In the lead up to the Lean Summit Africa 2018 taking place at the Vineyard Hotel in Cape Town from 30 October to 1 November, keynote speaker and CEO at Catalysis Inc., Kim Barnas, talks about the Lean Management System that develops leaders and people, identifies defects and solves problems.

Tell us about your background and how you became an expert in lean. 

I have been in healthcare for 25 years but my lean journey began when I was the Senior Vice President for ThedaCare under John Toussaint, who made a commitment to improving healthcare quality using the lean methodology. I was one of the first leaders to raise my hand and say I wanted to own a value stream, which led to me working with some exceptional lean individuals. What made this collaboration so beneficial was that they didn’t understand healthcare and I didn’t understand lean; and so we forged an agreement whereby I taught them healthcare and they taught me lean. We spent hours studying together and teaching one another about the essential elements necessary to make substantial transformation at ThedaCare. The whole experience was a great success because we implemented improvement initiatives in terms of access, quality, financial stewardship and customer satisfaction. We also discovered that the lean tools that we used were very effective in getting results, but they were not as effective in sustaining those results. So even though the value-stream worked, what was missing was the focus on management. I therefore developed, in collaboration with my team at ThedaCare, a management system based on lean methodology and lean tools.

News about the Lean Management System spread and because ThedaCare was unique in the healthcare market, we had 30+ CEOs visiting every couple of weeks who wanted to learn about what we were doing and ask for our help. This led to John stepping down as the CEO of ThedaCare to form ThedaCare Centre for Healthcare Value, which is now called Catalysis. Catalysis’s mission is to transform healthcare using our unique combination of operational excellence and lean methodologies. Three years ago I joined him as President with the mandate of coaching and teaching other executives during their transformation.

What we know of lean is that you can’t transform an organisation without significant behaviour changes from an executive team. Tell us more about that.  

Transforming an organisation with lean requires leaders to look at and reflect on their leadership style. Most leaders are very good decision makers with strong personalities and a strong management style. But with lean we want every individual within the organisation to become a problem solver; and that requires a different leadership style than what I’ve just described. The leadership style in lean is more about coaching, mentoring and teaching your teams in a way that enables them to make decisions, run experiments, and even fail at those experiments without fear; and once that fear barrier is overcome, there is an escalation of improvement.

We focus on coaching the C-suite executives, as well as the next level of management at an organisation, in the Shingo principles which gives them the opportunity to identify where their strengths are in this new management style, and also where the opportunities are for improvement. In partnership with our local South African hosts, the Lean Institute Africa (LIA), we work with each leader to help them assess and create a development plan for themselves. Then we work through the principles with them and evaluate the behaviours associated with each principle and how their behaviours are aligned with that; are there things that they can do better and are there things that they can change? This method has proven to be a transformational coaching process for executive team.

You and the LIA have been working through your Lean Management System with CEOs of public hospitals here in South Africa. Tell us more about that.  

Although work commenced over four years ago initiated by the LIA, over the last 18 months, Prof Norman Faull, Dr Anton Grütter, Dr John Toussaint and I have been coaching five public hospital CEOs from Cape Town and Gauteng through the principles I’ve just mentioned. Between us, we meet virtually and physically every week to talk about things like: whether there is a constant purpose; if their staff really understand the value they are providing in their organisation; how they identify waste; and how they are aligned in communicating the direction of the organisation. Consistent, on-the-ground support is as crucial, and Norman, Anton and Tshepo Thobejane (another of the LIA’s facilitators) provide weekly support to these hospitals, maintaining the coaching cadence and building on the confidence of the leaders. We’ve helped them develop what we call their ‘true north’, and we help them prioritise what their top four or five true north measures are so that they can gauge if they are making progress or not.

From there, we’ve worked with them on principles such as transparency – how do we share our failures; how do we let people learn from success as well as failures and how do we help them learn to take small steps that fail fast and then try another experiment to get to success. We’ve coached them through principles like standardisation as a leader – how do you develop standards for yourself and communicate that in your organisation. As well as how they demonstrate respect for every individual in the organisation and how that can be used to identify and solve broken processes.

We use a combination of practical, visual and scientific methods to help these CEOs implement and sustain transformation that really starts with them. Often leaders spend their day-to-day in crisis management, putting out fires but our goal is to get them to a place of thinking systemically. This essentially means knowing what their top value streams are and how they’re improving them, and knowing how they spend their time so that they can identify whether they’re in fact fire fighting or helping people solve the problem? How do they engage multiple departments? Those are the leadership behaviours that we start with, and once those are in place we encourage organisations to develop a management system.

