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No Bench Players: The Role of Senior Leadership in Pre-work to Adopting Lean Six Sigma

A key precursor to beginning a lean six sigma program is accurately determining the current state of your organization and its readiness for a significant philosophical change. Senior leadership plays a key role in determining the success of lean six sigma adoption. Consider the following questions:

A)     Does senior leadership understand LSS?

B)     Is senior leadership committed to LSS philosophies and practices?

C)     Does the organization have an established practice of open communication and strong alignment between leadership layers regarding organizational goals and priorities?

D)     Does the organization have sufficient resources available to provide needed support and nurturing of a beginning LSS program?

If you cannot answer yes to each of these questions, you should consider adopting lean six sigma tools only, and delay any wholesale adoption of an organization-wide program. Failure to have a strong platform in place before beginning will result in not only a likely failure of the program, but also lead to decreased confidence and increased cynicism of future change initiatives.


First, senior leadership must understand lean six sigma: what it is and what it isn’t, and what it does and what it won’t do. While it is not necessary for leaders to understand the intricacies of LSS, they must be able to confidently articulate LSS philosophy and intelligibly describe tools, processes and goals. Many organizations that fail to adopt lean six sigma effectively do so when leadership mistakenly believes LSS will do or be something that it isn’t. While some improvements will yield immediate results, full adoption takes more than a year, and improvement plateaus (or even dips) should be expected during this time.

Long-term care organizations, in particular, need to be cautious about alignment throughout the organizational structure, as there frequently are significant disconnects between line staff, front-line supervisors and executives. Third-party facilitated staff surveys and focus groups to identify communication patterns and levels of trust are highly recommended. (For an excellent resource on psychological safety in healthcare organizations, check out Team Effectiveness In Complex Organizations: Cross-Disciplinary Perspectives and Approaches.)


Merely understanding LSS and providing tacit support is not enough for a successful adoption: senior leadership must be involved. It’s important to structure this involvement properly, however, striking a balance between controlling too little and too much. Organizational practices must be examined for alignment with LSS philosophy, as line staff typically are keen observers of organizational doublethink—particularly if they have experienced a history of undiagnosed failed initiatives. Policies and procedures, for example, need to be rethought in terms of alignment with actual practice and employee-centeredness.

Staff must also have sufficient time to participate in improvement projects. While organizations are oftentimes loath to increase staffing hours, it simply is impossible to adopt an LSS program without dedicating time to learn, practice, and improve.

If the organization doesn’t have a trained LSS staff member, a trained consultant should be retained for three to six months during adoption and periodically over the first year until internal staff champions are trained. Experience with change process and LSS is critical to respond effectively to challenges and obstacles that are sure to occur.

Bottom Line:

If the above conditions aren’t met, the organization can still use Lean Six Sigma tools to assist with performance improvement projects. Indeed, most LSS tools can offer strong benefits even without total adoption (a 5S event is an easy start). Users should be cautious, however, about long-term sustainability of results, as organizations that don’t adopt LSS as an organizational philosophy will find inertia creeps in and reduces gains over time.

Lean Six Sigma in Aging Services

Lean six sigma is a powerful quality improvement methodology proven to improve efficiency and effectiveness. By combining the never-ending, systemic approach to identifying and eliminating waste of Lean with the principled, data-driven structure of Six Sigma, lean six sigma has the power to rapidly transform healthcare organizations.

Virginia Mason Medical Center and Thedacare began using lean six sigma in early 2000, and the philosophy has quickly made inroads across the acute and ambulatory care sectors. Unfortunately, it has been largely absent from long-term and community-based care, where performance improvement methodologies has remained stalled with older quality assurance-based models. Aside from missing valuable opportunities to improve performance and outcomes, the absence of lean six sigma robs LTC and CBC organizations of a powerful tool in creating vibrant, person-centered homes and communities. Indeed, lean six sigma could be a model for leading culture change projects:

1)      Lean six sigma places residents at the center of thinking. Rather than designing processes based on the needs of an organization or performing work based on worker autonomy, shouldn’t residents determine what we do? In lean six sigma thinking, value is solely determined by the customer—in our case, the resident. To be considered value, the product or service must be something the resident is willing to pay for (either monetarily or some other resource, like time), it must be changed or transformed in some way, and it must be done correctly the first time. To improve value, we must identify what the resident wants (gather the voice of the customer), optimize the process based on what we discover the resident wants (map the value stream and define the flow), and provide it at the right time (establish pull) while recognizing that change is a journey not a destination (continuous pursuit of perfection).

2)      Lean six sigma builds a culture of quality and efficiency. Think of the difference between a goal of zero defects and a goal of 99.9% accuracy: do you want to be the one out of every thousand residents who experiences an adverse event? Of course not! And neither does any resident. Lean six sigma philosophy creates a culture focused on doing the right work at the right time every time. It will reach into every corner of an organization and apply data-driven improvement tools to eliminate errors and waste. Since the methods are always focused on what a resident (or any other customer, for that matter) considers value, lean six sigma can help with any process anywhere in the organization.

3)      Lean six sigma is based on fundamental principles of team empowerment, active leadership, and decision making as close to the resident as possible. So much of culture change work has been on “warming the soil” of communities through staff empowerment, team building and open communication. Quality improvement activities, however, have either remained relegated to management roles or implemented broadly in half-hearted ways: the former is disempowering and the latter is discouraging; neither leads to an adoption of a culture focused on quality and efficiency. The beauty of lean six sigma is that it is based on the following key principles: interdisciplinary teams; resident focus; shared information; safety as a system responsibility; anticipated needs; and continuous waste reduction. Indeed, it’s an entire process improvement methodology rooted in the same principles as culture change!

Now is the right time for providers of aging services to embrace the promise and value of lean six sigma.



We are very excited to announce the launch of KnowlAge, a new project sponsored by principle consultant Sean Carey!

KnowlAge is an information dissemination project aimed at making evidence-based, proven practices and knowledge about aging services more readily accessible to providers and other stakeholders.

Lack of knowledge dissemination is a huge barrier to quality improvement in long-term care. Millions of dollars are spent researching and developing best-practices– only to be archived on an obscure website and never used by more than a handful of providers. Providers– administrators, nurses, and care staff doing the best they can to serve elders struggle to know what works and what doesn’t. Efforts are constantly duplicated, reinvented, re-imagined, and replayed in the tens of thousands of elder communities across the world.

There has to be a better way. After all, how is it that we know how cute a baby panda who sneezes is? Or who’s finger Charlie bit? That we can remember everything about everyone anywhere?

The technology behind this project is not sophisticated, as Sean’s background is in nursing home operations, not programming and web design. KnowlAge utilizes a basic shopping cart platform hammered into an idea library. The site is in beta right now, while the code is cleaned, content is added, and filters are selected to make the information useful, usable, and easy to find.

Take a look and let us know what you think!

Ready to get started? So are we!