Beyond Heroes, A Lean Management system for Healthcare, by Kim Barnas with Emily Adams, Thedacare Center for Healthcare Value 2014

When are heroics replaced by predictable, managed systems?  In manufacturing, the shift between steep hierarchies of top-down management to empowered teams and distributed power and decision-making took out much of the heroics.  But healthcare is different – at 17% of the US’ GDP, an industry driven by catastrophic injuries mixed with health maintenance and life milestones – birth, death and everything in between -  is it realistic to expect that a new system will evolve?

Well, the folks at Thedacare believe there is hope for a more predictably and comprehensively managed healthcare system.  Let’s look at their argument and evidence.

“For me, standard work is my road map.  It is what drives me through every day,” Vicki Van Epps says.  “If I didn’t have standard work, honestly, I don’t know what I would do.”  Following Vicki through her day we see how she lives to a routine that takes her out to gemba, back to huddles, and around to check-ins supported by more detailed discussions.  The routine doesn’t block her team from dealing with crises, but it is instead designed to prepare a foundation that eliminates much of the crazy heroics.  Vicki calls this routine her standard work. 

What does this repeated pattern of observation and checking do for the operation?  First, it supports open sharing of data and accountability.  But second, it builds a model for a particular leadership model, one that respects and includes the kind of information gathering that runs the operation.  For Karen, one of Beyond Heroes’ great examples, “the revelation of standard work has been the way that it has helped spread the weight of problem solving.” 

                She explains more about her concept of standard work:

“In the old world, in the way we used to manage, there were a ton of things on your desk and not everything got follow-through.”  Now she says, “We have a system of follow-up that is not wholly dependent on me and my to-do list.  It has taken away the onus that I was supposed to be the person remembering everything.”  This is not the standard work calculation the Frederick Taylor guys grew up with!

Look to Beyond Heroes for other simple examples of the basics of lean management applied to healthcare,  including value stream mapping, Visual Controls,  Problem Solving and Corrective Action processes, communications tools,  Leadership Discipline,  A3, the Huddle, Kamishibai  Board, and gemba tracking.  This book will be great starting point for teams looking to examples before they start their journey.