offers Jim Womack’s discourse on Mayo Clinic’s pathway revival. Jim Womack, the Chairman and Founder of Lean Enterprise Institute, had visited ten years back the Mayo Clinic’s large medical complex in Rochester, Minnesota.
He went as a lean anthropologist to the medical organisation for examining its thought process and behaviour from a lean perspective.
The trip was arranged by Dr. Don Berwick, the founder and president of the Institute for Healthcare Improvement in Boston.
Dr. Don Berwick asked Jim Womack to consider how a major medical system would go about implementing lean thinking across all of its activities.
Jim Womack followed a number of patient pathways as well as pathways for medical supplies, patient schedules and specimens going through the laboratories. (Lean Thinkers often call these pathways as value streams.) And Jim Womack soon reached a diagnosis - Severe sclerosis of patient and support pathways.
At Mayo (and in the many medical organisations Jim Womack has visited since), he found good doctors who were point optimisers, focusing solely on their narrow activity without much thought (or patience) for how it meshed with the other activities around them.
The hospital’s administrators, by contrast, were asset optimisers, trying to keep every expensive machine, hospital room and specialist busy, even if this meant delays for patients and heavy burdens for staff.
The nurses were the members of the organisation thinking about patient pathways and about core support processes like handling supplies and drugs. But they were doing this intuitively and reactively, to somehow keep things moving. They lacked recognition of the importance of their task and a rigorous methodology.
Together, the doctors, administrators, and nurses were providing healthcare that cost too much, took too long and often produced less than optimal outcomes. Jim Womack felt that to make a lean leap everyone in the organisation would need to change their way of thinking and acting.
Jim Womack’s prescription was to identify all major patient pathways as well as support streams. He suggested to map them from end to end and to ask how each pathway can be cleared of its blockages, backflows, and cul-de-sacs for the benefit of the hospital, its staff, and its patients. Jim Womack stressed on the changes required in organisational lifestyle in order to keep the pathways clear.
Jim Womack was troubled not about the diagnosis or the prescription which he was sure he was right, but about the prognosis. His recommendations would require that doctors, nurses and administrators (and suppliers too) change their behaviour and organisational lifestyle, which was a hard part of the treatment.
Given the difficulties involved, Jim Womack ended his first venture into healthcare in May of 1997, thinking it was premature to hope for much progress toward lean healthcare and did not return to Mayo for ten years till recently when he spent a day with Dr. Henry Ting, a cardiologist with a natural instinct for process thinking.
They looked carefully at the work Dr. Henry Ting’s team has done recently to speed patients from the point they suspect they might be having a heart attack, usually far from a hospital to the point where all appropriate treatments have been applied.
The results are quite impressive. Rethinking, this pathway could save lives because the more quickly appropriate treatments are applied, the more likely the patient is to survive and to survive without major heart damage.
And the good news is a lean pathway reduces costs for the hospital and makes life better for the staff. It is a win-win-win situation. Jim Womack’s scepticism on his previous visit was replaced with hope after this visit.
Jim Womack also realised that Dr. Henry Ting’s team had performed a good procedure on one of the easier problems to fix and sustain.
They had analysed a single pathway and one where the value of saving time is so obvious that any medical organisation will find it hard not to change its behaviour once the sclerotic state of the existing pathway is clearly revealed. (Their work is now being successfully paralleled throughout Mayo’s cardiology practice and by similar pioneers along other pathways in many healthcare organisations across the world).
Jim Womack feels the hard part was to tie together these pioneering, single-pathway efforts, which seemed beyond grasp only 10 years ago. There was a need to create a complete lean enterprise in which all pathways have been permanently cleared and the lifestyle of the organisation has been changed as well. This would require more than lean techniques, new management methods and a new type of leadership.
Given the urgent need for this lean leap, Jim Womack is happy that his long-time co-author Dan Jones has taken on the challenge of asking what a lean healthcare system will look like. He is leading the first Global Lean Healthcare Summit in the UK at the end of June in which they will be asking what kind of leadership and what kind of management will be required.
They have invited doctors, senior administrators, nurses, and suppliers to describe the challenge as they see it. They will then work together to develop hypotheses about creating lean healthcare on a systemic basis that we can all test.
The gratifying aspect of the recent embrace of lean thinking by the healthcare community, making the upcoming Global Lean Healthcare Summit possible is that these are important value streams in lives, which often determine the length and quality of lives.
Jim Womack told an Australian healthcare audience recently, “Toyota takes better care of car parts than most healthcare organisations take of their patients.” He feels this is not right and says there is a moral obligation to do better.
Jim Womack is encouraged that lean thinkers in the healthcare community are at last tackling important value streams, but concerned that it will stop short with single pathway interventions. Jim Womack is also worried that improvements in individual pathways cannot be sustained because the organisations in which they reside have not changed.
Jim Womack concludes that “What the patient -- the whole healthcare system -- really needs is to think through the entire system from a management and leadership perspective so we can truly create and sustain lean healthcare.”