Reading List: Beau Keyte and Jim Luckman

In "Perfecting Patient Journeys" ($70, Lean Enterprise Institute), authors Judy Worth, Tom Shuker, Beau Keyte, Karl Ohaus, Jim Luckman, David Verble, Kirk Paluska and Todd Nickel offer a how-to guide for using lean management to make progress toward improving service delivery and costs. Beau Keyte and Jim Luckman talked to Healthcare Finance News about the book.

[See also: Reading List: Fredric Tobis, 'The Healthcare Crisis: The Urgent Need for Physician Leadership']

Q: Please give us a brief description of your book, and share with us what you think is its most important take away for readers.

A: This book is a practical guide for healthcare providers to move the needle forward and make progress in their journey toward improving the delivery of healthcare services as a patient moves through the continuum of care. This results in improvements in cost, service, quality and patient and staff satisfaction. The message is aimed directly at leaders who want fundamental improvement and change across their organizations and are looking for ways to align necessary goals to the frontline activities which influence these goals. The book uses an emergency department as an example and walks the reader through key aspects of work redesign and management system redesign. The content covers the breadth and depth of cross-functional, systemic change that not only engages the organization in the right thinking, but clearly defines management’s obligation and process to support the new changes.

The most important takeaway is that all improvement effort is most effective when the people directly involved in the work engage in developing solutions to the problems they deal with repeatedly on a daily basis, resulting in better and less expensive care for patients and increased job satisfaction for staff. 

Q: When it comes to using lean in healthcare, I have often heard folks say that people aren't widgets, so there seems to be some resistance to lean. What do you tell those folks about lean and using lean thinking in healthcare?

[See also: Reading List: Stanley Chao, 'Selling to China']

A: While most of the early lean examples were the use of specific tools on manufacturing plant floors, lean has been successfully applied in all industries for some time. It represents a way of engaging the entire organization to think and act differently to improve how we deliver services to our customers/patients, and how to do so in an efficient manner that utilizes the thinking of those doing the work. This new thinking and acting initiates a culture transformation. In healthcare we’ve found great lean thinking being used to address many problems: harmful care, patient flow, staff and patient satisfaction, organizational performance, management systems, etc. A big plus for healthcare is strong correlation between its scientific problem-solving methods and how clinicians have been scientifically trained. 

Q: What, in your opinion, is the biggest benefit lean offers the healthcare industry?

A: The healthcare industry is going through some significant and rapid changes as a result of the awareness of excessive cost. The Affordable Care Act is evidence of these changes. Lean thinking in healthcare can create a more adaptive response to these new expectations through the development of a culture of problem solvers and learners, strategically tied together for the purpose of meeting these new demands. This represents a fundamental transition in our daily work from “just getting through the day” to continually finding ways to improve care and the burden of providing care. 

Q: In your experience, what is the most difficult thing to overcome when you have worked with healthcare organizations implementing lean?

A: We see two big barriers to overcome. The first is overburden, or having too much on people’s plates for too long. With all the internal and external stakeholders pressuring for change, most organizations find themselves treating all requests for improvements or support with the same priority. As an example, we recently met with leaders in a large health system that created 36 strategic initiatives for 2013. The people on the receiving end of that plan didn’t know where to begin to help, and were frustrated in balancing time to support the plan and time for their normal responsibilities. Selecting a few key priorities and aligning the organization around supporting them is a big step in the right direction.

The second is socialization, which is a way of engaging everyone in helping to improve the organization. This industry appears to be more autocratic than others, which isolates good thinking and prevents teamwork in solving complex, cross-functional, systemic problems. The healthcare organizations we’ve seen actively socialize (as opposed to dictate) changes have a distinct advantage in addressing the industry autocracy. 

Q: Is there something about your book that I haven't asked you that you would like to add that you think is important for readers to know?

A: There is some great thinking in healthcare that outlines what we have to be good at and how good we need to be. This book accelerates the learning of how to unleash our natural talents to make the fundamental changes that delivers better outcomes, happier staffs and adaptable organizations. 

[See also: Reading List: Steven Dinkin, 'The Exchange Strategy for Managing Conflict in Health Care']