Here are some of the different ways to start, stated with some of the pros and cons.
Some hospitals take the approach of starting with many Rapid Improvement Events (RIEs), sometimes known as Kaizen Events or Rapid Process Improvement Workshops (RPIWs). These events generally range from two to five days and give staff and leaders dedicated time to work on significant problems that need to be solved.
One pro is that RIEs can be used to solve problems that can make a significant impact on measures that matter, including safety, quality, patient flow, cost, and staff morale - that is if projects are selected carefully. One downside to starting with RIEs is it can take a long time to get everybody in the organization exposed to Lean through the RIE learning-by-doing approach. Some organizations, like ThedaCare, have learned that RIEs need to be supplemented by other methods, like Daily Kaizen, Lean management system practices, and strategy deployment.
Some health systems choose to start small by getting many staff members involved in small continuous improvements through the “Kaizen” methodology. Franciscan St. Francis Health is one organization that began with this approach, rolling out a Kaizen methodology throughout the organization within a year or two. One pro of this approach is that Kaizen is easy to teach and it’s less scary to start by solving small problems in the Plan-Do-Study-Adjust format. Learning PDSA through Daily Kaizen is incredibly helpful if you then want to move to more complex improvement methods (also based on PDSA) like RIEs and A3 problem-solving.
One con of starting with Daily Kaizen is that some people might worry about demonstrating the impact of lots of small improvements, so there might be pressure to take on more significant challenges. Daily Kaizen also requires specific leadership behaviors that might be challenging for people to adopt, whereas RIEs can be implemented more easily, perhaps, in an organization that’s not yet a culture of continuous improvement.
Some organizations worry that disconnected RIEs or small Daily Kaizens might not move the needle on measures that matter to the organization as a whole. So, some organizations choose to start strategically by ensuring alignment of the “true north” direction of the organization before starting their Lean journey. One pro of starting with this approach is that executives can be learning PDSA and Lean concepts from the start, helping them lead by example, setting the tone for the rest of the organization. One con of starting with strategy deployment (aka “hoshin kanri”) is that leaders might tend to push goals and priorities in a strictly top-down way instead of engaging others in the more collaborative “catchball” process. As with all of these approaches, having a good coach can help avoid problems like that.
Other health systems have been inspired by other organizations that built upon a foundation of RIEs or a culture of continuous improvement to extend Lean thinking to a broader daily management system. Having a Kaizen process is excellent, but a Lean Daily Management system includes huddles, leader rounding, aligned metrics to create a more integrated system that drives improvement and keeps everyone on the same page. A pro to this approach is that it helps develop staff and leaders in a structured way, but a caution is that an organization might try to embrace some of these more advanced methods without a solid foundation of PDSA thinking. There’s a theme here… PDCA or PDSA thought is the key to any of this.
It’s easier to define “what Lean is” or “what a Lean culture looks like” than it is to identify how you should get from here to there. What path should we take toward Lean? How do we get started? That’s open to debate. There’s no reason the options above should be considered either/or choices. These approaches can be combined, and there’s probably more power in that.
The key, I think, is working on problems that matter. Instead of implementing Lean tools or Lean methods, start with a problem or an opportunity. That, right there, is the essence of PDSA thinking. Another critical point is to think about an iterative plan for your Lean journey. Instead of developing a three-year plan that’s known and certain, think about your plan as something that will adjust and adapt over time as you get more experience and learn. Plan, Do, Study, Adjust… and good luck!