers or colleagues happier?

More narrow, yet open-ended, questions like this will introduce the concept of Lean in an easily-digestible way that will automatically motivate people to get involved. Who WOULDN'T want their boss's approval to make a change that would make their work day better? Questions like these illustrate how small scale improvements can be, thus avoiding the mental block created by asking for large-scale, strategic improvements. 

For more information and examples on each of these, check out the HBR article that inspired this post. While their article focuses exclusively on the healthcare industry, I think you'll agree that the principles outlined in it are universal. The factors that cause a sticky improvement culture are the same for all of us.