Sunday, April 15, 2012

"Aikido is a Japanese martial art in which practitioners apply established principles of balance, leverage, position, and movement to achieve power without effort. In recent years, Aikido has become a model for leadership and management development at organizations, universities, and governments throughout the world. It as an approach that promotes harmony and collaboration rather than competition--and it provides a highly effective strategy for managing change."
"For many organizational leaders, the experience of managing large-scale change is akin to rebuilding a crowded boat on a stormy sea. Conflicting agendas, complex issues, and high emotions can swamp even the most promising initiative. Under these circumstances, traditional management skills are seldom enough to keep even the most dedicated change managers on course. Aikido can help them find and keep their organizational 'sea legs,' even in turbulent waters."
Barry Tuchfeld, PhD, Nidon

OK, What is "Lean"?

Simple. "Lean” process analysis classifies tasks as
  1. Value adding (from the customers' point of view);
  2. Non value adding, but necessary;
  3. Unnecessary ("waste")
We want to maximize time spent on #1, minimize time spent on #2, and eliminate tasks in category #3.

[T]o embrace lean healthcare you—particularly if you are the senior leader—must do lean healthcare by going to the gemba, the place near the bedside where value is actually created for the patient. You need to involve yourself directly in process improvements and learn to see both waste and value. The improvement initiatives described in the pages ahead do not require your direct and undivided participation because of your technical knowledge or authority. Indeed, both may get in the way. Rather you need to apply your hands directly to resolving the problems you will find as part of an improvement team of doctors, nurses, support staff, line managers, and patients because this is how you will change your own thinking about waste, value, and leadership in healthcare. 
This prospect is frightening at first for most leaders because they have been trained in a management model where the senior leader (particularly when a doctor) should know all the answers. In fact, lean leaders can only know how to ask the right questions in a collaborative spirit.
- James P. Womack, Founder and Chairman Lean Enterprise Institute, Forward, "On The Mend"
More from "On The Mend" -
[A] different kind of healthcare is possible—care that is patient-focused, with less waste and cost and better medical outcomes. Using the improvement model popularized by the Toyota Production System, we have arrived at lean healthcare and three organizing principles—focus on patients, value, and time—that are built upon a foundation of continuous improvement and respect for people. We have learned how to apply these principles to a large medical system with striking results.
- John Toussaint, MD and Roger Gerard, PhD,  Introduction, "On The Mend"


We have much work to do, in enterprise generally, and in health care in particular. Notwithstanding that decorum dictates that organizations pay lip service to "collaboration," "team-based care, "people are our most important asset," etc, physicians are trained to make decisions on complex matters, frequently under severe time pressure, without significant opposition. There remains to a signficant degree a power relations / pecking order, one requiring much courage to contest on the record.

In the current marketplace, professional autonomy extends not just to decision making but to execution of decisions. That is, autonomous physicians are free to perform at varying levels of proficiency. High standards are not enforced. Although peer review mechanisms and malpractice litigation purport to enforce some standards of performance, those standards are not well defined, and are not set at a high level. Moreover, the marketplace does not consistently reward high standards: patients are not well positioned to assess quality, reimbursement from third party payers is poorly linked with quality of performance, and malpractice litigation is ineffective at distinguishing between high and low quality.
In many economic contexts, it is productive for consumers to be able to choose among a wide range of trade-offs between quality and cost. But this is rarely the case in medicine. In that market, demand for less-than-high-quality performance is minimal, because the usual trade-offs between cost and quality are absent. Several reasons are apparent. Substandard performance can easily cause enormous medical and economic harm; cost and quality often do not correlate; the quality of performance and risk of harm are difficult to judge for consumers and third party payers alike.
- Lawrence Weed, MD, and Lincoln Weed PhD, "Medicine in Denial," pg 211
More to come...


An initiative of

Can we inculcate comprehensive operational and physical Feng Shui into the necessary enterprises of humanity, for the material and spiritual benefit of all beings and our collective environment?


Really, we must, irrespective of how we choose to label the methods. The efforts and the results are what count, not the cultural labels.

More to come...