LEAN Thinking – FRAMING, It's all About Framing

I like words. My belief is that words I use say a lot about me, in addition to what I am meaning to say.

One word I have been paying attention to for some time is “framing.” I first became aware of framing in the early 1990s while studying psychology; and then it was “reframing” that caught my attention. I was at a training and talking with other participants, one of whom was offering what I heard as a negative critique of the earlier talk. I had appreciated the talk and made a comment that took the idea being expressed and transformed it into one I felt was more positive. One of the others listening complimented me on a “good reframing” of the other person's point. I had not thought that was what I was doing and filed away what I took as a compliment to think about later. ¹

As my studies progressed in psychology, I learned more about reframing and used it in a more conscious manner. I learned that it is a very powerful method of working with and influencing others. A seemingly simple shift in the context of the item or issue being discussed can change the way it is being perceived. In the field of psychology I've used reframing to clarify the possible intent of a comment heard or action experienced by a client. In business I've used reframing to change or broaden the context of what is being discussed. An example of this would be to take an aspect of business performance that may look like a positive attribute in terms of how it helps a business unit perform within a service line, but when looked at in terms of the customer's needs, may turn into a negative that does not benefit the customer. Here the initial context may be “How does this make my job easier?” and the new context is “How does this benefit the customer?”

The “frame” that most of us utilize in our working lives is “What will do the best job in this case?” And that frame has benefited us. We do want to do the best job and asking that question, in the frame of “my job” and “this case” puts into focus the way we usually think. Lean thinking asks that we look at a new way of “framing” our questions. We put down a personal, team, or company frame and adopt a client frame. The new questions are “Will the client pay for this? Does this add value for the customer?”

And this means that a new frame needs to be used from top to bottom of our organization. To become more effective at what we do, we all need to reframe our conversation, or questions. We will still ask about the top and bottom line, and all the other questions. However, our first questions will be with the customer, about the customer, and from the customer's perspective. 

1From Wikipedia, the free encyclopedia: The term reframing designates a communication technique which has origins in family systems therapy. ... Another meaning or another sense is assigned by reframing a situation or context, thus sees a situation in another frame. A frame can refer to a belief, what limits our view of the world. ... Psychotherapists trained in the reframing by communication attempt to let scenes appear in another point of view (frame) so that someone feels relieved or is able to deal with the situation better.

A LEAN Approach in Healthcare – Lean Patient Centered

An Institute for Healthcare Improvement (IHI) Innovation Series white paper (2005), Going Lean in Healthcare, spells out how the principles of Lean management or Thinking can and do apply to healthcare. (http://www.ihi.org/knowledge/Pages/IHIWhitePapers/GoingLeaninHealthCare.aspx) The paper includes examples from Seattle’s Virginia Mason Medical Center and northeast Wisconsin's ThedaCare, Inc.

The paper provides a brief summary of what Lean thinking or management is and where it came from. It looks at the value stream mapping approach and emphasizes how important it is to maintain our focus on the patient – the patient who defines value in our system.

Given that this paper was released in 2005, why has healthcare not embraced Lean thinking more extensively?

The paper addresses one major impediment – skepticism in the form of “we are not making automobiles, this is healthcare.” While I also believe this is an important point, I see more to our reluctance than skepticism. I believe that it is also a complex combination of “lacks” - lack of consistent leadership, lack of time, lack of money, and lack of a compelling reason to change. As long as we think we are doing an adequate job of providing service as measured by our peers, we have little motivation to make a change. And change is hard.

Yet, if we will take a look at the potential benefits of Lean thinking – improved flow, reduced costs, decreased adverse event rates, improved patient satisfaction, etc. – it makes a move to Lean practices one of the most critical steps any healthcare organization can take.

One additional reason for not jumping into Lean may be the name; Lean. While we may want to be lean ourselves, for the organization we work in we seem to prefer Fat; fat in all ways, so we think we are safer or protected in some way. We want fat or extra supplies, and the same with people ready when we need them. All of this leads to excess in our systems and processes that do not add value, value in the only terms that matter, those of the patient. Lean thinking turns this around by looking at our systems or processes with the patient answering the question: Does this add value? So while the system and processes become leaner, it is not just to satisfy a financial goal; it is to satisfy a patient goal. It is very Patient Centered – a goal we can all support by whatever we call it. Lean Thinking, Lean Management, or Lean Patient Centered. 

Let me know if you want to learn more about how to get a certificate in Lean Thinking.  I can offer training in conjunction with an excellent trainer.  (Send me an email: dr.fritzmb@gmail.com)