Leadership is Key, but not Always Enough

Posted on by Paul Pejsa

Road amidst Mountains

As members of the Catalysis Healthcare Value Network team, we have a unique perspective on healthcare transformation because we go to see many organizations every year. When I reflect on the organizations that I have visited one thing stands out, leadership is key, but it is not always enough.

This year I have seen a few scenarios that demonstrate why an organization needs to work diligently to engage all areas of the organization in the transformation journey. Below are a few of examples of these scenarios played out:

Senior Leaders Delegate Change

We all know that leadership support and participation in organizational transformation is paramount in achieving true culture transformation and sustainability. I see the scenario time and time again of leaders delegating the lean transformation to the continuous improvement team and feeling that they don’t need to change. The team can get some traction within the organization and even help the operations teams realize improvement and engage in the transformation; but at some point, the new processes and systems begin to deteriorate.

Leader Support Varies in a Large System

Another scenario that I have observed is when there is variation in the level of buy-in and support from senior leaders within a system. One of my CHVN key contacts was leading improvement efforts and culture change at a hospital within their system. He did an outstanding job facilitating the implementation of a management system and coaching leaders in that hospital to the principles of operational excellence. Such a good job, in fact, that he was asked to go lead the change at another hospital within the system just miles down the road. At this location, the senior leadership was not engaged, and they struggled to get any traction at all.

Leaders Support Transformation, but it Falls Apart Anyway

I have also seen great progress decline when a strong improvement leader leaves for another opportunity either inside or outside of the organization. This can be a sign that that improvement team was owning the work rather than ensuring that the ownership stays with the operations and support teams.

There are many situations that cause a bump or detour along the transformation journey. One of the improvement teams at a CHVN member organization spent years working to support improvement at the operations level, but they didn’t have the backing and buy-in from senior leadership that they needed when they went through a major leadership change. Now that organization is finally gaining traction with leaders and is looking forward to the possibilities ahead.

These observations from my trips to the gemba remind me that the transformation house is indeed the best-known way to create a sustainable organization-wide transformation.

Change is hard, and it takes dedicated people, like yourselves, to constantly strive to make the organization better. Thank you for the work that you do!

Please share your learnings around leadership and transformation in the comments section below.


Paul Pejsa, Director of Delivery Operations


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4 Responses to Leadership is Key, but not Always Enough

Melanie McDonald says: 12/18/2018 at 9:59 am

Nodding “yes” while reading your post, Paul. I agree with and have seen all of it. Senior leaders face significant pressures to achieve measurable targets within short periods of time. Regulatory agencies, boards of directors, donors, physicians and others expect and require results (low cost, high quality, and outstanding customer service among other priorities), and how those results are achieved has historically mattered less than that they are, in fact, ultimately realized. Those pressures reinforce outcome-based, rather than process-focused, approaches to management and leadership.

Dirk van Rossum says: 12/18/2018 at 12:12 pm

On this very topic Bob Emiliani’s articles or book on “the Triumph of Classical Management over Lean Management” provides some provocative food for thought and possible avenues to explore.

Mark Welch says: 12/20/2018 at 1:44 pm

Dirk – I read Emiliani’s book just last month and shared my experiences and thoughts on it with other well-respected lean thinkers I know. My thinking has changed over the last several years. I believe Total Lean Transformation is an unrealistic expectation for the vast majority of organizations seeking it. I no longer subscribe to the lean purist approach I once did. It’s not reasonable to expect the kind of engagement from top leadership that lean advocates prescribe. That kind of engagement is rare, and it’s foolish to expect it more than perhaps 3-5% of the time. So, I’ve stopped beating my head against that wall. The approach I take now is, “Using lean thinking, how can we customize an approach for X organization and engage them to at least be better than they were, knowing that they will not likely be the next Thedacare or Virginia Mason?”

Dwayne K. Spencer says: 12/31/2018 at 8:53 am

Good discussion and one that could continue indefinitely. Simply put: there is no “one size fits all” solution for Lean deployment that we appear to be eluding to. Did it work here? Great. It doesn’t mean it will work there. Did it fail there? Great. Doesn’t mean it will fail here. Find what works, do what works. This is where the rub begins. We want clear cut, evidence based, repeatable solutions that oftentimes, are not possible in that application. One key factor for success -but NOT the final solution by any stretch!- is the upfront analysis of the situation, long before pen hits paper (or a keystroke on the laptop is made), take the time to fully understand what you’re up against. Paul is right in that Leadership isn’t the magic lamp needed for success, but it’s extremely difficult to sustain improvements long term without it.
To Mark’s point, sometimes you just celebrate the small victories and stay the course. Other times, you back up and punt. The wise can understand when to do which. I was once told that a good Lean consultant is simply someone who has made all the mistakes. If that’s true, I’m a really good consultant!


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