Lean a concept developed and implemented in industry is directly applicable to state health care organizations. The entire health care organization’s Lean approach is to inspire health care workers and the public to participate in bringing a renewed interest in the states health and senior services by focusing on raising the level of quality and public awareness of health practices.

One of the first efforts is to develop an all inclusive Mission Statement. Mission statements are not easy to develop but the difficulty can be somewhat eased by developing a proposed list of accomplishments which the organization thinks it can achieve. Then try to boil these down into a single goal statement which includes all stake holders as well as the general public. Remember that volunteer workers can be a significant asset to the state. This is where the “role of state health care” is defined a necessary step given the limitation of state resources. Many states have differing roles especially in the area of Medicare Management.

This was the “inspiring” portion of the approach the next step is in bringing innovation in health care through Lean Teams which I would rename to something more relevant such as: Health Quality Teams (HQT). A facilitator trains and guides each HQT as it elects its own leader. The goal is to “empower” health care workers in each function to develop ways of improving the health care processes and raise the level of health care quality in their function.

The team should review the current processes used by the function. The best way to do this is to create a Processes Flow Chart on long sheets of wrapping paper or butcher paper taped to the conference room walls. The long sheets can be taken down and rolled at the end of each meeting. Each process is created on 8 ½ x 11 sheets and taped to the wall allowing changes and corrections to be made to the wall as the method proceeds. After discussions an improvements to the process are agreed upon by the team a second Process Flow Chart is added to the wall chart showing the improved method. The reason for doing this is to show the costs and the time to perform each of the processes in the improved method. In the interests of improving quality the time to perform the new processes may actually be longer than the old method. If some way of getting the improved quality can not be found while reducing costs the method is still presented to top management for approval as the improved processes to be used by the function. If approved the method is documented and given to a budget analyst for costing-out the processes.

Note that there is a closer relationship developing between top management and the HQT functional teams. The empowerment of HQTs inspires them do more innovation and to continuously improve the function’s processes. The second phase of government reform begins by making the HQT leaders the leaders of Functional Management teams. Top management becomes the Steering Management team. The lower level managers at this point become redundant however some may be required as part of the Steering Management team. Steering Management has the role of guiding and steering the organization while Functional Management deals with the day to day operation of the functions. Steering Management is responsible for telling Functional Management “what to do” but not “how to do it”. This is a loose-tight organization with Steering firmly in control of the budget leaving Functional Management free to determine how best to do the job. Those in industry will recognize this as straight from the book “In Search of Excellence- Lessons from America’s Best-Run Companies” by Thomas J. Peters and Robert H. Waterman Jr., Harper and Row, New York, 1982.

The goal is to reduce bureaucracy by removing layers of management while putting more functional employees to work thus improving health services. The overall difficulty is in finding the best balance of choices for what should be done with what can be done with limited resources.
For more information see: Article 8. Work Place Continuous Improvement. Article 49. Practices that Encourage Teamwork and Continuous Improvement.