BOOK REVIEW: Healing Healthcare–A Leadership Journey

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5/5 stars.

Overview

An exceptional presentation of Lean Six Sigma principles applied to healthcare, told in an unusual but very effective format: a fictional story about the CEO of a typically mediocre medical center being coached to transform the entire organization by the CEO of a world-class Lean medical center.

As the CEO knows very little about Lean Six Sigma, the book starts out as a beginner’s guide to Lean Six Sigma, but builds in a clear and systematic way to become a comprehensive roadmap for transforming a large multi-hospital health system. It literally starts at the beginning of change management, with addressing the misconceptions and changing the mindset of one person at the organization (in this case, the CEO or course), to the first small steps to gain buy-in from a few others, all the way through to designing and managing a massive system-wide transformation.

No small feat in a brief 150 pages, but the author does a masterful job, bringing together his varied experiences as healthcare executive, consultant, professor, Black Belt, and psychologist. Aside from the idealistic CEO-first methodology and the rather stilted prose, this book is highly recommended for the easily digestible way it presents the merits of LSS for healthcare and walks the reader through the “Leaning” of a large health system. Now to get all healthcare CEOs, executives, and doctors to read it!

 Highlights

Several highlights include the “Quality Hierarchy” as modeled after Maslow’s hierarchy, “Healing Pathways” as Value Streams for healthcare, and the book’s overall structure as a health system transformation roadmap:

Quality Hierarchy

The publisher’s foreword praises the book for incorporating the many different aspects of quality into a seamless whole, rather than focusing on one or a few as “flavors of the month.” This is presented as a helpful Quality Hierarchy modeled after Maslow’s Hierarchy of Needs, which addresses human needs as layered from the most basic to the most advanced, with each building on the other:

Maslows-hierarchy-of-needs

The publisher’s Quality Hierarchy includes the following levels:

  • At the basic level is inspection and quality audits. It performs the important role of determining what is conforming and what is not.
  • The second level is total quality management. The organization builds on the basic level and engages all employees in improvement with the managers working on the system and employees giving insight because they are closer to what is really going on.
  • The third level is lean six sigma. This builds on the two lower levels by focusing on a company-wide improvement plan and ties each improvement project to that plan. It also adds statistical and lean tools that improve the effectiveness of the improvement effort.
  • The fourth level is creativity and innovation. This level corrects the number one weakness of the lower levels by supplying tools to generate new ideas at the beginning, intermediate, and advanced level. These tools are selected based on the level of difficulty of the problems and the level of sophistication of those on the team.
  • The fifth level is the transformation and organizational breakthrough level. This level ties together the goals of the organization with the goals of individual employees. It adds the best of organizational development and good change theory and practice.
  • The sixth level corresponds to Maslow’s self-actualization level. It looks to the purpose of the organization and looks to issues such as sustainability, spirituality, and improving the planet.
Healing Pathways

The valuable Healing Pathways tool can revolutionize patient care delivery. It addresses the common concern that the LSS methodology cannot apply to healthcare because patients are not “widgets” but rather especially vulnerable, needy people, the sick/impaired/dying, and because the goal is not merely efficient production but better health. Widgets do not “experience” the processes they flow through, as patients do, and thus an added perspective is needed. The true goal of all healthcare processes is (should be) better health for patients, and the Healing Pathways tool incorporates this goal into the patient-facing processes themselves. Poorly performing processes are proven to frustrate and inhibit healing, but even perfectly performing processes may not take healing into account. Processes can be analyzed, streamlined, and redesigned to heal.

Just as a value stream is analyzed for the Eight Wastes (which form the mnemonic DOWNTIME), Healing Pathways are patient-facing value streams additionally analyzed for the Eight Impediments to Healing (SICKNESS):

  • Stress & Anxiety – a common state of our patients created by the cause that brought them to us, uncertainty and fear about what may be wrong with them, and unfamiliarity with our setting
  • Inactivity & Waiting – Idle and unproductive time created when we cannot tend to our patients at a rate appropriate to their treatment
  • Coldness or Apathy – An aloofness or distancing from the patient by one or more caregivers
  • Knowledge Gap – The lack of information patients have about what is wrong with them, what is happening to them, and what is going to happen and when
  • Neglect – The absence of steady interaction and information sharing with the patient
  • Embarrassment – A negative patient experience caused by a lack of dignity in the treatment process
  • Submission & Helplessness – A state of learned helplessness exacerbated by information, power, and social status differentials
  • Statistic – Depersonalization of patients (e.g., “the chest pain in room five”)

Conversely, the Eight Enablers of Healing are the opposite of the Eight Impediments, and form core values of a world-class health system:

  • Calm & Comfort
  • Progress
  • Caring & Warmth
  • Abundant Communication & Understanding
  • Engagement
  • Dignity
  • Respect & Empowerment
  • Special

The book further describes how these are applied within the Lean methodology, which alone is worth the price of the book.

Health System Transformation Roadmap

The overall structure of the book forms a comprehensive “Health System Transformation Roadmap” (which will be discussed at length in an upcoming post).