Posted by: Knightbird | September 12, 2012

Best Practices

I read a lot of emails from the tribal health system talking about best practices. Consultants who have spend years, if not decades, having their idea run through the process to become deemed a best practice hire out to organizations struggling with the same issues, come and teach their best practice, then leave to see the idea founder. More often than not, the process accounts for very little sustainable gain and burns up a lot of cash and employee time. Often, the experience leaves a bad taste in the mouths of employees who then become resistant to further change.

When Chugachmiut started on its lean journey, it was not a best practice. Earlier pioneers of lean healthcare like Seattle Childrens, Virginia Mason, Parke Nicollet and Thedacare had yet to prove the system. And we were different from the hospitals. We are a tribal organization that manages about 50 separate programs. And we are very accountable in a close and direct way to our tribal members. In the past 6 years, not one of the executives who also serve us from the tribal primary care system has called upon us as an organization to see what our needs are. And I have not seen a single executive from the Alaska Native Tribal Health System in the past 3 years, despite promises to visit. They don’t find our needs as important as we find the needs of our tribes and tribal members, whom we visit on a very regular basis.

Chugachmiut started applying lean to all aspects of our organization in a cultural transformation without much guidance or resources. We also had resistance from tribal members who said, “We are not an auto company.”  I have one persistent critic of my blog from Nevada who says I am out of place. We had resistant employees, even as late as this week. We have learned a lot, but what I am proud of is our ability to sustain and continue to make improvements. This has all been done without any “best practices.” We find what fits our needs, or exercise our creativity to identify and try new ideas. We are not afraid of failure as a management culture. Failure is a term we don’t really use. We call our failures “defects” or “treasures.”

We did participate in one “best practice” exercise, but very quickly found that it did not serve our long-term needs. We did find some good information, as one can with any practice. We learned from that, and let go of the rest.

Today, our best practices are memorialized in a value stream map and standard work. It is taught to new employees using the tools of Training Within Industry. When an employee encounters a “treasure,” they write up a problem statement in an A-3 and move towards identifying the best available solution, for us, and implementing it after it proves out. We will gradually become an organization that is holistically managed, and will ourselves become a best practice, for Lean in non-profits.

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