An open letter to former Treasury Secretary Paul O'Neill:
Don't get me wrong, it is great to have you on board the lean team. Even though your 'think tank', Value Capture, is really a wheel re-invention tank, the basic idea of promoting lean in health care is a really good one. You, however, can do a whole lot better than that.
Sooner or later your team is going to figure out what the rest of the leading thinkers have figured out. Right now you have only mastered that which Mark Graban figured out and wrote up a long time ago. You and your guys got on top of all of the lean tools, then found out that the tools are not enough, so you are doing a good job of pounding the importance of leadership and commitment on the part of health care executives. So far, so good. But pretty soon you are going to go back to the tank and figure out that even that is not enough and that fundamental changes in management structure, processes and, most important, accounting are needed.
With all due respect and with sincere hopes that you live to an age that puts Methuselah to shame, you are 76 years old and we might not have time for you to keep learning about lean the hard way.
Business in this country – manufacturing especially and health care not far behind- are severely hamstrung by accounting practices that drive everyone to short term optimization at the expense of the long term, are right next to useless in terms of putting clear information in the hands of people who can do something with it, and utterly fail to capture the actual value formed and delivered. Those accounting practices are the prime driver of organizations being so non-lean, and they are institutionalized by your old posse – the IRS.
As great as it is to have you promoting continuous improvement, the highest and best use of your time and talent is in straightening out that problem. Please, please – pretty please with a cherry on top – quit mucking about with hospital CEO leadership lessons – and read a good book on lean accounting. Show up at the Lean Accounting Summit. I have a few connections and can pull some strings to get you in cheap if it is money that is holding you back. We have lots of folks who can do what you are currently doing, but only one former Treasury Secretary committed to lean and in a unique position to have a critical impact on American competitiveness. Don't waste any more time.
No doubt there is good money to be made on the lean consulting trail, but as lucrative as being a Mark Graban imitator probably is, you can and should do a lot better. I will be looking for you in Orlando this fall.