In my previous column in this series (see the Operations and Strategy column in the September/October issue of JHM), I described the structure of a Lean healthcare or rapid-adaptability system. In such a system, every employee's job is to find and fix problems using the scientific method. The system consists of varying degrees of standard work for all-from technicians to senior executives-and management practices that are as reliable and repeatable as the transformed frontline care-delivery processes. The pieces of the system fit together to ensure that people are not only solving problems but are solving the right problems.To people who have not worked in a Lean system, this can seem like pie-in-thesky idealism. While it is true that much change is required for traditional systems to become Lean and rapidly adaptable, these transformations are happening around the globe and the changes required have become well known. In this article, I describe the more systemic changes that must be made to ensure that all support systems transform along with operations.BREAKING DOWN SILOSMost healthcare systems keep support functions such as finance, human resources (HR), and information technology in separate silos. Each department speaks its own language and keeps jealous control of certain aspects of the organization. When operations leaders begin the Lean transformation and experiment with new roles for managers or new job descriptions for registered nurses, they often hit the HR silo's brick wall. When they try to obtain daily data reports or rewrite profit and loss statements to reflect the new focus, leaders run into walls labeled IT and finance. This happens at every organization. Misunderstandings that turn into turf wars can scuttle a transformation. On the flip side, stronger partnerships between operations and support functions will accelerate progress. Over the past decade, as I have studied and assisted in transformations at more than 160 organizations around the world, I have seen many health systems take creative approaches to breaking down the silos and begin rowing together.OPERATIONS AND SUPPORT SERVICES WORKING TOGETHERAt ThedaCare's hospitals and clinics in northeast Wisconsin, our biggest breakthrough with HR occurred when leaders in operations (I was CEO at the time) realized how much we needed HR to help us keep our promises. In a Lean transformation, the first and most important promise we make is to our employees when we say that nobody will ever be laid off because of productivity improvements. People will not improve themselves out of a job. However, few organizations plan for redeployment. Whenever we look closely at a traditional process, we almost always find that, over time, additional labor is the easy answer to a problem. A continuous improvement team usually finds that the same care can be delivered more reliably and efficiently with fewer people, which means that a unit or clinic might have extra staff members who need to be reabsorbed into the organization. Operations cannot do this alone. We tried. After a receptionist atThedaCare quit because there appeared to be no place for her after her job was made redundant, people started saying that Lean was mean.We learned that HR needed to become actively involved in every improvement effort from the planning stage. During months of careful negotiations, HR and operations created a process that has been replicated many times. Essentially, an HR representative is assigned to every improvement project in which Lean facilitators suspect there will be a workforce reduction. Following standard work practices, the FIR representative then consults with area managers to select candidates for possible reassignment and assigns people to new jobs, new training, or temporary labor pools while waiting for permanent jobs to open up. Before any improvement project begins, all staff members know that they will be taken care of in the case of redundancies. …