Fundamentally, Lean is about changing the paradigm of how organizations work. In traditional organizations, decisions are handed top-down, and lower-level staff have no say. In our hospitals, that means that deadly mistakes go unreported for the sake of following orders. Nurses and doctors are frustrated. Patients feel lost in the process. Lean gives us the tools to end this mismanagement.
 
Lean makes every employee, patient, and family member a valued part of the care process. Every person participates in quality control. The results? Better care, zero defects, and a richer bottom line.
 
But culture change is difficult. Any type of change, even if it’s good, meets resistance. People’s lives are on the line—no one wants to take chances. That’s why culture change requires bold leadership, a bold vision. Leaders must believe in their organization’s ability to deliver the highest quality of care. Leaders must work day and night to get everyone on board, to build new bridges between patients, care teams, and staff.

​Fewer falls. More successful surgeries. Chemotherapy patients in and out faster, and back home to recover.
 
Changing the culture to be open to criticism at all levels is a huge shift. Yes, it’s difficult. But it saves lives.

​World-class healthcare organizations are structured differently from the rest.  They have a "high performance organizational design." 
 
Traditional organizational designs don't allow employees to make nimble changes to the process of care delivery.  Traditional designs don't allow staff to be as patient-focused as they need to be. And traditional designs don't permit the kind of rapid, successful deployment of excellent patient care that typifies world-class organizations.
         
A "high performance organizational design" is different from traditional hierarchical structures.

This chart illustrates how traditional organizational designs change to become high performance.  The traditional structure in Stage 1 is a hierarchy.  Obviously, top executives are at the top, workers at the bottom. A pyramid structure.  Not much direct communication.  Not much teamwork. Not much responsiveness to problems. Not much flexibility. Lots of rigid, formal structure. Plenty of work for producers of organization charts.
 
Stage 2 on the chart shows how the pyramid begins to flatten out on the top.  Less distance between top management and the workers, fewer layers of management, more teamwork.  Companies that aspire to become World-class are often in this phase. 
 
Stage 3 illustrates a World-class structure. A team structure. There is no long chain of command.  There are minimal layers of management. There are fewer structural barriers to communication. 
 
The advantages of team-centered organizational designs are many.  Communication is incredibly direct.  All functions needed for a project are present on the team.  New knowledge is created and integrated at a level far beyond what a traditional structure can achieve.
 
People and processes can be shifted to meet new innovations in patient care, and new requests from patients.  There is much more flexibility and responsiveness.  Responses are more focused and efficient.

​Perhaps the most dramatic advantage is that frontline staff are empowered and rewarded.  They are no longer at the bottom of the pyramid following instructions. Processes established by managers are no longer far removed from the hospital floor and the patient.  Processes get improved by the ones who know best how to make them better—the doctors, the front desk, the nurses, everyone who makes the hospital hum.
 
World-class Lean leaders know how to step back and restructure to capitalize on their human potential. Most importantly, world-class organizations aren’t afraid to re-organize until they get it right.
 
Be sure to check out my other posts on world-class organizations. And as always, feel free to reach out to me for more ideas about how to make the transformations in quality patient care that will set your organization apart.

​World-class healthcare organizations have an intense patient focus.
 
Talk is not enough.  "Patient focus" is more than just a pleasant slogan.
 
World-class healthcare organizations are redefining the idea of patient focus.  They know that true patient focus is not passive—it is active, aggressive, passionate, fervent, energetic, and tireless. You must have an unconditional commitment to your patients.
 
The patient is not just involved in the process—the patient is an indispensable part of the process, and it doesn’t work without the patient's involvement. Care cannot be delivered or innovated in a vacuum.
 
This means inviting patients into their care.  This means pursuing what the patient wants—chasing down what they need both in terms of medical care and in terms of the atmosphere, logistical processes, and family support that may be involved—until you get it right. It also means leaving behind attitudes such as, “That’s the way we have to do it,” and “Look, this is how we do it around here,” or worse yet, “Patients may not like it, but it works better for the doctors or staff this way.”

​World-class organizations have realized that success happens when they center operations on patient needs. What do I mean? I mean you no longer have to make educated guesses about patient expectations. You just ask the patient. Then you shut up and listen.
 
The best intentions in the world mean nothing if your patient isn't satisfied with and impressed with his care.  Patient satisfaction is the key measure of performance.
This focus on patient satisfaction does not compromise medical care or organizational efficiency. It enhances both.
 
Patients are at your doorstep because they need your help. They are hurting. They are going through medical crises they can’t solve on their own. But at the end of the day, you have to believe that the patient ultimately knows what is best for them. The patient — and sometimes, their loved ones — can and should collaborate with you on their care.
 
How are the best organizations focusing on their patients? First, they include the patient in the process of collecting information about his needs and expectations. Next, healthcare professionals analyze what that information means and learn to understand it in the context of the medical situation and care environment. Then, they implement the results by creating the care plan that best meets patient expectations, needs, and preferences. Finally, they measure patient satisfaction, including the medical, emotional, and logistical aspects of their care. From start to finish, the approach is true patient focus.
 
When world-class Lean leaders focus on their patients, they achieve real results. They put patient input into action. Take a look at the experience of Ted Gachowski, a patient at Virginia Mason when JBA was consulting there.

