Flow: The art and science of perfect health care

2012-05-25 Flow

When I look back on my notes from last week’s tour of Autoliv, Virginia Mason, and Seattle Children’s Hospital, one word pops up repeatedly: Flow.

In Lean, flow describes the perfect process we aspire to, where there is no waste and no wait. It is about “just-in-time” processing, delivery, or preparation. It is about having what you need, exactly when you need it, and making the right thing easy to do and easy to do well. This VISA commercial captures the essence of flow in about one minute (how efficient!).


One of the leaders from Autoliv shared that “repeatable results can only come from repeatable processes” and it is only when these documented and stable processes are in place that we can begin to maximize flow.  Those who talked about flow described an overarching sense of calm, order, and predictability in their work. As one care provider from Virginia Mason put it, “it is like taking the noise out of your day.”

This idea of flow reminded me of a great book I read a while back, called Good Business: Leadership, Flow and the Making of Meaning.   While it’s not about Lean, it seems to have everything to do with what we are trying to achieve with Lean in Saskatchewan’s health care system.

According to author Mihaly Csikszentmihaly, flow is ‘the optimal state of the inner experience,’ where we are able to fully utilize our skills and capabilities while simultaneously achieving joy and happiness in our work.  Csikszentmihaly’s flow is akin to an artist or athlete being “in the zone” or “in the groove.”

In his book, Csikszentmihaly outlines the conditions of flow:

  1. Commitment from top management to an environment that fosters flow
  2. An overriding purpose or mission for the organization
  3. Continuous communication of this throughout the organization
  4. Clear performance goals at all levels
  5. Good feedback mechanisms
  6. Matching of challenges to skills.

In reality, both kinds of flow are important and nurture each other. What I observed on our tour of companies and health care facilities that have adopted Lean was that well-designed processes tend to go hand-in-hand with employees who have positive energy. Everyone we talked to understood the goals of the organization and how their work was connected to those goals.  Lean offers us the science of how we can achieve flow through the application of tools and data. Csikszentmihaly’s concept of flow reminds us not to lose sight of the ‘art’ part of our work in health care.

For more on the concept of flow, check out this video of Mihaly Csikszentmihaly’s TED presentation.

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