World Class Blog Post

 

Source: http://www.icangiveyouhouse.com/2010/09/04/world-in-our-hands/

Have you dreamed of eating the Grove Café’s world famous pancakes or been lucky enough to try them yourself?  What?  You never heard of them before now?  It almost sounds like a classic Onion article.

Many hospitals aspire to be “World Class” but there is no measure to know if they succeed at it.  Just like the pancakes, only that hospital seems to define themselves as achieving that level of success.  For that matter, I am not sure what would make them stand out with that definition since a Google search of “world class” and hospital returned 47,300,000 results.

Do patients choose a hospital based on a world class definition?  Similarly, do local “top doctor” magazines drive patients to hospitals or is the US NEWS” Top Hospitals” issue a key deciding factor (despite its questionable criteria)?

I would worry about achieving the level of “World Class” (whatever that actually means) since being at the top of  a benchmark usually does not inspire people to improve once attained. 

I think a better mission for hospitals is to strive for “perfect care”.  Patients deserve predictable clinical outcomes and they shouldn’t get harmed or sicker by being in a hospital.  Patients want better customer service and should not have to experience any unnecessary waits.  Lastly, healthcare should have a fair and reasonable price for their co-pay and insurance.

Hospitals need to ask their patients if they want to be treated at someplace famous or where they will receive perfect care.  If forced to choose one over the other, which would they pick?  Focusing on the means (providing perfect care) will help hospitals achieve outcome of being deemed world class.

If you liked this post, then try:

• Guest Post: How Does Your Hospital Give Excellent Service?
• Crème de la Crème – What makes a world-class hospital? by Matthew N. Skoufalos
• Make Healthcare Awesome

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Walk The Talk

I learned a lot at the recent Lean Healthcare Transformation Summit and will blog my reflections from it.  The first thing that stands out to me was the consistent effort leaders were making to walk the talk.  I think the list below is a great start of what will help leaders help transform and sustain their organizations.

• Go see, ask why, show respect, and learn
• Practice respect for people as individuals, engage their heads & hearts, and don’t shame or blame.
• Be humble
• Lead as though you have no authority
• Teach and ask questions
• Persevere
• Experiment
• Be inclusive of everyone
• Be free from the “smartest society” trap and don’t fear appearing to be outed as incompetent

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Make Healthcare Awesome

I was pretty excited to come across this “Make Healthcare Better” SlideShare presentation from Drew Weilage (RSS readers may need to click link to view).  His message of focusing on the patient and moving away from mediocrity in hospitals is exactly the mission I have.  I think Lean helps hospitals work to make things convenient for the patient and not just the provider.  I hope you find this interesting as well.  He also has a blog that is worth checking out.

This presentation really fires me up about what I do and the potential for hospitals.  I love the ending line: “Good is not good enough”.

Please share your comments about the presentation.

If you liked this post, then try:

• A C.O.W. Tale
• Doctor PDCA
• More Committed Than Ever

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Shhh! People Are Learning

Photo Source: http://mrshocket.info/default.aspx

I had a great experience recently when I was able to sit in on a meeting that was being led by a client.  They were debriefing an event and dealing with some uncovered problems afterwards.  I was thinking of some potential counter-measures or approaches to understand the problems deeper but the team came up with everything I was thinking on their own!

As leaders and consultants, it is so important to give people the space and time to figure things out on their own.  Be there to help if struggling, but allow them the ability to experiment and try things.  Coach to the method of thinking but not the solutions.

For me, Lean is about developing thinking and getting results. Unless there is an emergency requiring quick action, no result is worth sacrificing the time spent developing thinking.  Investing in people will help organizations thrive in the long term.  A company or hospital with more Lean thinkers will be more competitive than another that is just implementing the tools.

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Communication Or Announcements?

Photo Source: On The Sauce http://onthesauce.net/?p=391

You have a new change coming, do you communicate or just announce it?

I define communication as two-way where input and feedback is requested and announcements as one-way “this is coming or it’s already here” kind of messages.

Announcements are not an effective way to bring your organization along on your Lean journey.  People feel done-to or it appears as though they have no voice.  Announcements give the impression of very top-down leadership even if you had some of the front-line staff involved in creating the change (intent versus impact).

