A difficult but necessary phase

Posted on December 21, 2012 by

We are 2 and a half weeks into going “live” with some considerable process changes and improvements in the psych services value stream. Despite this short timeframe, we are already beginning to see a number of significant improvements in outcomes results – just from the first event. Specifically, these improvements have better defined psych patients by classifying them according to risk and acuity. We will now be able to standardize levels of care for patients of varying mental health status in a way that will hopefully deliver more value to our patients at less cost.

However, large changes to daily process impact frontline staff and management alike. I just received an earful of frustration from a supervisor who feels overwhelmed, that there are large training gaps, and problems “all over the place” as people learn the new system. I suspect some of these reactions are the result of growing pains in stabilizing changes, yet some of this is negativity may stem from people stepping outside of comfort zones. In my experience, I have found it is very difficult when standard work is initially introduced as it is often received as a direct afront to “how I do things.” So how do we win over the “hearts and minds” of staff in this complicated environment? One important first step (often overlooked) in developing standard work (or even embarking on lean) is team-building. This includes establishing team norms, building trust by becoming transparent and vulnerable (see Lencioni model), and committing to the notion that the team can take ownership of problems and outcomes in its improvement journey. If a team cannot function as a team on a basic level, how are they supposed to standardize their own work much less adhere to it.

So the people component in improvement work is often very hard at the beginning, and is especially compounded when there is a history of a lack of trust within teams, and between staff and management. All too often, the risk is that lean and its concepts are seen as an extension of this lack of trust regarding the true intent of management. I had the great pleasure of working with a sensei who told me the best reflection of management is what you will find on the shop floor. There is lots of wisdom there, and how management responds to these growing pains is critical and should not be delegated. It means being present where the work is, udnerstanding the barriers, not having all the answers, coaching / teaching, as well as praise. The good news is that over time changes become more stable (with effort) and people may become more adaptive to change. Much of this depends on what leaders say and do on a daily basis. If nothing else, not blaming individuals but rather faulty systems and processes. With luck, once staff understand the good intent that they begin to let go of grudges, and approach the work differently.