Physicians and Lean

“Tell me again, Curmudge, about the connection between physicians and Lean.”

“It’s pretty simple, Jaded Julie. A hospital-wide Lean transformation must involve the physicians. It would be like trying to produce an opera without the star sopranos and tenors. On one hand, doctors don’t want to be told what to do, but at the same time, most are too busy to serve on the kaizen teams that work on improving hospital processes. That puts all of us—the docs as well as the hospitals—between a rock and a hard place.”

“The IHI White Paper that you gave me to read, Engaging Physicians in a Shared Quality Agenda (1), looks like the definitive work on the topic. (Did I say definitive? That’s a Curmudge word, not a Julie word.) But most people aren’t going to take time to read all of its 49 pages.”

“And that, Julie, is why we are going to use this blog to share some of its more important points. To begin with, throughout their education and training physicians have been taught to think and perform independently. As a result, to use the words of IHI, they have a ‘fierce attachment to individual autonomy’ and a deep sense of personal responsibility for the outcomes of their patients. Thus we need to improve their ‘systems’ thinking.”

“Lots of luck, Curmudge.”

“Physicians have a strong sense of collegiality. In that, we can see good news and bad news. Physicians will be slow to accept a change in procedure devised by ‘some nurse in an office,’ but they will be receptive to ideas presented by another physician whom they respect. To be accepted, one must ‘walk a mile in their moccasins’ almost on a daily basis. When you think about it, that’s pretty consistent with Lean; one must ‘go to gemba’ for meaningful knowledge.”

“I knew—sooner or later—that you would bring Lean into this.”

“Physicians are certainly acquainted with evidence-based treatments. Thus their thinking can be influenced by evidence they consider credible if it is presented properly and by the right person. Here are some other factors that should increase physicians’ acceptance of quality initiatives:

Select physician Project Champions who possess courage and social skills.
Identify respected ‘early adopters’ of the proposed changes.
Base proposed new protocols on medical evidence and test them locally on a small scale.
To the greatest extent possible, involve physicians in contemplated changes from the very beginning.
Couch proposed changes in physician-relevant terms such as better patient outcomes and less wasted physician time.
Make clear that proposed standard work is not ‘cookbook medicine.’ ‘Standardize what is standardizable; no more.’
Implement change incrementally, and make the right thing easy to do.”

“Hey, Curmudge, that sounds pretty straightforward, but I know that it isn’t. What’s the bottom line—the hook that will increase physician engagement?”

“Physician leaders, using incontrovertible data if they have it, must show their colleagues how participation in Lean events will bring about improvements in their patients, their practice, and their personal lives. And remember, Julie, success will breed success.”

“(Incontro…? Sounds like evidence-based.) Thanks for the insight, Old Guy. You may now return to your morning nap.”

Affinity’s Kaizen Curmudgeon

(1) http://www.ihi.org/IHI/Results/WhitePapers/EngagingPhysiciansWhitePaper.htm