For people to be engaged in the change, ensure you are seeking input and feedback from those affected.  Firstly, before you make a change or set a target condition you should have gone and seen the actual process.  Use this time in gemba to get feedback about the problem.  I have seen flipchart paper put in an area for staff to add input prior to developing counter-measures to trial.  Use staff meetings to ask for thoughts before you start improving.

When developing counter-measures, share ideas with stakeholders or involve them in the trial.  Ask them what works or what further adjustments should be made before it becomes the new standard work.  Their input will make a better counter-measure and help them be invested the change.

After the standard work gets implemented, have leadership and key coaches on the floor soliciting feedback and providing clarifications.  The counter-measure may have some missing pieces that are only discovered after “launch” or people may not understand it enough to follow it.  This communication helps your organization sustain the improvement.

Honestly look at your “communication” strategy.  Is it really just announcements or are you actively asking for feedback to be seriously considered?  Did you bump the communication discussion from every agenda and now stuck in the mode of announcing because a counter-measure is developed and ready to go?

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Lean Advice From Sobek & Smalley

“From our experience, improvement efforts in companies become ineffective when the emphasis becomes adhering to a standard tool and enforcing a certain way of doing things.  Inherently, the adherence is all well intended as a means of promoting standardization and ultimately improvement.  Unfortunately, the implementation of a certain tool or technique can become more important than improvement of the process or current situation.  In other words, the means trump the ends……place the emphasis on performing, improving, and learning rather than on conforming to templates, tools, and procedures.” – From the highly recommended book “Understanding A3 Thinking (Sobek/Smalley)” page 133.

If you liked this post, then try:

• Book Review: Understanding A3 Thinking
• Are Results > Improvement Process?
• Accidents Do Not Equal Success

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When Visual Controls Go Bad

While this picture is a piece of artwork it made me think what your organization can look like if you view Lean only as a set of tools.  Losing the perspective of your system can easily lead to creation of complex and unusable solutions like this traffic light. 

 When I look at this traffic light tree, I picture one team adding one of the lights, then another team comes along and adds a light for their use, then a management team adds a third light to summarize what the other two teams lights represent, then more teams continue to add their light for their own use, and so forth.  While a new light may be a solution for each group individually, the net result is a confusing and unusable tool for the system.

When you set out to improve things, think about the needs and impacts to the system.  Take the time consider all options before acting.  It is not true improvement if you optimize one area but the result is sub-optimizing another.

Keep on improving!

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More Committed Than Ever

I am now back from my wonderful 4.5 weeks of paternity leave and am more committed than ever to help hospitals become lean.  Through the birth and follow-up pediatrician visits, I have been a customer of health care and see many opportunities for staff and patient satisfaction.  Here are some of the things I experienced:

• New IV Ports – One nurse had trouble connecting an IV port on my wife during labor.  She exclaimed “they changed our ports a few months ago but we kept on using the old ones.  Now the old ports have been thrown away and we are forced to use the new ones.  I don’t see why they switched them.”  Another RN mentioned the ports later and said “I was on vacation when the ports changed so I never got the training for how to use them”.
• Lack Of Patient Centered Care – Our OB seemed to have an agenda on the day of labor and increased medications without telling us first despite our birth plan and previous conversations requesting informed consent for things like this.  The OB was using scare tactics to push for a c-section without explaining pros and cons for alternatives.
• Pediatrician Office Visit Late – For our one month check-up the pediatrician was 20 minutes late.  The doctor looked visibly flustered and distracted.  He apologized for running late and expressed how bad he feels to be running behind and hates to make people wait.
• What Is Up With Our Hospital Bill? – The day before we discharged, a person provided an estimated amount and asked for a credit card.  A month later we get a bill in the mail for half the amount we already paid without any indication our initial payment was credited towards anything.  I called their billing customer support only to be told the initial credit card amount was applied later in the day that my bill was mailed.  The rep told me the lower bill we got in the mail was incorrect and we really owed the larger amount we originally paid for with a credit card (plus an additional $68).

Lean transformations can help each of these situations.  Using better training, job instruction sheets, and explaining why would help the nurses with their ports (although I question what prompted the change if they were allowed to use the old ports for a few months if someone claimed safety was the reason).  Helping providers understand what their patient’s wants and needs are will allow them to better serve their community and will most likely help with growth.  Doctors can have reduced stress and better engagement if the root causes for being late for appointments are improved.  Lastly, recognition that the patient experience usually ends once everything is paid can help improve billing accuracy/clarity and save money from rework due to patients calling in to ask about their bill.

