This Post in <50 Words: Nate Hurle, from the Cleveland Clinic, writes about their visit to Intermountain Health to learn about their “Lean Management System,” what they mean by a “management method,” and the difference between “Management by Objectives” and a Lean style of leadership.

By Nate Hurle

Last year, and earlier this year, Mark Graban wrote about a late 2015 visit to Cleveland Clinic. In his posts, Mark describes what he sees as both strengths and opportunities. Being continuous improvement-minded professionals, we gravitated to the opportunities.

The Cleveland Clinic Improvement Model was created as a way for us to be both aspirational and directional as we worked with teams. We knew that we wouldn't have all elements in play at a high functioning level as we headed down this path. Of particular interest to us was our gaps in organizational alignment and we set out, over the past year, to learn more about what others are doing and to begin infusing those practices into our work.

Regularly, I hear about the term “Lean management system.” That cultural transformation occurs when you have a Lean management system and good problem solving skills. We've been working hard on building great problem solvers, where every caregiver every day is capable, empowered, and expected to make improvements. I've always struggled with translating a Lean management system into terms a layperson can easily grasp. What is a Lean management system exactly and how can I help others see its benefit or need?

Recently, Tim Pehrson, Regional Vice President of the North Region and Executive Vice President of Continuous Improvement, and Bryan Crowell, Assistant Vice President from Intermountain Health care invited us to come out and see their work. It was a fantastic two days, not to the mention the day of skiing that I was able to fit in. We also learned a little bit about meteorology and what an inversion is in Utah.

Mike Clark, Administrator of McKay Dee Hospital for Intermountain, brought up a different way to think about this Lean management system, as he referred to it as a management method. That made me think, what's our management method? If I were to ask leaders what their management method is, would they have a succinct answer, could they show it to me? Can we see evidence of this management method at work throughout the organization?

We have begun to conduct a few experiments within our organization on creating a management method. As with all experiments, we will probably learn what doesn't work well before we learn what does work well. Our team in our finance division is hard at work to create clarity throughout the organization around what matters most. Through “True North” goals and tiered huddles, this team is working towards establishing a management method.

Another great lesson shared with me by Bryan was the difference between “Management by Objectives” and a Lean management system. Bryan illustrated that, at the senior leader levels, their metrics are typically outcome focused or lagging indicators. If we just cascade these goals down through the organization, then we have management by objective – what's the target and did we hit it?

In a Lean management system, as we get closer to the frontline, the metrics become process measures and leading indicators. I thought that was a great way to distinguish the two.

While we know that Lean in healthcare is about putting “Patients First” (as we say at Cleveland Clinic) in everything we do, differentiating how that relates to different levels of the organization can have a profound impact. By driving improvements to the process, we will drive improvements to the outcomes.

What do you find to be key components of your management method?

I'm excited to continue to learn from others as we head down this path and further build examples of this system where we can bring Mark back to share with you our progress.

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