​I highlighted Ted’s case and the leadership of his doctor in the second edition of my book:

​Ted’s physician, Dr. Henry Otero, saw the needless difficulties created by the treatments that were supposed to be helping Ted feel better. Otero galvanized the hospital staff to find solutions, and greatly improved the quality of Ted’s care.

​Patient focus, front and center, put into action by Dr. Henry Otero, a world class leader who gets it.

Today on the blog, I’m going to lay out a vision for elevating your organization to a world-class level so you can achieve excellent, effective patient care on time and on budget.
 
There’s two keys to becoming the best in the business: your people’s passion and your commitment to continuous improvement.
 
World-class organizations know how to harness these keys to success—world-class organizations know how to aggressively focus human potential to excel far beyond all known or imagined standards of performance.
 
Let’s break down that statement. 

​Focusing human potential
 
People are your most potent resource. No machine can match the human mind’s ability to innovate. No machine can match the compassion your people bring to patient care.

​World-class companies really go after all that their people have to offer. They tap into the intellectual, physical, spiritual and emotional strengths of their employees. They consciously and energetically depend on their nurses and doctors to innovate the best care delivery possible. They understand and believe absolutely in the value of their people.
 
Your staff chose healthcare because they are deeply committed to serving others. World-class organizations amplify their employees’ passion for patient care by investing back into their people. Education and training levels are kept high—they are a planned, significant part of each worker's year.  Actions and policies—not just talk—reflect the value placed on people by world-class companies.
 
 
Excelling beyond known or imagined standards
 
To excel far beyond all known or imagined standards of performance.  This statement has two parts. First: “to excel far beyond.” Not just meet, exceed, or improve upon—but to completely and emphatically surpass those standards. This means committing to continuously improve, even after you’ve met your original goals.

Second: “all known or imagined standards.”  World-class organizations don't just excel relative to established standards.  They defy our imaginations with their performance.  They don't just perform far better than what we know. They outperform the best we've imagined!
 
That means quality increases by factors of 100—or 1000. Cutting costs in half.  Five times as many patients seen in the same facility—or ten times as many!  Reducing supplies inventory by 90%. Doubling productivity—then doubling it again!  Lead times reduced by a factor of 5 to 10. Cutting new product, service, and process design lead times in half.
 
Amazing, dramatic, impressive improvements—completely shattering all previous, current, or imagined standards. Again, this means supporting innovative improvements even after you achieve your original goal. Stagnancy leads to financial instability and under-performance in care quality. Don’t stop, keeping evolving. Your results will keep evolving, too.
 
Finally, world-class organizations excel in all aspects of performance. This means all aspects—patient satisfaction, inventory management, care innovations, staff management—you name it.  World-class leaders continuously improve their whole system, never leaving a division behind.
 
Be sure to look out for upcoming posts on the blog. My next series will take a take a closer look at five world-class aspects of performance: customer focus, operations, product deployment, organizational design, and leadership.
​

For example, head physicians in the U.S. military during WWII chose to ignore their colleagues’ calls from the frontlines to transition from plasma-only to whole blood transfusions. War is hell. It’s not easy to lead during a war. But had the management culture been more receptive to continuous improvement, battlefield physicians wouldn’t have had to fight so hard to implement life-saving technology.
 
There were several factors that contributed to the use of plasma rather than whole blood for transfusions at the outset of WWII. In the North Africa campaign there was no such thing as a blood bank where whole blood could be refrigerated and stored until it was needed. Then, no one had developed the means to send refrigerated blood to the battlefronts where it was needed. Lastly, physicians believed that plasma was better than whole blood.
 
However, as the war progressed it became clearer to frontline physicians and surgeons that there was a better outcome for severely wounded patients when whole blood was used. In this case the change agent was a physician, Colonel Edward D. Churchill, surgical consultant to the U.S. Army in the Mediterranean theater. The Colonel presented a new medical concept for the treatment of hemorrhage and shock: whole blood.
 
He started lobbying for change and hit several brick walls. He was swimming upstream against a long held notion that plasma was better, contrary to the evidence from battlefield physicians and surgeons. He quickly realized change could not come from within the military system. Even after a U.S. Navy Surgeon (Lieutenant Henry S. Blake) invented a special box to hold and transport refrigerated containers of blood, the Navy’s Surgeon General didn’t think it was that great an idea and refused to have the box used regularly in navy medicine.
 
Blake didn’t give up on his invention, and Churchill took the case for military use of whole blood to the New York Times. The Times wrote an article on August 26, 1943 titled, “Plasma Alone Not Sufficient.” The American public was upset when they read the article, fearful for the lives of its sons at the front. Finally, the U.S. Army Surgeon General felt pressured enough to quickly accept whole blood for Army use on the battlefield.
 
Look, I’ve seen firsthand how well the medical system works and how thousands of soldiers lived because of the expert care and miracles performed by surgeons, physicians and nurses on the battlefield. During my second tour in Vietnam, I was medevac’d back to the states. I was loaded on a string of medevac’d flights starting in Saigon, from Saigon to Guam, overnight then to Hickam Field, Hawaii, five hours parked in the heat on the tarmac because we were all infected, then to San Francisco, VA Medical Center, overnight, then to Madigan General in Tacoma, WA, and hospitalized for 30 days.