Creating, Structuring and Sustaining a Culture of Continuous Improvement in Healthcare

We have had the pleasure these past 5 years to lecture and share the story of our journey of continuous improvement all over the world. Most audiences see the results we describe and the visual artifacts of our way of working throughout the laboratories as the success. Initially, we described in the peer reviewed literature our plan to transform to a functional culture that allowed for continuous improvement (Transforming to a Quality Culture: The Henry Ford Production System, AJCP 2006;126(Suppl 1):S21-S29). We have learned much since that early plan. It is that culture change and what we have learned in that quest that is the true success.

As a product of the culture that we created, we have been transformed, leaders and workers alike. We have learned many lessons by doing, succeeding, failing, adjusting, reinventing, innovating and doing again. In reflection, we have performed continual and successive PDCA cycles in that transformation to a quality culture. This next series of Wednesdays Words of Quality will review our lessons in the implementation 'how to' create, structure and sustain a culture of continuous improvement in healthcare with parallels borrowed from Henry Ford, W. Edwards Deming, and the successful Toyota manufacturing management system.

We don't make cars in healthcare. We make people well and we work differently in a very complex environment of hand-offs with much variability. This requires understanding the best from others' work systems and innovating approaches that mine those successes to achieve our goal of transforming our culture. What will follow are our implementation lessons learned from first hand experience in creating an effective PDCA-based culture of continuous process improvement that aren't typically taught in Lean training courses. This is from the 'school of hard knocks'.

This series will address the following aspects of Lean culture change:

  • Part 1: Philosophy that promotes people
  • Part 2: The case for change
  • Part 3: Organizational structure and teams that promote communication and relationships
  • Part 4: New roles and responsibilities
  • Part 5: Work rules that promote standardization
  • Part 6: Work principles that promote efficiency
  • Part 7: Improvement tools that promote innovation and adaptation
  • Part 8: Sustaining the new culture

Part 1:

A culture of Continuous Improvement is founded in philosophy, supported by a management system and operationalized by people working in structures that produce a daily focus by empowered workers on improving the work according to defined rules and principles. At the core of the Henry Ford Production System is the philosophy and management principles of Deming that foster respect for people and human development. This allows for a culture of respected, empowered and accountable employees who are recognized for their expertise and knowledge of the work that they do. The pillars of respect for people and continuous improvement underlie Toyota's Way. In the Henry Ford Production System, this is our way as well.

The figure below illustrates these two core values of respect for people and continuous improvement that meld our development of people with a supportive management system and effective technical tools. This enables our empowered employees to achieve and maintain a stable and ever improving work state.

The underlying cornerstones of behavior reiterate our tenets:

  • our promise to prioritize our patients' needs;
  • to be sensitive to each other as mutual customers and suppliers in our daily work, often being aware that functional work takes place horizontally not in vertical silos;
  • to be motivated and trusted to solve our own problems as empowered teams, based on data (PDCA);
  • that the identification and resolution of problems is at the level of the work and that the worker is the expert in this domain;
  • that we will assume nothing but rather 'go and see' to understand the condition for ourselves before leaping to conclusions that may result ineffective solutions; and
  • that we take ownership for the quality of our work so that we never pass a defect. Defect correction is rework, a time delay, a patient and customer dissatisfier and not a compensated task.

Philosophy sept29