And how would you say the project is going?

When we started working with the five aforementioned CEOs the LIA identified two hospitals, Leratong and Groote Schuur, as centres of excellence to start implementing the Lean Management System. As part of the upcoming Lean Summit Africa 2018 I’m going to visit these two hospitals to see how the programme is going.

This project is a replica of the management system that we created at ThedaCare, which is written about in the book ‘Beyond Heroes: a Lean Management System for Healthcare’. We are implementing the same system in Brazil, Belgium and the UK, and we have 100 hospitals in the US who are actively using the system.

We want to demonstrate that this system works everywhere in the world and that is one of the reasons why we identified these two hospitals to work with. A second critical reason is the strong leadership commitment demonstrated by these leaders. But what’s unique about what we’re doing in South Africa, is experimenting with implementing the system virtually, coupled with strong local support, and then physically going to the sites to see progress. Last year, after we had finished coaching on these principles, John spoke at the Lean Healthcare Summit 2017 and then visited those hospitals and said “OK, what have we learnt, can you show me what you are doing?” And he found incredible results.

Grey Dube at Leratong is an amazing leader and we have seen incredible transformation in terms of his personal development, but also how that has cascaded down to his leadership team and to the front line. Mr Dube and his team will be about three quarters of the way through implementing the management system by the time I visit and I’m looking forward to witnessing what they’ve been able to achieve. In short, we are running some significant experiments and so far we’re seeing some fantastic results.

South Africa’s healthcare system is moving towards universal care and a value-based reimbursement model. Can you tell us how implementing the Lean Management System can help people make the practical shift towards value-based care from volume-based?

We’ve been working with the concept of value-based care for many years. We know that the value proposition of value-based care is that you improve quality while simultaneously reducing cost by pulling the waste out of the processes so that you are focusing on what is most important. Lean methodology is the only system I’m aware of that not only helps organisations reach operational excellence but enables the value proposition I’ve just described.

In lean typically, the true north metric is aligned to the next tier: the top quality and safety problems, the top engagement problems in terms of staff and patient; and the state of financial stewardship or cost management. So as we implement the management system we focus on the top problems in four or five areas and begin the problem solving process, which then cascades down to the top problem in every unit.

For example, almost everyone has a measure of reducing harm to patients, which should be the number one measure because your ultimate goal is zero harm. You may set a goal to reduce harm by 50% in a year, but it cascades into the organisation so that each unit would then have a measure and a scientific process that experiments with how to reduce their harm. One area could be infection, which was the case in one of the hospitals in Gauteng where they had a high mortality rate in their Neonatal unit. It turned out that the number one problem was hand washing and as a result they were passing on germs and infections. So they focused on hand washing and aimed to reduce their harm in that area by 50% in the first year, and they actually ended up reducing it by up to 90%, which has stabilised to 75%.

It comes down to value-based improvement whereby you’re focusing on the right problems to create value for the customer, while simultaneously reducing cost because you are eliminating the waste that’s associated with the improvement.

Tell us a little bit more about what you will be presenting at the Lean Summit Africa 2018.

I’ll be doing two keynotes and a workshop. The first keynote is going to be on leadership behaviours where I’ll be going into more detail about what the behaviours looks like for the CEO, what it looks like at middle management and what it looks like at the front line. I’ll lead some specific discussions around the importance of changing our leadership style to escalate improvement across organisations. The second presentation is going to be about exploring and explaining the eight elements of the Lean Management System itself and why they are important. I’ll explain how it is a system, and you can’t just implement one element because they interface with each other to create a system that reduces defects and waste and improves quality and reduces cost. Rose Heathcote (CEO of the LIA) and I will also be hosting a workshop at Leratong hospital where we will visit three wards that are progressing well, and discuss the key elements of the Lean Management System in development there. We invite those interested in seeing the work first-hand to join us.

I’m very excited to visit South Africa and meet the people who I’ve been talking to for these past 18 months, as well as the other Summit speakers and attendees. Working with the LIA on this important work has been a privilege and without their leadership and support this would never have worked. They are physically on site every week checking and talking to and encouraging the hospital CEOs. The LIA is also helping us to develop the performance improvement campaign in these hospitals; they are teaching them these skills, and they are actually the ones following up with them on the ground every day to make sure that they have what they need to be successful. I cannot stress enough how honoured I am to speak at this Summit because I’m speaking at the Summit of our partners. They are doing fabulous work and we’re just so pleased to be able to work with them.

The Lean Summit Africa 2018 will be taking place from 30th October to 1st November 2018 at The Vineyard Hotel in Cape Town. More information about the event can be found here.

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