Monthly Archives: December 2010

Book Review: On The Mend

“On The Mend” by John Toussaint, Roger Gerard, and Emily Adams is highly recommended for any level of leader in a hospital.

The authors stress the importance of how leaders need to change themselves in a Lean transformation.  Insights to the thinking of leaders at ThedaCare will challenge a hospital’s current management approach and hopefully inspire experimentation of a new style.

Woven throughout the book is the continual discussion of the impacts of a shame and blame culture.  The authors discuss some of the root causes of shame and blame.  They explain some of the counter-measures they used to improve the culture.  There is a whole chapter on engaging doctors that is of value for any healthcare leader.

The book greatly shows how time reduction is not only a productivity metric, but how timeliness impacts the health and safety of the patient.  Other examples throughout the book demonstrate that Lean can make great improvements in a hospital.

I appreciate the credibility of the authors.  Many times, they state when things did not work well, how they were the problem in some cases, and how they would approach differently in the future.  I think it is important for these sort of books to be honest since a Lean journey is not easy.  “On The Mend” provides a realistic look at how this kind of thinking can make lasting transformation in hospitals.

More information about the book including videos, author interviews, and a free chapter available at L.E.I.

Disclosure: A review copy of this book was provided to me by the publisher.

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Filed under Book Review, Health Care, Improve With Lean, Lean Hospital, Lean Hospitals, Learn Leadership, Plan-Do-Check-Act, Problem Solving, Productivity, Quality, Respect For People

A C.O.W. Tale

Does your hospital have a system to ensure nurses have working equipment or they know how to get them fixed?

I recently visited a hospital where the answer would be “NO”. 

Last week, a family member needed a day surgery procedure done at a local hospital.  There were signs in the prep/recovery room touting their move to electronic medical records and no longer needing paper charts.  The problem for the nurse was, the Computer On Wheels (C.O.W.) did not work.  The nurse was unable to access or update the electronic chart!

A second nurse came in during the morning before the procedure to try to troubleshoot the malfunctioning C.O.W.  It was decided to grab a C.O.W. from another room and use it instead.  I am not sure if other nurses had to search for the missing C.O.W. now that it has been moved into our room where it sat there for four hours.  A third nurse eventually pulled it away to put back where it belonged.

The first nurse came back in and tried to access the original C.O.W. in our room and commented “This still doesn’t work yet?”

I looked at the C.O.W. and there was no signage about how to troubleshoot or who to call.  I do not know if a nurse tried calling their helpdesk out of my view but it looked like nobody knew what to do with the broken computer.  It seemed like nobody knew who was to take charge in fixing it.  One can almost infer they expected it to magically fix itself!

Three nurses spent time reacting to faulty equipment that could have been better used providing care to patients.  Instead of spending their creativity solving patient issues, they use it creating workarounds.

Lean thinking can help hospitals put systems into place to ensure equipment always works.  Procedures can be created for what to do when something is broken and how to handle.  Make things visual so staff doesn’t have to rely on memory or look up procedures because instructions are attached to the item being used.

Helping remove waste and frustration from those giving care with make a better experience for those receiving care.

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Filed under 5S, Business, Change Management, Gemba, Health Care, Improve With Lean, Improvements, Lean Hospital, Lean Hospitals, Problem Solving, Productivity, Respect For People, Standard Work, Value Added, Visual Language, Visual Systems, Waste