Lean Leadership in a

Hospital Environment

Dr. Stefan A. Metzker

CEO, Hospital SMA

Zürich, Switzerland

Personal Background

• Medical Doctor (University of Zurich, Switzerland)

• Specialist in Internal Medicine and Emergency Medicine

• EMBA (Business School, University of Cape Town)

• Consultant Air Rescue of Switzerland and Senior Consultant Lung

Unit Tygerberg Hospital/Cape Town

• Co-Founder and Director of Capestorm (Pty) Ltd and Managing

Director of PrionTex (Pty) Ltd, South Africa

• Director of the Clinics of Valens, Switzerland

• CEO of the Hospital of Männedorf, Switzerland

• Married with 3 children

Hospital of Männedorf

One of the most beautiful

Hospitals in Switzerland

A Hospital that has everything

Most Modern Theatre in

Switzerland

Robotic Surgery….of course

The most expensive Hospital in

the Province

One of the most dangerous

Hospitals in the Country?

One of the most dangerous

Hospitals in the Country (cont.)

80

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Januar Februar

März April Mai

Bed

s

Monate

Number of occupied Beds

Occupancy like a Fever Chart

An Organisation stuck in

Bureaucracy

INFANCY●

ADOLESCENCE●

PRIME●

● STABLE ●ARISTOCRACY

● BUREAUCRACY DRG

poor

Systems

SMA

Lifecycle Stages according Prof. Ichak Adizes

Lifecycle-Theory of Organisations

What is going on?

«We work so hard every day, but don’t seem

to get anywhere»

Paradigm Change

in Healthcare

‚From fee for service to global fees (DRG)‘ from covering costs to competing with costs

Goal: Competition

= Selective Evolution

Challenges for Hospitals

• permanent battle for finances, poor incentives, 70%

of infrastructure > 40 years old (Switzerland)

• no awareness for the fact that hospitals are selling

time (> 60% of TO), difficulty in measuring ‘intangible

costs‘

• Low awareness for margins – poor cost accounting:

It needs 100 USD to compensate 1 USD spent

unnessesarily – ’cost covering mentality’, covering

costs seems to be god enough for doctors (as long

as they can secure their income)

Challenges (cont.)

• Problems recruiting qualified personel – ‘war for talents’

• Generation ‘Y’

• People working in a social or technical environment

are inherently incompatible with lean processes (Prof.

Luc Hoebeke, Make Work Systems better)

• there are no trained specialists in operations

management to be found in healthcare….

Hospitals are Expert Organisations:

‘Make Work Systems Better’ (Prof. Luc Hoebeke)

…..many different Languages

under one Roof

“If a lion could speak,

we would still not understand him” Ludwig Wittgenstein

Radical Constructivism

(Prof. Humberto Maturana)

There is no reality, there is no objective view

of the world!

The world as we experience it is a

construction of our senses and memory.

Every experience is entirely subjective.

Prof. Humberto Maturana: Arzt, Biologe und Philosoph. Spezialgebiet Neurobiologie, Systemlehre,

Kybernetik, Harvard, MIT, Universität Santiago

Lean Thinking in hierarchical

Structures

How to create horizontal flow through vertical

structures…

Value streams are horizontal but management

structures are vertical…

→ Segmentation and breaking of the flow in a

complex environment

‘Patient-Flow’ is horizontal!

Disasters to happen

Der «Risikofaktor Mensch»

Vor drei Jahren starb Rosmarie Voser bei einer Herztransplantation.

Die Ärzte des Universitätsspitals Zürich hatten ihr ein Herz mit einer für

sie unverträglichen Blutgruppe eingepflanzt. Jetzt wurden der damalige

Chefchirurg Marko Turina und zwei Ärzte aus seinem Team wegen

fahrlässiger Tötung verurteilt.

What now?

Common Language and the

universal Law of ‘Flow’

Hagen Poiseuille:

Ώ Ohm:

Pressure = Resitance x Flow

Flow = Pressure : Resistance

Hospitals and Complexity The Promise of Lean in Health Care

Mayo Clinic, USA

John S. Toussaint, MD, Leonard L. Berry, PhD

Mayo Clinic Proceedings

Volume 88, Issue 1, Pages 74-82 (January 2013) DOI: 10.1016/j.mayocp.2012.07.025

http://www.youtube.com/watch?v=W217mMcYpTI&index=51&list=PLC1C3C

D40865769C9

http://www.youtube.com/watch?v=YirbV9W7U3E

Value Stream MAPPING Defining the Teritorry*

•

*Prof. Karl Weick, Author of ‘Making Sense

Of the Organiszation’ and ‘Managing the Unexpected’

Value Stream according to

Toyota

Introduction to Process Managment

Creating time for creative people!

