Prescribing Agility: Injecting Change into Healthcare
Healthcare organizations can feel like pressure cookers for managers and frontline staff. The pressure to perform is driven by senior leaders, funders, and the public, sure - but above all by staff themselves. Sometimes in the boardroom we forget healthcare is about people caring for people – no one gets into a caring profession because they want to take it easy with evenings and weekends off. Our staff care. Teams want to maximize outcomes for patients and their families but are often frustrated due to healthcare’s penchant for bureaucracy, hierarchical decision making, and regulation. This can trigger two causes of burnout : Perceived lack of control; Values Mismatch. Organizational safety mechanisms don’t have to stand in the way of an Agile, Lean, and patient-centered health system. Organizations that effectively tap into their greatest strength, their people, and provide them with winning methodologies are patient-focused supercharged change leaders! My prescription in a nutshell: Let your team of creative care professionals do what they love - it is our job as leaders to frame a problem and then give staff the training, resources, and trust to solve it.
Agile started as a project management methodology in software. Lean Six Sigma came from the automotive sector (Toyota to be exact). These two methodologies paired with high performing teams is my prescription for transformation. (I won’t spend today talking about the nuances of how these methodologies work – if you’d like extra reading check these out websites or set up a conversation! Six Sigma Definition - What is Lean Six Sigma? | ASQ & What is Agile? (pmi.org)) Of course other methodologies also offer enormous value. Regardless of the processes and systems you choose to prioritize, the underlying principles of staff engagement around processes to maximize outcomes are the same.
Agile and Lean processes drive innovation and efficiency, but I consistently see organizations making a common (and preventable!) mistake. Organizations only move at the speed of trust – you can have all the Agile and Lean processes in the world but without high-trust, collaborative, and psychologically safe teams, real change is impossible.
Helen Bevan shared a post while I was writing this article which resonated with me (see below). She points to the evolving nature of job descriptions – from rigid task-focused roles to ones centered on outcomes, skills, and team dynamics. A move away from the waterfall approach where individuals work within well defined silos – to a world where expectations are evergreen.
Helen Bevan’s post:
Job descriptions are changing. As the pace of change quickens & organisations move toward more project-based work, static JDs that set out a series of tasks/duties don't work as well. Three new approaches are emerging:
1) Outcomes focussed: specify the outcomes expected from a role rather than the specific tasks the person is required to perform
2) Skills focussed: emphasis shifts from the tasks a person is supposed to complete to their talents & how those can be applied
3) Team-based: Rather than individual JDs, there is a collective set of objectives, outcomes & deliverables
An Agile approach is about maximizing B. To maximize what a staff can do we need them to feel empowered and integrated into teams that communicate effectively and without fear. They need to know they have adequate resources and autonomy to propose and trial solutions. Staff have skin in the game, so let’s be clear about the rules and let them come up with a gameplan that fits within them. A psychologically safe staff team who can say what they see and challenge the status quo will supercharge performance. Staff will not only work to their full scope – but beyond the concept of scope. This is how we build systems that are more nimble, easier to work within, faster, data driven, and that are seamlessly integrated- which translates to better patient care and reduce burnout!
Lean and Agile concepts can be used to build a team that accepts change AS the status quo but only if they feel psychologically safe.
This isn’t to say it is easy. Managers have to work harder to ensure staff feel supported and trusted. Managers need to be equally comfortable critically challenging teams and being challenged by them. Everyone is working towards the same goal - a better healthcare system.
Lean and Agile approaches break down ideas and projects into their smallest iteration and get the right group of people around a project to tackle it quickly (often called Sprints). Healthcare is too complex a system to tackle as a whole, so we need leaders who can analyze and define problems quickly, articulate these problems in their smallest iteration, and build agency in frontline teams to tackle these sprints. To do this managers and staff both need to be comfortable working in the grey (forget the job description)! A quick way to self-diagnosis how your organization is doing is to ask yourselves: have your Huddles just become top-down communication opportunities, or are they staff led drivers of change in your organization?
There you have it, my prescription for a high-performing, change-oriented health system (taken twice daily). Let your team of creative care professionals do what they love. It is our job to frame a problem, give them parameters, adequate training, resources, and trust to solve propose solutions. Pair this with routine evaluations of project outcomes and staff reported psychological safety metrics.
- Becoming Agile and Lean is not about implementing hard to learn systems, it’s about communication. It is a team-based approach to solving our healthcare problems. I’d be happy to start a conversation about it with you or your teams!
How to Become Agile and LEAN 101:
I. Define and focus on the Value as seen by the patient (how can we reduce waste?)
II. Define and understand the Value Stream (design, understand, and improve the process)
III. Determine and optimize the Flow (understanding takt time and its fluctuations,
IV. Ensure that the outcomes/deliverables meet needs (optimized outcome /effort)
V. Aim for Perfection (our work is never done – anyone can propose improvements)
What do you think? Agree, Disagree? Let’s start a conversation!
