Test Beliefs Against Data

I like this quote because it touches on a couple of other ideas I have read before. One author I like (Joiner) states that all leaders need to treat decisions as experiments.  Lean challenges HiPPOs (Highest Paid Persons Opinion) to use data in decision making instead of through assertiveness or by being charismatic. The quote below is a good reminder to always experiment with theories to be able to show data if the theory is true or not. It also helps me really notice when opinions are made verses asking for objective data to support.

“In a world without data, opinion prevails…Most managerial dictums are hypotheses. A hypothesis by nature is useless unless proven by data…Asserting an opinion as a fact is a lot easier. Pretending that our assuredness reflects objective truth is certainly convenient …we need to test our beliefs against data…Managers must see themselves as experimenters who lead learning, not dictators who impose control.” – Peter Scholtes “The Leader’s Handbook pages 29,33

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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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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.

If you liked this post, then try:

• My Past Book Reviews 
• Fire At Will!
• Book Review: Lean Hospitals

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A C.O.W. Tale

Photo Source: http://www.flickr.com/photos/amosville/3165780788/

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.

If you liked this post, then try:

• More Committed Than Ever
• Martyrs and Hidden Problems

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Lean Related Posts Roundup

Since my work banned access to twitter, it is not as easy to share great Lean related articles.  I will do this on my blog now!

• Failure vs. Mediocrity – Dan Pink has a great thought about the creeping disease of mediocrity.
• How To Scold Like A Kaizen Sensei – Jon Miller explains the heart of scolding, something that surprised me in the Birth Of Lean book.
• Lost In The Land Of Firefighting –  This short video shows how we can easily lose sight when putting out fires.  I think it also shows why gemba walks need to be done instead of those doing the work saying “I already know it because I do it everyday”.
• An Idea Is Not Always Enough – Jamie Flinchbaugh uses an Aesop fable to demonstrate the importance of taking action on an idea instead of just talking about it.
• Of 777s and Heart Rate Monitors – Mark Graban tells a story about a hospital death due to a heart monitor being turned off and illustrating the need for error-proofing.
• Who’s Most Responsible for KPO Development? The KPO! – Mark Hamel encourages KPO offices to have intellectual curiosity to the point of obsession to be able to develop itself.
• Mocking Boards – Mike Wroblewski’s post demonstrates the effects of making problem’s visible.
• What does it take to be a Lean Manager? – Tim McMahon gives some practical advice for what makes a Lean manager.
• Magical Street Graffiti – 35 Breathtaking Illusions!! – Not Lean but the artwork is amazing!

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Lean Times Require Lean Thinking

Vodpod videos no longer available. Jason Yip & Paul Heaton created this outstanding SlideShare presentation “Lean Times Require Lean Thinking” (RSS readers might need to visit improvewithme.com to view).  I love the sketches throughout and really like the cartoon of 3 wastes.  The description of wastes are mostly hospital based which is nice to see.  The slide describing the difference between authority-based vs responsibility-based focus is a great reminder of the culture we are trying to create in Lean enterprises.

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

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more about “Lean Times Require Lean Thinking“, posted with vodpod

Lean Leadership Articles

I really found a lot to reflect on these great articles related to Lean Leadership.  Check them out!

• The 7 Wastes of Lean Leadership – Common Errors in Working With Continuous Improvement Teamsby Jeff Hajek
• Seeing Things for Yourself by Lee Fried
• 12 Leader Standard Work Questions to Ask on the Gemba by Jon Miller
• Toyota leadership model in healthcareby John S. Toussaint, MD (break out your headphones to be able to hear the video’s audio)

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

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Beware Of Integrity Loss

Many organizations are facing difficult times due to the financial crisis.  It is an easy temptation to get things out rather than get things right when the pressure is strong.  The integrity of your Lean journey may be lost if your approach changes drastically.

There are two basic philosophical ways to implement Lean in your enterprise: Coaching towards the solution or coaching towards the method (check out Mark Graban & Jamie Flinchbaugh’s excellent discussion for more on this).  If your approach has been to coach towards the method, think of the repercussions if you begin to coach towards the solution. 