With renewed energy and passion I return to work to help those in hospitals see the opportunities all around them while providing guidance for how to capitalize on them.

Keep on improving!

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Book Review: Lean Hospitals

Mark Graban’s “Lean Hospitals” is a must-read for any hospital going through a Lean transformation.  I recommend it for all staff and not just leadership.

I am an internal consultant in a Lean hospital.  One of the biggest challenges is helping clinical staff understand how stuff from the automotive industry and manufacturing is relevant to their work.  Mark’s book provides descriptions and case examples that tie the Lean philosophy and tools directly to hospital work.

A strength of the book is the realistic way to approach Lean in a hospital.  There are many nuances for standardized work that are valuable.  Wastes are identified as things people in hospitals experience.  Mark points out common issues faced by hospitals if you are looking for a place to start.  I can not emphasize enough how many valuable tidbits are throughout this book.

Leaders will get a lot from this book.  Lean requires management to change in order to support front-line improvements.  Mark provides many concrete things leaders can do to make their journey successful. 

The continued focus of  patient needs and employee engagement drives all aspects of the book.  This brings purpose behind everything else that is explained.  This book will help drive valuable change for hospitals.

• Get the first chapter for free here. 
• See a video with the author here.
• Follow Mark Graban on his blog andor twitter.

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Growth Versus Development Warning

“We pursued growth over the speed at which we were able to develop our people and our organization, and we should sincerely be mindful of that.” – Akio Toyoda (2/23/10)     Quote obtained from Jon Miller.

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How Does Autonomy Fit Into Lean Management?

Dan Pink’s new book “DRIVE” made me wonder how Lean management�will work with the book’s premise that knowledge workers seek autonomy.��Do standardized work and job instruction sheets take away from the need to have autonomy over what tasks people do, when they do it, who they do it with, and how they do it?

The book’s premise is that old motivating ways of using the carrot as a reward or the stick as punishment�does�not work for knowledge workers.� Knowledge workers are motivated by autonomy over task, technique, time, and team.� They are also motivated by the pursuit of mastery and fulfilling a purpose.� I posted a video from the author explaining the concept a couple of months ago.�

Pink breaks down processes into two categories:

• Algorithmic:� Tasks where you follow a set of established instructions down a single pathway to one conclusion
• Heuristic:� Tasks which require experimenting with possibilities to devise a novel solution and no single pathway exists

Carrots and sticks work well for motivating people with algorithmic tasks (to some extent) but�cause damage when applied to heuristic tasks.

One of the challenges at my hospital is that most providers think providing all elements of care is heuristic.� They each have their own special skills and experiences�to create care for the patient.� From a Lean perspective, we have variation and unpredictable results which cause waste.� Provider teams in the hospital are working at transforming some of these tasks to be algorithmic.� We�are able to meet our patients’ demands better, less people are idle, and supplies are getting closer to point-of-use.

Despite these wins, is Lean thinking taking away autonomy by transforming heuristic tasks?� I do not think so but we have look at things a little differently.

Just because a task is algorithmic does not mean creativity is lost and robots are created.� For patient care, maybe all of the steps leading up to diagnosis are algorithmic but the value added part is heuristic.� This frees up the provider’s mental capacity to focus on the true customer problem and not on the problems getting up to the customer.

Another way of looking at this is that the problem solving part of everybody’s work is heurestic.� If every task is somehow transformed into a single pathway, your staff should still have the autonomy to recognize problems and experiment to fix them.� Helping people understand that their creativity will be focused on trying to improve experiences instead of trying to figure out what to do next or where something is.

Lean management should strive to motivate people as autonomous knowledge workers.� Even if standardized work makes tasks look ripe for the carrot and stick treatment, recognize you are asking staff to be creative and solve problems.

What do you think?

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Presentation Secrets Of Steve Jobs

Vodpod videos no longer available.

more about “The Presentation Secrets Of Steve Jobs“, posted with vodpod

 

Steve Jobs has a reputation for being an outstanding presenter.  This slideshow from Carmine Gallo is inspired from the book of the same name which I have seen a lot of references to lately (RSS readers may need to open post to view). 

What tips do you have about presenting?

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Development Versus Deadline

For Lean improvement workshops, non-customer driven deadlines should be negotiable to ensure time is given for quality development of staff.