Gemba Walk

How to solve a Problem

Identify the Green Stream

80/20 Dr. Iain McGilchrist:

The Divided Brain and the Making of the Western World

Quality and Patient Satisfaction

Use of Corporate Six

Sigma Performance-

Improvement Strategies

to Reduce Incidence of

Catheter-Related

Bloodstream Infections

in a Surgical ICU (J of the

Amer College of Surgeons, 2005)

Conclusions:

This represents the first successful application of Six Sigma corporate performance-

improvement method impacting purely clinical outcomes. CR-BSI reduction was highly

substantial and sustained after other traditional strategies had failed.

Broad based Process

Improvement Campaign

Process first – quality is a result

• Internal team: Operations Specialist

heading the team

• External team: Proven track record,

chemistry, sustainable approach

Toyota -> Hospital

Visualisation by Simulations

Strategy-Model with priorised

Actions 1. Stationäre Angebote strukturieren

2. Ambulante Angebote strukturieren

3. Personalgewinnung

4. Prozessmanagement einführen

5. OP-Management verbessern

6. Klinik-Informationssystem

weiterentwickeln

7. Leistungserfassung strukturieren

8. Vernetzung mit Hausärzten und

Zuweisern festigen

9. Kooperationen mit Belegärzten

verbessern

Pro

jek

tpo

rtfo

lio

Vision Wo sehen wir

uns?

Mission Wofür stehen wir?

Unternehmensziele

Welche Ziele setzen wir uns?

Unternehmensstrategie Wie wollen wir unsere Ziele erreichen?

Klin

ik M

ediz

in

Klin

ik C

hirurg

ie

Institu

t A

nästh

esie

und Inte

nsiv

mediz

in

Institu

t R

adio

logie

Bere

ich H

um

an R

esourc

es M

anagem

ent

Bere

ich O

PM

Bere

ich P

flege

Bere

ich F

inanzen &

Die

nste

Klin

ik G

ynäkolo

gie

und G

eburt

shilf

e

Um

se

tzu

ng

Unternehmensstrategie

Strategieumsetzung

SWOT-Analyse

Risiko-Analyse

Rep

ort

ing

Discipline: From a Vison to

Strategy aligned Project-Portfolio

Bereichsstrategien

Lean Road Map

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Januar Februar

März April Mai

Bed

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Monate

Number of occupied beds

Occupation of Beds as a Result

of poor Planning

Actual Beds

Strategy of the ‘Postmodern’:

Systems-Thinking, Innovation- and

Operations-Management with the

goal of achieving a better way of

adapting to a complex world!

«Viability beyond Survival» (Prof. A. Schwaninger, University of St. St. Gallen)

Strategies of The ‘Postmodern’

Use of Systems Thinking (Cybernetics…), Innovation and Operations-Management resulting in better adaptatbiliy to a rapidly changing environment

• Structures that promote autonomie and the capability of problem-solving, therfore resulting in greater autonomy (management of herterarchic (flat sturctured) networks by making use of the diversity nn!)

• Transformation of the culture of organisations to greater openess, transparency, participation and self-organisation (=empowerment)

• Preconditioning of the development of co-workers ( Generation Y) allowing them to find their own solutions, to influence the organisation, to form, to create!

• Implementation of mechanisms, which allow autonomy and cohesion (gravity!)

• Creation of structures, which support reflection

Toyota Kata (Mike Rother)

• A way of doing something: a

method or routine

• A pattern

• A standard form of movement

• A predefinde, or choreographed,

sequence of movement

Improvement Kata &

Coaching Kata

Coaching Kata for Leaders

Management is:

«The systematic pursuit of desired

conditions by utilizing human

capailities in a concerted way.»

Mike Rother, Author of Toyota Kata and

Learning to See

Coaching Kata

«The primary task of Toyotas managers and

leaders does not revolve around improvment per

se, but around increasing the improvement

capability of people.»

Mike Rother

«We have to accept the fact that learning is a

lifelong process of keeping abreast of change. And

the most pressing task is to teach people how to

learn.»

Peter Drucker

The Lean Leader’s Role

• to research (lean starts with a research process) and to ask questions

• to set targets

The intention of targets is:

• to create problems

The intention of problems:

• to create thinking people!

• to teach them to see

• “to remodel behaviour” (John Toussaint, CEO Thedacare Center for Healthcare Value)*

*Psychoanalysis vs. Behavioural Therapy (Ian Mc Gilchrist – The Making of the Western World)

Dealing with People!

http://www.youtube.com/watch?v=Wdroj6F3VlQ

Love your product and lead with the heart……

To make Lean a Success

«virtus non sufficit, si ordo deficit»

Innovative thinking, mindfulness,

mutual trust and respect!