Opinion, South Africa

Dr Stefan Metzker: On Overcoming the Postmodern Challenges of Healthcare

Dr Stefan Metzker talks about the paradigm shift required by healthcare leaders to empower staff and improve patient care.

Stefan Metzker - EHN

In the lead up to the Lean Healthcare Summit 2017: Empowering Healthcare Professionals Through Continuous Improvement taking place in Johannesburg on 7th September, keynote speaker and CEO of the Spital Männedorf Hospital in Switzerland and member of the EU group of lean hospital directors, Dr Stefan Metzker, talks about the paradigm shift required by healthcare leaders to empower staff and improve patient care.

How did you become a leader in lean healthcare in Switzerland?

The Swiss healthcare system’s interest in lean was essentially triggered by the introduction of Diagnosis Related Groups (DRGs) in 2012, a hospital financing system that aims to increase efficiency and transparency of healthcare. The country’s 288 hospitals, providing care for a 8.4 million population, had to adapt to the pressure of the new system because in the past if a hospital had a deficit it was covered by communities, but not anymore.

Having worked in lean for some years already, I quickly engaged with different healthcare groups, like the Hospital Association of Switzerland, to show them how we were successfully using lean to improve transparency and efficiency in Spital Männedorf Hospital, and before that another hospital I was running. Since then a lot of other hospitals started looking to us and engaging with us to learn how lean could help us to improve quality and to effectively and efficiently manage our patients. I’m often invited to talk at conferences about the introduction of lean and was invited to engage with executive boards to discuss lean, with the University Hospital of Basel for example.

Spital Männedorf has a reputation of being a modern hospital with the latest technology. Tell us why even the most high-tech facilities require lean.

A modern, technically advanced environment doesn’t necessarily imply a lean culture. Spital Männedorf has invested close R1.5 billion in the last seven or eight years to ensure that it has the most modern theatres in the country. But even though it’s a very luxurious establishment, it had absolutely no lean culture within the organisation. The hospital was the most expensive in the province and ranked 180th in a national quality survey about postsurgical infections. Before I came on board as the CEO three years ago there was no formal way of dealing with processes in the organisation; there was systematic project management and no way of dealing with the issues in terms of a clear strategy and leadership.

The introduction of DRGs in 2012 really threw a curve ball at most of the hospitals in Switzerland because they were confronted with issues, problems and challenges that they never had before. And in that moment a lot of the hospitals, including Spital Männedorf, realised that they were not fit to deal with these challenges and had to essentially start from scratch in thinking about processes in a different way. From there a lot of Swiss hospitals jumped onto the lean bandwagon with the focus on the continuous improvement and other lean tools that could presumably help them provide their services to patients at a lower cost to ensure sustainability from a business point of view.

This is the classical lean interpretation; however people soon realise that their lean efforts get stuck and that there’s a lot more to focus on, like developing the leadership skills of people to ensure they provide the support to staff to ensure lean is successfully implemented and works. A lot of people expect that it’s going to be a quick fix but, in reality, it’s a long journey that requires a cultural transformation in their organisation.

How can lean impact the change management process, for example, with the implementation of technology?

Lean provides a good set of visual tools that allows people to see the future state of processes. Words aren’t very precise, for example we can easily get lost interpreting meetings and the pages of meeting notes. But lean and the tools provide a good view on how things are and how they should be. I like to compare it to going on a hike – if you have a map that you can look at it really makes it easier to get from point A to point B. In lean the maps allow us to engage people, to show them where they are in the process and where the benefit lies. Visualisation of processes is an important aspect of change management and it requires a huge investment in leadership skills on all levels to provide the support to all the people involved in the detailed aspects of their work every day. That is an important component of change management.

During your career you’ve held various roles here in South Africa, e.g. Co-founder of the Lean Institute Africa (LIA) and Cape Storm, as well as a senior consultant at the Lung Unit at Tygerberg Hospital. What has your experience been here and what’s your opinion of the South African healthcare system?

When I co-founded the LIA with Prof Norman Faull, Dr Anton Grütter and others we initially focused on educating the market about the concept of lean. At that stage Barclay’s Bank, De Beers and a number of other big South African organisations and car manufacturing firms were busy with the whole lean idea, but it was very early days for healthcare. During the time LIA was established I did a workshop through the UCT Business School and a lot with private hospital groups, like Mediclinic, and also with the Department of Trade and Industry. There were several people that were very interested in the idea, one being the late Deputy Minister of Health, Molefi Sefularo, who actually did an Executive MBA with me where we were tutored by Prof Faull.

To answer your question about the local health system, I have a lot of experience working in the South African public healthcare sector as I worked at Tygerberg Hospital for many years. The work that is being done there is absolutely remarkable because despite certain restrictions and limitations being in place, the people who work there are engaged and enthusiastic and want to do a good job. However, a lot of these efforts also get neutralised because simple things don’t work, like there aren’t any surgical gowns available. Even at a facility like Tygerberg Hospital surgeries repeatedly had to be cancelled because the supply chain was broken.

However, even with limitations like this you can still do tremendous work. When I worked in Cameroon for half a year I learnt that you can deal with 80% of the patients in a really good way with 20% of the means that are available. But there’s still space to improve a lot of things in the public sector, also in the private sector of course, to provide a really great healthcare service in South Africa. The conditions in South Africa are far better than in many other countries that I’ve seen, so I’m very hopeful that people in government and hospital CEOs will engage more with lean to provide an even better service.

During the Lean Healthcare Summit you’ll be talking about lean in light of the postmodern challenges of healthcare. What can attendees expect from this session?

There are a number of lean thought leaders that have influenced my behaviour as a leader and what I like to talk about. Professor Tom Ryan from UCT has taught us about the developments in the postmodern society and organisations and how management has to adapt. And then there’s Professor Russell Ackoff and Karl Weick and, more recently, Dr John Toussaint who have shown us that we have to really rethink management in general for all industries, but particularly in hospitals that have very traditional archaic structures where  knowledge is power and not necessarily leadership qualities.

According to lean, the way hospitals are managed needs to evolve to promote and nurture a more active engagement from doctors and other healthcare staff. We have to get away from this hierarchical structure in hospitals to provide support to the people that work with the patients every day. This is very much linked to the challenges of our time where younger generations have completely different and new ideas about life than people from my generation, the Baby Boomers. It comes down to a mind shift that we have to adapt to; we need to empower people in the hospitals who want to get their ideas heard and we need to encourage them to bring their ideas to the table to provide better care, and that requires a new kind behaviour. So that’s what I’m going to talk about – I’ll be taking a sort of helicopter view on change in general in organisations that link to paradigm shifts in our thinking.

Lastly, is there anything else that you would like to add in terms of the benefits for attending the Lean Healthcare Summit?

Lean is broad and it involves everybody; it’s a way of collectively working better together in the interest of the patient. So from that aspect, anyone who works in the healthcare setting, from a porter to a hospital CEO to a government official, would benefit from learning more about lean.

The Lean Healthcare Summit 2017: Empowering Healthcare Professionals Through Continuous Improvement will be taking place on 7th September 2017 at The Forum, Johannesburg. The one-day event will inspire the South African healthcare community by demonstrating the benefits of using lean management in healthcare, and motivate those already adopting lean management. More information about the event can be found here.

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