Micro Organizational Behaviour

There is a rigour to Lean thinking that can appear supremely cold and calculating. However, its unwavering focus on “what the customer sees as value” should curry favour with those who are receiving (e.g., paying for) the end product, which ideally equips companies to look after their people and their environment. Welcome to the triple bottom line.

See… it’s not all about the relentless pursuit of cost savings.

There are some very real inefficiencies (waste, or “muda”) that can be rid from any system with this approach. This may be part of the reason we are seeing such approaches embraced in non-traditional areas, including the service industry and, yes, health care.

The Flo Collaborative

The Flo Collaborative kicked off in September 2007 in order to examine and improve the flow of care in Ontario health care. Two Ontario hospitals acted as pilot sites for projects under the Flo Collaborative, working with the regional Local Health Integration Networks (LHIN) and Community Care Access Centres (CCAC). The overall “flow” of care crosses several different organizations; for example, a client/patient moves from admission into a hospital medical unit, receives treatment and care within the hospital, and then transitions from the hospital to receive an appropriate level of care. The approach for improvement includes “The Model for Improvement,” Lean methodology, Six Sigma Tools, and PDSA cycles.

Not surprisingly, many initiatives that offer the possibility for “quick wins” target frontline staff who are actively engaged in their current standard processes. Andrew Ward, Senior Manager at the Erie St Clair CCAC, worked on the pilot project in Windsor between his CCAC and the Hôtel-Dieu Grace Hospital. He explains, “Often times, staff are well aware of shortcomings within the process but remain silent in expressing their ideas for improvement.” He adds that now, because of the Flo Collaborative, staff have greater opportunities to discuss and try new process changes. Often resistance to change is common in such improvement projects; however, Andrew still found an appetite for the improvements: “Many times we overlook that the frontline has lived with their current system inefficiencies and that they want the change, as well.” As with other change efforts, people have to feel comfortable contributing their individual insight to realize the overall process improvements.

Assessing and Influencing Authority
Asked about lessons learned in getting the all-important “buy-in” from “naysayers,” Andrew sees great potential in gaining involvement from the beginning. He says that it is well worth the initial investment in time to determine who has informal authority, in addition to those with formal authority. “No process change is made in a vacuum,” he explains. “Many things must be considered prior to making an adjustment in staff workflow.” Project leads and others within the team need to feel involved in order to want to share information.

There are some natural barriers that people can hit if they take a “business” approach to anything related to health care. Nonetheless, there are some significant improvements to be gained from a systematic approach, such as that with the Flo Collaborative. Like in any change initiative, it is ever so important to unlock the knowledge of the frontline by enabling good two-way communication. Andrew concludes, “By taking the time and identifying team members of formal and informal authority from the beginning, process changes will yield higher and more sustainable outcomes.” Don’t be mistaken: just because it’s soft, doesn’t make it easy.

This originally appeared in the June 2008 e-Newsletter for the Canadian Supply Chain Sector Council (www.supplychaincanada.org).

This week’s Longwoods newsletter (www.longwoods.com) lists instances of LHINs “starting to show some muscle” in enforcing balanced budgets for hospitals. The tally of resolved vs. delayed agreements from the London, ON, area is on the Longwoods Healtcare Blog. There is specific mention of a resolution, whereby the South East LHIN lent one of its area hospitals the shortfall to balance the budget for 2008; and of a conflict, whereby the North West LHIN and the Thunder Bay Regional Health Sciences Centre dig in on there competing positions.

The people working in these negotiations must feel like Gary Sinise in Apollo 13 when he is trying to simulate the landing procedure while not exceeding an unprecedented voltage level. In the movie (and the real story), he does it, which provides more evidence that the impossible is attainable when we work together.

What if the impossible is really impossible?

I can guarantee you that the word “impossible” has come up in the discussions and negotiations between Ontario’s hospitals (legally bound to budgets) and funders (LHINs whose job it is to enforce this accountability). I am equally certain that, in the end, some of the things deemed “impossible” were so in actuality, while others were not. The only way to separate the two is discussions (apparently still ongoing in Thunder Bay) that remain open and solution-focussed amid a cloud of rising tension. This is no mean achievement.

Unfortunately, “out-of-the-box” solutions are not always there, but they won’t even be entertained if there is a breakdown in the shared goal, which is getting a sustainable health care system in place. If a situation is truly unmanageable, then there is a responsibility to find a solution together. It demands a different approach than traditional “us vs. them” negotiations. A healthy dose of mutual trust will be necessary for resolutions or re-evaluations.

I am intrigued by the cost savings at Quinte Health Care from implementing third-party (Murphy Walsh) consultant recommendations for improved quality of life for nursing staff. Such experts can add tremendous value in honing systems. Of course, time tells whether the dollar return on these efficiencies will help with the budget shortfall. People also have to embrace the changes, and time also tells whether the changes are actually workable for the staff. One hopes that there is a peppering of “sell” in the “tell” for any change required.