How do you start with lean?

I am frequently asked how to make a start with lean and how to determine the objectives when starting with lean. First of, lean is an improvement strategy. So there are no lean objectives. There are only team, division or hospital related objectives. The lean principles, instruments and way of thinking, can be used to accomplish these objectives. Where to start, thus depends on what you want to accomplish with a team, division or hospital. 

Are your issues for example:

• A declining number of patients?
• Enough patients, financially healthy, but we want to improve quality and service delivery, because this is our vision and/or we want to achieve stronger patient loyalty?
• The workload is too high; the work of the care providers does not provide enough fulfillment anymore?
• We see the world changing, and are worried whether we are able to change rapidly enough to keep up with these changes? We want to become more flexible and improve on a systematic basis.

Are you making a start with lean only to solve short term problems? The use of a few relevant instruments will be sufficient. Or do you desire to develop your team or organization on the long run? Do you want to work on the DNA of your organization? Your answers to these questions are relevant for how to make a start with lean.  

No matter what answers you may provide: start today. Everyone who wants to make a start with lean thinking is able to apply one of the lean principles or instruments today. They are concrete, in many books and articles well described and applicable for every (care)process and team. Give an answer to the questions raised above, however do not wait for the answer.  

The way to learn lean is putting it into practice, which can be accomplished by making (especially) small efforts. As soon as it starts to work, point your effort at the most important issues. Certainly mistakes will be made, because you have insufficient experience or you are not able to oversee everything. When you are able to learn from these mistakes, you will achieve a lot more then when you keep on searching outside the daily work. 

Certainly do not start with a lean project if you want to work on the DNA. Lean thinking can not be achieved by projects, because that contradicts with the lean principles. By creating lean projects, lean is stated as something special, which causes a disconnection from the daily work. Then you can expect issues with regard to ‘communication, resistance to change, and assurance/safety’. Lean is about involving everyone, every day. 

When you want to make a start in daily practice, without knowing the answers yet to the questions raised above, there are two good instruments to introduce lean thinking:

• The improvement chart (See previous blog) 
• 5S workplace organization methodology (The core of this methodology is that a team cleans up the workspace, arranges the workspace reasoned from a process perspective, and visualizes and standardizes in order to improve work practices for everyone. Click here for further explanation http://en.wikipedia.org/wiki/5S_(methodology))   

 These two instruments offer a few strong benefits to start with:

• They are easy to explain to your team and offer the ability to start today.
• They do not request any investment.
• They deliver direct visual results for everyone.
• They involve the entire team. Everyone can participate individually (clean up workplace, make notes on the improvement chart), but the results are collective (collective decisions about the workplace organization, collective decisions with regard to countermeasures at the improvement chart).
• In this way they extend the ownership of the improvement approach and the work processes.
• They ensure that improving becomes a part of the daily work. 

These benefits are worthy of consideration when thinking about how to make a start with lean. Certainly lean principles and instruments can also be used in improvement projects. Value stream mapping is for example a good instrument in order to improve processes. However, do realize that using this instrument does not mean you are making lean thinking an aspect of everyone’s daily work. The more success you accomplish with it, the harder it consequently will be to make lean small and valuable for everyone. 

I do not believe in the statement that one should first reach results with projects before everyone is convinced. What you can do is organize projects in a way that really involves everyone and make improvement in small steps. In this way the project becomes a learning environment and by practicing, learning will be achieved and collective meaning will be attached. 

How did you start? (How are you about to start?) Why? And what have you learned? 

P.S. my gratitude goes to Nynke Reitsma for translating my Dutch blog