Matthew E. May discusses how organizations are so addicted to action sometimes that the deadline drives people to get things out versus get things right.  To me, “Getting things right” does not mean taking no action until something is perfect.  I think it means staff has a solid understanding of how to assess the current state, how to use data to determine where to begin improvements, how to see in gemba, how to communicate to gain consensus about the problem and the countermeasures, how Lean tools can help them, and how the workshop can be a model for their daily work. 

To move forward without that deep understanding poses a big risk for your organization for its long-term Lean growth.

With workshops at a hospital, sometimes dates are set aside before the work has truly begun.  Nurse and provider schedules are a very real constraint to work with.  I think dates should not be set until after the assessment.  This may draw out your lead time to an event, but it will have a better long-term effect on your organization.  The trick is to not have the event so far away from the assessment that momentum is lost (easier said than done).

When deadlines are put above development of staff, a consultant or Lean expert in the area ends up doing the work or telling people what to do.  While you may get the desired results with this method, the problem solving process was not followed.

The best scenario would be to ensure all of the development and understanding happens before the deadline.  Sometimes Lean can be so counterintuitive that people need more time.  One last caveat, I do not define development as “after one single event the staff become experts” since the Lean journey is iterative.

Do you let deadlines rule over staff development?  Do you think one is more important than the other?  What do you do to get both done on time?

My 2009 Hansei: Scarcity inspires creativity and innovation.  How can I help harness that inspiration?

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Lean Consulting Challenges

Being an internal lean consultant at a hospital has some challenges.   In my consulting practice, I find countermeasures vary greatly depending on relationship with client and what stage they are on in their Lean journey.

Below are a couple of challenges to which I am still trying to discover my best approach.  I love what I do and things like this make everyday exciting.

• Pair of hands consultant versus collaborative consultant – A good portion of my clients initially expect the internal consultants to go and do for them.  They want their people involved in an improvement event but claim too busy or too understaffed when resources are needed for assessment, planning, and sustaining.  As a collaborative consultant I try to do as much WITH the client instead of FOR the client so they can be engaged and learn how to do this work themselves in the future.  I really see a lot of people struggling with this collaborative model. 
• Physician culture can be a tough nut to crack – While we have some excellent physician Lean champions, there are still a fair number of doctors that are not fully committed to the journey yet.  Providers are incredibly smart and independent.  They have a lot of goals such as providing excellent patient care, doing research, writing/publishing  papers, and educating Residents/Fellows.  Sometimes the systems-thinking focus and overall patient flow is not a top priority for them.  Some incentive plans make them compete against each other for surgical time so they are less likely to share best practices with each other.  The “what is in it for me” part isn’t always an easy answer if a focus on the patient doesn’t seem to be enough.

Have you experienced either of these?  Do you have a best practice?  Is everything really a case-by-case issue (get to root cause for each individual)?

My 2009 Hansei: Scarcity inspires creativity and innovation.  How can I help harness that inspiration?

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Keeping Lean Japanese

There is a trend towards removing the Japanese language or jargon from Lean transformations in the U.S.  I understand why organizations would want to make lean thinking and the  corresponding tools easier to digest, but I think we should seriously consider keeping it Japanese.

• People get used to new words and phrases better than you might think – Until a few years ago nobody knew what an iPod was.  A cougar used to be a big cat and not a woman who likes younger men.  Jewelry is now commonly called bling.
• There is no standard for Americanized Lean – Some call Gemba “three actuals (actual place, actual process, actual people)”, others brand it as “direct observation”, some refer to it as just “process walk”, and I am sure Gemba goes by other names.  The problem with this is members of your organization can not easily learn Lean from external sources.  Article and book authors tend to use the Japanese terms at least in reference but your staff may miss it if the original word is not shared with them. 
• Lean transformation is a significant change and language should reflect that – A lot of Lean will seem counter-intuitive at first and there is a major shift in thinking that will take place on your journey.  A significant change in the language will help communicate to the culture that things will be different from here on out.  To paraphrase Deming, you are no longer using the language of the old world.

Choosing the language of Lean is a strategic choice for your organization.  It is easy to dismiss the notion of keeping the Japanese out and making easier translations.  Please consider the pro side of keeping the original language.

I am very interested in your comments.

My 2009 Hansei: Scarcity inspires creativity and innovation.  How can I help harness that inspiration?

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