Lean Transformations Group

Why Lean So Often Fails: Lessons from a City-Wide Healthcare Initiative

In my 24-year journey with Lean, I have only seen a few moderately successful applications of this way of working. Still, I am a passionate proponent of Lean mostly because of an early experience I had in 1994 at New United Motor Manufacturing, Inc. (NUMMI). The two years I spent at NUMMI served as a fantastic eye opening experience that has since guided me in my efforts to help organizations embrace “Lean as a way of thinking.”

But why does Lean so often fail? The case I want to share involves a group of organizations, eight in total, working together in a major U.S. city for the purpose of more effectively treating individuals who encountered mental health issues.

The larger group of players included two of the area’s three hospitals, local police, local fire, a Christian mental health services organization, an ambulance service organization, and two private clinics that treat mental health patients. The State Hospital Association wanted these organizations to work together because each of them touched a significant number of the mental health patients who typically started their path to wellness in the two hospital emergency rooms. The project did not deal with all of the area’s mental health patients, but it did reach a sizeable group of individuals who were struggling to get help on their own. Instead, these individuals usually got looped into mental healthcare services while on the street with local fire and/or police responding to a 911 call.

When I consulted on this project, we got started by putting together a workshop on “value stream mapping” the many paths that an individual could take in an effort to stabilize their mental health condition. We gathered team members from each organization and worked with parents of patients who had followed this same path to mental healthcare treatment several times, but kept getting stuck in an emergency room visit loop (frequent ER flyers). Project participants represented folks who were hands-on with the patient (let’s use the name “Patient” now that the individual has entered a treatment plan) as well as manager level folks. We did not have senior leaders there, but senior leaders did charter team members in their organizations to participate as a result of a push from the hospital association.

The workshop covered multiple ½ day sessions over a period of several weeks. At the end, this larger team had very visual representation of the paths a patient could take on their path towards wellness. They were also able to identify a number of problems that interrupted the individual’s path to wellness. Most problems appeared at the “handoff points” between organizations. Team members from each side of the handoff point in the process created a problem list and then dedicated themselves to solving one of the higher priority problems.

When each group reported back their learning, the results were mixed. In order to effectively address individual organizational problems affecting the larger system, people realized that this meant making operational changes within their individual organization. Some of these changes worked when piloted, but when it came time to institutionalize new procedures, there simply was not enough support from leadership at each of the organizations to create lasting change.

I have seen this scenario play out time and time again; lean learning doesn’t translate into new practices, processes, and/or policies. After observing team member interactions and listening to folks reflect on this project, I believe lean fails for the following reasons:

  1. Organizations did not self-select into the project work. Leaders from each organization signed on to the project by way of an influential call from state hospital association leadership. How do you refuse the hospital organization in your state, from whom you will need many things throughout the year?
  2. Project work was viewed as separate from the work of each individual organization. The leadership teams of the non-hospital organizations only gave lip service to the project. Although they may have assigned the right people to it, the project work became an add-on job, not part of the team member’s daily work or the strategic work of each individual organization.
  3. Leaders weren’t personally invested. The leadership teams from most of the organizations (including the hospitals) never came to the final project reporting session. Participants felt abandoned, thinking that all their effort would go nowhere even though so much could be gained by the patient needing mental health treatment who was stuck in a broken system.

What does it tell me when I see this scenario play out? We are simply not at the point in today’s society when multiple, separate corporations who are intertwined in a complex value stream can regularly work together. Individual organizations have internal metrics that drive their behavior within their piece of the pie. And most of the time, organizations simply have too many constraints that would have them do otherwise. Most of the time...

But then again, as I saw at NUMMI, organizations are made up of people. Every now and then, people work together to change the conditions that prevent system-level work from being done. When this happens, Lean is possible, and yes, people have a chance of solving those really tough, seemingly intractable system-wide problems.

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