Posted by: Knightbird | March 16, 2015


In 2004, I introduced Lean Management and Lean Healthcare to a small, rural Alaska nonprofit with great success. Improvements were documented and I presented the proofs numerous times to health care executives and leaders in Alaska. I failed to convince them of the incredible benefits that accrue to patients through adoption of Lean Healthcare. In 2007, I cosponsored the first and only Lean Healthcare Conference in Alaska, with the Alaska Primary Care Association. I wrote letters to and attempted to engage the Alaska Native Health Board, the Alaska Native Tribal Health Consortium, the National Indian Health Board, the State of Alaska Healthcare Commission, the State of Alaska Department of Health and Social Services, the Indian Health Service and Maniilaq Association’s board of directors. I failed, and patients continue to suffer.

As I write this, I am very mindful of the enormity of the task I have undertaken. Perhaps I am obsessed with this change occurring in Indian Country. I have three relatives that I loved dearly who died prematurely because of medical issues. And I know many more who have suffered at the hands of a medical care delivery system full of flaws, errors and defects. I find very protective behaviors when I speak about the flawed health care system. I am constantly challenged. Yet the facts speak for themselves. And the facts are themselves flawed because of the collegial nature medical errors are discussed, the hiding behaviors that occur in systems that are punitive for the employees engaged in healthcare and the bullying behaviors from those that are in charge—from boards of directors, CEO’s and executive level management.

And I will fail to convince most of you. I can document extremely beneficial levels of improvement that accrue from using Lean Healthcare in the right way. I listen time and again to patients who believe they are not well served by the system. I listen to leaders who continually ask the federal government for more money and technical assistance on all kinds of issues that could be addressed through Lean Healthcare. By reducing the incredible amounts of waste in the Indian Health Care funded systems, we could be delivering far more health care than is currently provided. How do I know that? Because patient services increase in systems that use Lean management techniques. The Clearview Cancer Center managed a 45% increase in patients served after it used Lean tools to change its management of cancer patients. They did have to hire more nurses, but all other employee categories remained static. Virginia Mason handled 1400 more patients annually in its redesigned cancer clinic. I saw an ability to serve almost 230% more patients annually at my last CEO assignment, with no new employee requirements.

I will fail again. I will fail to achieve my goals of a Lean managed Indian Healthcare System with most of you. You will not be persuaded about the incredible potential we have. But I am not disheartened by failure any longer. I learn through every failure what I must do in order to help patients receive the care they deserve. Lean Thinking taught me that failure is required in order to learn and advance. That, and a burning platform, will help us move forward.

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