Defining Reporting Relationships for Accountability

In the Henry Ford Production System, we have adapted to our healthcare environment the best of several structures (see figure below): 1) Toyota's line-level organizational structure for quality improvement using Group Leaders, Team Leaders and their respective Team Members aligned with 'work stations'; 2) Team Members empowered to represent their team in Customer-Supplier meetings in the interface as work is passed across work stations, units, departments and hospitals; and 3) Process improvements lead not by the Team Leader as in Toyota but by the empowered healthcare Team Members themselves. This requires leaders to adopt the Deming-style of management rather than merely applying the principles and using the tools of Toyota's efficient production system in focused projects. 

That organizational structure is depicted in the cartoon below for continuous improvement linking numerous multidisciplinary workstations and teams at the level of the worker. It is expanded for the work designated "Initial Patient Evaluation" into further sequential Teams along that path of workflow contributing to "Initial Evaluation." If there is no designated Team Leaders, for these 'work stations,' make sure that there are. The designation of a Team Leader for process improvement is an HR-free one, that is, it requires no Human Resources Department permission. I view this role as an expansion of the job description duty usually listed as - "other duties as assigned". In an effective Lean culture that "other" box can and should become very large. This person is key and is tasked with driving and facilitating the team-based approach to process improvements at the level of the actual work.