Nurse Leadership in the Lean Healthcare Model

Nurse Leadership in the Lean Healthcare Model

Elizabeth Hanes, RN, BSN
Health & Medical Writer

Ask any bedside nurse a question like, “Why does it take so long to…,” and she usually can give you an immediate answer. Working on the front lines allows nurses to identify inefficiencies like “why does it take so long to turn over the operating room between cases” or “why are we nurses constantly under-scheduled on this unit and then called in on our days off” and then develop creative solutions to the problem – solutions that sometimes never get implemented because they don’t fit the historical “order of things” within the healthcare system.

Now, some organizations are changing this dynamic. Some systems have embraced the move to Lean management, a concept developed in the 1960s by Toyota Motor Corporation. A type of continuous process improvement methodology, Lean healthcare seeks to identify inefficiencies by fostering higher employee engagement in order to deliver higher-quality care. And while implementing a Lean healthcare model can pay big dividends, it may be easier said than done. Nurse leaders can play a key role in at least three respects when transitioning to Lean management.

1. Obtaining staff buy-in for Lean implementation

People may be naturally resistant to change, especially if they feel it is being done ‘to’ them instead of ‘with’ them. As a nurse leader, you can prepare for staff pushback by educating yourself about how Lean methodology benefits staff members as well as the organization.  Lean management focuses on increasing employee engagement by asking them to continuously identify inefficiencies in their practice environment and suggest ways to address these issues – something many nurses and other front-line employees already do but may feel they do not get rewarded for. By emphasizing that you want to implement Lean methodology ‘with’ their input and participation, staff members may be more open to the changes to come.

You also can be transparent about the challenges of implementing Lean methodology. Transitioning to Lean requires great effort in the beginning because it requires a major shift in mind-set. The problem-solving required to implement Lean can lead to disagreements and tense interactions. Staff roles may be upended in certain respects. For instance, traditional nursing tasks may be reassigned to unlicensed assistive personnel for the sake of efficiency, and everyone needs to be open to this possibility if it does not affect patient safety. Through your candor regarding the challenges ahead, you can instill confidence in everyone’s ability to navigate any trials that arise, which can set your team up for success.

2. Providing active, engaged leadership

According to Lean healthcare consultant Marc Hafer, many organizations make the mistake of thinking they can delegate Lean implementation as if it is an IT project, but successful organizations provide active, engaged leadership throughout the experience. The nursing staff at all levels will play a key role in the success of your Lean project, and you should actively champion Lean among your nurses by holding Q&A sessions, routinely visiting departments where Lean is being implemented and performing other hands-on activities that demonstrate your support of both the project and the staff members undertaking this Herculean task.

3. Following up with continuous process improvement

Don’t go into Lean implementation thinking that the project is complete when the installation is finished. As a continuous process improvement methodology, Lean requires ongoing nurturing to succeed. Indeed, you should be vigilant to the possibility that people may lapse back into old habits and roles after the initial months of implementation are finished. To avoid this, you should continue to meet regularly with staff and other stakeholders to follow up regarding how the process is working, how it can be improved and what new tweaks they suggest. You also can keep Lean at the forefront in executive meetings with the CEO and other key organization leaders.

Fostering culture change

Lean management is not a quick fix that you apply to a small problem in the organization, and then it’s done. Rather, Lean represents a wholesale culture change regarding how healthcare is delivered within your system. As a nurse leader, you can play a key role in ushering in an entirely new culture that provides value to your organization for decades to come.

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