• The “learning organization” goal may be compromised when you do not allow people time to get a deep understanding of the problem
• Change will not feel owned by those doing the work
• Those that coach towards the solution may not have gotten their hands dirty (think of executives who don’t go to Gemba but dictate a solution)

I highly suspect organizations that already coach towards the solution will probably not switch to coaching to the method in a crisis.

This warning is just to ensure you use discernment before choosing to change your methods.  Understand that a temporary change of course can potentially bring you to an undesired destination.

If you liked this post, then try:

• The Cult of Done Manifesto and Lean
• Mediocrity vs Pursuit Of Perfection

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

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Poka-yoke Health Care

I recommend a great resource for you to check out: Mistake-Proofing the Design of Health Care Processes from Agency for Healthcare Research and Quality. 

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Value Added – Happiness as Your Business Model

Vodpod videos no longer available.

Tara Hunt from Citizen Agencycreated this brilliant slideshow (RSS readers will need to open this article to view).  This really helps me get a picture of the mind of the customer.  Once we understand their minds, then we can ensure our process steps are creating value.

Slide 124 inspires me from a Lean perspective.  While there are some necessary non-value-added steps that have to be taken (especially in healthcare), look for the possibility to make it value added by giving the customer tools to personalize their experience.

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more about “Happiness as Your Business Model“, posted with vodpod

 

 

 

Tim Ferriss – Profitability & Pareto

Tim Ferriss wrote a great piece called The Margin Manifesto: 11 Tenets for Reaching (or Doubling) Profitability in 3 Months.  His suggestion to use the Pareto 80/20 rule for “Hyperactivity vs Productivity” is right on the money.  His comment about all the time spent firefighting makes me reflect on how lean can help remove the waste and variability that creates the fires.

If you liked this post, then try:

• Effective vs Efficient
• Book Comments
• A Dim Outlook

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Last Week’s Event

The team did an outstanding job last week.  A couple of their targets were to increase on-time starts for lab draws in the cancer clinic and create visual systems to see demand.  They met their targets and really caught the spirit of improvement.

One factor that made the workshop a success was having a patient’s parent involved.  The parent was able to come in and explain their experience and perspective.  Their participation created a lot of value for the team.

This event demonstrated the power of going to gemba.  A team-member commented how it always felt chaotic but could never pinpoint where the chaos was coming from until they observed and broke it up into pieces.

Last but now least, I saw how important data is for an event.  I am a data consultant so this was impactful to me.  Data in other events seemed to stop after establishing the current state of a process.  This team was looking at cycle times and percentage scheduled during time of day all week.  This helped them figure out specifically where to make improvement adjustments.

I had a great time and learned a ton!

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Value Stream Assignment

I am excited to be assigned to a value stream.  I have been learning our standard work as internal consultants at my hospital for the last few months and have just received my value stream assignment. 

I will now be working primarily in our Heart Center as a Lean Data Consultant.  The Heart Center team is full of great people and I am honored to be a part of the improvements that will take place.

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Effective vs Efficient

I think Lean practitioners should replace the word EFFICIENT with EFFECTIVE.

This thought has been ruminating in my mind since reading Timothy Ferriss “The 4-Hour Workweek“.  The book explains how you do not want to spend your time being efficient on tasks that are not effective.  It reminds me that we do not want to be efficient with non-value-added tasks, we want to remove those wastes. 

Lean is sometimes lumped into the category of “efficient changes” but it really goes deeper than that.  Lean is all about optimizing effectiveness.  Procedures will become efficient as a result of the attention to being more effective.  By stating our purpose to increase effectiveness, the efficiencies will follow.  Replacing a simple word has a deep impact.

I recommend Kevin Meyer’s post from Evolving Excellence about how this book can apply to Lean thinking: Productivity: Eliminate Before You Optimize.

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Seyi Oyesola: Rich hospital, poor hospital

This TED video made me reflect on the how much Lean is needed in hospitals around the world.  When we consider the challenges in our US hospitals, think about some of the images you see in the Nigerian hospital.

Vodpod videos no longer available.

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more about “TED | Talks | Seyi Oyesola: Rich hosp…“, posted with vodpod