Creating, Structuring and Sustaining a Culture of Continuous Improvement in Healthcare

These words are meant for those who are tired of the status quo and intend to create, lead and manage a Lean enterprise based on a Deming-style management system.  I am not talking about accomplishing leader-prioritized Lean projects with selected tools but rather creating a culture of a healthcare workforce engaged, structured and incentivized to participate in the work of improvement at all levels. That is to say, a Lean enterprise, defined as a culture of continuous improvements made by empowered workers. 

As of this writing, we have had the pleasure these past 6 years to lecture, train and share the story of our journey of continuous improvement all over the world. Most audiences see the results we describe, the standardization, and the visual artifacts of our way of working throughout the laboratories as the success. Initially, we described in the peer reviewed literature our plan to transform to a functional culture that allowed for continuous improvement (Transforming to a Quality Culture: The Henry Ford Production System, AJCP 2006;126(Suppl 1):S21-S29). We have learned much since that early plan. But it is that culture change and what we have learned in that quest that is the true success.

As a product of the culture that we created, we have been transformed, leaders and workers alike. We have learned many lessons by doing, succeeding, failing, adjusting, reinventing, innovating and doing again. In reflection, we have performed continual and successive PDCA cycles in that transformation to a quality culture.  In this next series of blog entries, I will review our lessons in the implementation 'how to' create, structure and sustain a culture of continuous improvement in healthcare with parallels borrowed from Henry Ford, W. Edwards Deming, and the successful Toyota Motor manufacturing management system.

We don't make cars in healthcare. We make people well and we work differently in a very complex environment of hand-offs with much variability. We don't have a 'shop floor' but we do have work as seen by those closest to it at the level of the 'bench' and at the level of the 'bed pan.'  Lessons from Lean must therefore be extrapolated to very different work conditions and professional relationships. This is hard work and requires understanding the best from others' work systems and innovating and adapting approaches that mine those successes to achieve our goal of transforming our healthcare culture.

What will follow in subsequent blog entries are our lessons learned from first hand experience in creating an effective PDCA-based culture of continuous process improvement that aren't typically taught in Lean training courses. This is from the 'school of hard knocks.' I was intent on writing a book but I feel this is the most efficient way of sharing these lessons so others may adapt and implement successfully in their own environments as well. We don't have time to waste in American healthcare.

I call this series that follows THE LEAN LEADERS GUERRILLA HANDBOOK.

I hope it helps you.

Let me hear from you so we can all learn something.