Alignment of the initiative to the organization

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Alignment of the Initiative to the Organization Senior executives emphasized that Lean is part of the corpor ation’s strategic plan to transform the organizational culture, build teamwork, and increase staff engagement. The system recognizes that embedding Lean in the organization will take a long time. A senior executive indicated that Lean fits with the shared governance structure that nursing at Heights Hospital has had in place for 20 years. Nurses are involved in making their own schedules, creating new policies, and making other types of decisions that impact their work. She indicated that Lean offers additional opportunities for nurses to provide input. Project Scope and Pace The scope and pace of Lean activities at Heights Hospital were viewed in a positive light by executives. The focused effort of prioritizing two value streams for launching RIEs, conducting multiple projects within those value streams, and branching out to other value streams over time was seen by senior executives as a productive approach to Lean implementation. One executive commented that maintaining a disciplined focus on the value stream implementation plan can be difficult when something “comes up” outside of the selected value streams. Failure to adhere to the plan by becoming reactive can scatter resources. Several interviewees noted that the project scope must be clear and include realistic goals or the project can become unmanageable. For example, the wide scope of the ambulatory care value stream was identified as a barrier to successful implementation. At first, the value stream attempted to conduct a series of projects in each area of ambulatory care —women’s health, internal medicine, pediatrics, and an eye clinic. However, the administrative director found that without focus in one specific area at a time, the chiefs of service were not engaged and
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201 committed to Lean. Ultimately, the value stream was revised and the scope limited to just internal medicine at first. The pace of Lean activities was an issue at the department level, with clinical staff and leadership not always in agreement. An executive and a department manager stated that the key to getting more people to understand Lean is to do a series of small projects in one area. However, the clinical staff interviewed found the concentrated focus in one area to be the most trying aspect of Lean. Multiple projects in one department resulted in a great deal of staff being away from patient care for an extended period of time, sometimes repeatedly. The corporation and Heights Hospital have not kept up with the aggressive implementation plan they originally developed as they were embarking on Lean implementation. The system had hoped to launch Lean at all 23 of the largest health care delivery sites in 3 years. This time period has been extended to 6 years because of the need to give every process redesign project more attention than anticipated. At Heights Hospital, the BDO noted that a lack of staff resources and the extensive time required for RIE-related work slowed progress. He felt a good pace was one
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