Volume 22, Number 8
Dave Barrett looks at the ways health-care systems can run more efficiently
Dave Barrett draws on his more than 15 years of coaching hockey to explain his research into Lean Management.
“If you want to play hockey, I can draw up a beautiful strategy on the board and say: ‘OK now go do it’,” says the Ivey Assistant Professor and Executive Director of the Ivey International Centre for Health Innovation. “And you could say, ‘Well we can’t skate, we’re out of shape, we’re not mentally tough.’ So there are many things that have to be done in preparation before a hockey team can implement the designed strategy.”
In the same way, preparation is critical in the successful execution of Lean Management – which is basically the removal of all activities in an organization that are wasteful, and that don’t add value to the customer.
Barrett’s interest in the successes and failures of Lean Management forms the basis of his dissertation and was founded in his work as a supply chain management consultant in a variety of industries doing process improvement – everything from Six Sigma to Total Quality Management.
One of Barrett’s last engagements was in a hospital – a setting that lagged behind other sectors in its ability to implement the recommendations of strategies like Lean Management.
“This led me to my dissertation because the health-care space was under tremendous pressure from a financial perspective and a performance perspective. Increasingly, many health-care organizations are turning to Lean Management as a philosophy to effect change, yet they are struggling with the adoption and subsequent management of Lean-based process improvement initiatives. Hospital administrators are actively interested in, yet problematically undertake, Lean Management deployment strategies and approaches that are intended to result in effective and efficient design and delivery of health-care services, but are experiencing varying degrees of success.”
Barrett’s hypothesis was there were underlying organizational issues that were either inhibiting or enabling certain organizations from deploying Lean successfully. A review of the academic literature showed much had been done in the practice of putting Lean into play, but there was little research that looked at the preparation required to be successful.
“We tended to measure the execution piece in an organization and not really look at the preceding investment in preparation,” said Barrett.
Through extensive interviews with employees at four different hospitals, Barrett created five constructs that reflected an organization’s capability at preparing itself for Lean implementation:
- Lean skills – The project management, problem solving, communication and teamwork abilities that employees could utilize during Lean-based initiatives.
- Lean executive leadership – The efforts of the organization’s senior leadership to explicitly communicate the purpose and objectives of Lean-based initiatives, engender commitment from direct reporting personnel, provide oversight, and engage personnel involved in those initiatives in a visible, persistent and authentic manner.
- Lean supervision – The project management, problem solving, communication and team abilities that employees could utilize during Lean-based initiatives.
- Lean climate – The operational environment that exists in which policies, practices, and procedures exist to facilitate the undertaking of collaborative and productive Lean-based initiatives.
- Lean culture – The collective views and beliefs held within the organization that reflect the norms, values, and assumptions that exist with regard to the importance and functioning of Lean-based initiatives.
Further research focused on 200 emergency rooms in the U.S. and interviews with ER nurses who had participated in a Lean management initiative in the last three years. It showed that 82 per cent of an organization’s Lean Competence was attributed to its Lean Preparation Capability – to be competent in executing Lean is because it prepared well. Only seven per cent is from its Lean Implementation Capability.
“It demonstrates the criticality of preparation,” said Barrett. “Most people know this intuitively, but no one really had measured it. We developed scales around these preparation attributes so that an organization can measure how well it has prepared; thus understanding, before it starts implementing, how Lean Competent it will likely be. The more competent an organization is, the greater its Lean preparation capability will be as reflected in the five preparation areas.”
The conclusion for hospitals and health-care systems is implementing a Lean Management strategy is more than reading a book or hiring a consultant – practices that could end up costing organizations a lot of money without any return.
“If you’re serious about it, cultivate the preparation capabilities ahead of time before attempting to deploy Lean,” he said.
The dissertation work fits nicely into Barrett’s role as Executive Director of the Health Centre, which focuses on increasing value for the patient and eliminating wasteful practices and policies throughout the health-care system.
His research has the potential to meaningfully impact society by making it possible for hospital administrators to deploy Lean properly through preparation. And it’s a topic that, because of limited tax dollars and an aging population, is going to become more critical for the health sector as time goes on.