In the past two years I have had the privilege of facilitating sessions with senior leadership teams at more than ten healthcare organizations, with the objective of helping them develop their roadmap to operational excellence, or lean. A number of these teams identified cultural issues as a barrier to transforming their organizations. More importantly, they put these items at the top of their list of barriers to address.
Some examples of cultural issues that have surfaced include: silo mentality, lack of commitment to team decisions, punitive consequences for surfacing problems, no transparency of results, top-down management styles, and fear in the workplace. In organizations in which any or all of these behaviors are present, it is impossible for operational excellence to take hold or sustain over time.
Culture can seem vague and elusive to those of us who are concrete, process thinkers. However, the consequences of ignoring it, or not understanding it more deeply can be high because the energy and resources spent adopting the tools and systems of operational excellence will be lost.
What is culture? From Roger Gerard, PhD, past Chief Learning Officer at ThedaCare, I learned that the culture resides in our relationships and manifests in our conversations. Jake Raymer, co-developer of the Shingo Model, states that “culture is the collective behavior of the enterprise in how it achieves results.” So culture equals prevalent behaviors.
The senior leadership teams I have met with realized that in order to change the culture within their organizations, they needed to start with themselves, and more specifically with their own behaviors and relationships. According to Jake Raymer, “senior leaders are responsible for the climate of culture and managers are responsible for the systems that drive behaviors.” Paul O’Neill, former Treasury Secretary and CEO of Alcoa Aluminum, also asserts that one of the main responsibilities of the CEO is to drive culture. Thus senior leaders must define and model the desired behaviors by which the organization will obtain its results. That said, changing culture is hard and requires purposeful study along with helpful advice from those with experience in the field.
For organizations aspiring to adopt or accelerate the introduction of a lean operating system, the Shingo Model provides guide posts for identifying ideal organizational behaviors through the Principles of Operational Excellence. Both objective and universal, these principles serve as a foundation from which the culture of the organization can develop. The Model groups these principles in three dimensions, as follows:
- Align (around the critical few)
- Create Value for the Patient
- Create Constancy of Purpose
- Think Systemically
- Enable ( employees)
- Respect for Every Individual
- Lead with Humility
- Learn Continuously
- Improve (operational processes)
- Assure Quality at the Source
- Flow and Pull Value
- Embrace the Scientific Method for Problem Solving
- Focus on Process
- Seek Perfection
- Understand and Manage Variation
It is easy to see that when these principles guide behaviors, the entire organization benefits. For instance, Respect for Every Individual, can translate into the practices of seeking input from those affected by a potential change, engaging in positive conflict, supporting and advocating for team decisions, making results visible, coaching others for improvement, welcoming problems as opportunities, and reacting to failures not by blaming others, but by learning and adjusting for the future.
Moreover, most organizations have already taken the time to identify how their associates should behave. Oftentimes a walkthrough against the Shingo principles results in only minor adjustments to existing stated ideal behaviors. The challenge for senior leaders then is renew the commitment to consistent practice and to hold each other accountable to this commitment.
What do you know about your culture? If you are a senior leader in a healthcare organization that aspires to embark on a journey to operational excellence, and you don’t know the answer to this question, now would be a good time to learn more.
ThedaCare Center for Healthcare Value