I am not going to focus on the specific tools required to achieve each of the framework components because there are many ways to implement this framework and you must find the right way for your organization. Usually that means working with external sensei or teachers and each has their own process on how to achieve results.

Today we are focused on the first core structural principle Toyota uses for any initiative;Purpose.Every organization exists for a reason. It's important to be able to clearly state that reason so that employees,customers and the world understands why the organization does what it does.In many cases this starts with an organizational mission statement. A mission statement should help  employees understand what they are supposed to do when they come to work each day.

I have seen many healthcare mission statements and frankly, they are almost always about the same and not very revealing. I am not opposed to mission statements but taken by themselves they don't provide the guidance people in organizations need to understand what they are supposed to do. Take this healthcare mission statement; "Our mission is to improve the health of our communities". Now this is certainly a laudable goal but it begs a number of questions. Who is actually going to do this? What is meant by health? How much  will health be improved? Which communities are impacted? The fact is we really don't have a very good understanding of this organization's  purpose from the mission statement. Defining purpose is a lot like defining a problem. If we make it too general we are trying to solve for world hunger, if we make it too narrow we may miss what is really important. So, a mission statement without a statement of strategic purpose leaves staff unclear on what they need to do.When purpose is unclear staff do what they think is right which may be far from organizational priorities and goals. Management's job is to bring focus by making purpose clear. 

It's important to understand the back round of information that is applicable to the organization before creating the the mission and then a strategic purpose statement. Is the geography important?  Who is actually involved in delivering services? Is there contemplated growth? Is there focus on population health outcomes? What about and overall cost? Who are the customers? 

As executives put more rigor to understanding the environment including focus on stakeholders,customers,and the marketplace, defining strategic purpose becomes easier. Here is the same healthcare organizations' strategic purpose statement "Our strategy is to deliver measurably better value to our customers defined as 3.4 defects/million opportunities ,no interruptions in customer flow i.e. waiting and/or workarounds, and lowest cost". With this statement the mission statement makes more sense and the staff have a clearer understanding of what they are focused on doing. But there are still a number of open questions. Who is going to do this and where are they  going to do it? We do know who they are going to do it to which is the customer(the patient) and what they are going to do, deliver reliable quality at 3.4/million opportunities performance with no waiting.The process of continued dialog and discernment is critical to improve this strategic purpose statement however.

As this dialog  process continues a second iteration of the strategic purpose statement brings us to another level of understanding. " The physicians and staff in the 7 counties in eastern Wisconsin where we have health care facilities will deliver measurably value to our customers defined as 3.4 defects/million opportunities,waiting times for all services of less than 15 minutes, and lower prices than any of our competitors in the market". With this statement it is clear what is going to be done where it will be done,who will do it and how success will be measured.If we now look at the mission statement and strategic purpose statement together it is much more meaningful."Our mission is to improve the health of our communities"." The physicians and staff in the 7 counties in eastern Wisconsin where we have health care facilities will deliver measurably value to our customers defined as 3.4 defects/million opportunities,waiting times for all services of less than 15 minutes, and lower prices than any of our competitors in the market". Do you see how far we have come? Can we make it better?What are we missing? Is there more back round we need to make the purpose more clear? What would you do next?

This important job of defining purpose is the job of the board and senior management teams but involvement of all staff and physicians is critical to obtain the engagement in the ideas, it is the front line staff and physicians that actually will make this happen. My recommendation is take the time necessary to get this done well because without  this compass the organization is lost.

Now that we have discussed  our first topic, "Purpose", we will move to "Process" next week.There are three topics under the process rubric: true north metrics,transparency of performance, and methodology for improvement.  Next week we will tackle "True North Metrics".