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.
Does your workday frequently feel like mayhem? I have talked with many people who feel like their job is filled with unnecessary chaos. I believe a lot of organizations self-inflict themselves with craziness. There is a way to stop the mayhem!
Overburdening people (and equipment) is a form of waste. Your organization must first identify where people experience this waste. Usually it is very easy to find just by asking who feels they are overwhelmed.
Here are some examples of what you may find (also note that most below do not have a paying customer waiting for the outcome):
Leaders asking for non-standard reports with quick deadlines (usually to sit on their desks for weeks before they look at them)
Constant edits or change of direction to documents because planning is often done afterthe content was created
Support departments get projects dumped on them without ever problem solving around their ability to have capacity to do the work
Somebody’s procrastination or lack of planning becomes another person’s urgent priority
The next step is to acknowledge this kind of mayhem is a problem. This step is difficult because firefighting heroics and the rush of adrenaline from last-minute deadlines becomes “how things are done around here”.
As an outside observer, I usually see little need for subjecting employees to this kind of work condition and believe it lowers engagement. Until teams align that overburdening staff is a problem, it will continue unabated.
The final step is to identify the root causes of the mayhem and eliminate them.
What sort of unnecessary mayhem do you experience in the workplace?
(NOTE: The attached video is only related to this post because of the title and I thought it was a cool rockabilly song!)
“Toyota Under Fire” by Jeffrey Liker and Timothy Ogden is a highly recommended book for leaders, Lean-thinkers, and people interested in media criticism.
I initially thought it would solely be about the recall crisis which NASA has already vindicated the company. The book also details the challenges faced by Toyota during the recession. The authors provide candid information about how the company could have done better and show how they turned the crisis into an opportunity to become stronger.
The final chapter transforms Toyota’s story during the crisis into lessons other organizations can use to help them be prepared for a crisis.
The book helped understand the power of the Toyota Way and reaffirms why they are a company to be admired. There are many great insights into the thinking of the people in the organization. Some of my favorites were about how deeply respect for people is practiced, the examples of how important it is to be close to the problem to be able to improve it, the importance of culture, and how the five why’s were used to accept responsibility of the problem.
For those interested in media criticism, this book provides a lot of data that was distorted or omitted in the news during the recalls. The examples of sensationalized reports with no follow-through once disproven will serve as a reminder to take what we consume from the news with a grain of salt.
One thing I found surprising in the book is that many cited sources were from bloggers and websites. Since the traditional media seemed slanted against Toyota, these other sources appear more neutral.
Liker and Ogden’s book show how Toyota practices the Toyota Way. It is not just about theory and philosophy but a demonstration of how it was recently done. This was an excellent book.
Disclosure: A review copy of this book was provided to me by the publisher.
While cleaning up various packaging after my son’s first birthday, I noticed an interesting pamphlet from toy manufacturer Fisher-Price. They have a “Play Lab” where they observe kids and families using their products to determine how to make them better!
Watching how your customers interact with your products and services will help your organization be more successful. You will be able to better understand their needs to create new things to satisfy them. You will spend time improving what matters because you are able to improve based on what problems you see them experiencing.
Here are a few quotes from the flyer:
…start in our Play Lab, where thousands of children test our toys in a fun, nurturing environment. And our product designers get right down on the floor with them.
Have more than the customer-facing staff observe your customers. Help others see how their work supports your customers. Have leaders gain first-hand knowledge of how your products and services are being experienced.
…Fisher-Price does thousands of in-home tests – so we can really grasp how kids interact with our toys, how toys fit into their lives and how they play.
While simulated environments can tell you a lot, there is even deeper learning when observing in a natural setting.
…we created Mom Panels, informal groups where moms can see our toy development and let us know what works for them and their children, and what doesn’t.
Engaged and loyal customers will tell you what is broken about your system if you just ask. They will also tell you what is valuable to them.
Does your organization have a “Play Lab”? If not, create the opportunity for many different people to be able to watch your customers use your products and services.
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.
“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.
I recently had the opportunity to ask Robert Martichenko and Kevin von Grabe some questions regarding their new book Building a Lean Fulfillment Stream. I have not had a chance to read the book yet but I have flipped through it to come up with my questions. I am excited to read it since I have not done any fulfillment stream projects or outside supplier work yet on my Lean journey.
1. At what point in the Lean journey do you recommend improving the fulfillment stream? Is this more advanced thinking or can be done in parallel in the beginning?
There are a few different approaches that can be taken.
a) You can improve the fulfillment stream in parallel with the other aspects of your Lean Journey. If you take this approach it is important to note that you may be making improvements in the fulfillment stream ahead of being able to fully leverage the improvements.
b) You can improve the fulfillment stream as it becomes a constraint on your Lean Journey. In other words you have a manufacturing strategy and your fulfillment stream is preventing you from taking the next step, you then transfer focus to those constraints.
2. How is the book relevant for service industries such as hospitals?
The section in the workbook regarding SKU classification and rationalization is particularly relevant for service industries. In hospitals SKU complexity is a problem as each practitioner has preferences regarding supplies, tools and equipment. This poses traditional fulfillment stream challenges regarding inventory levels, stocking locations and replenishment methods.
3. The book has a calculation for keeping both buffer stock and safety stock. How do you see these two as different and why have both?
It is important to calculate buffer stock and safety stock separately and to review your inventory levels frequently. Buffer stock protects you from common cause variation in demand. You should routinely have a need to use buffer stock as demand fluctuates. Safety stock protects you from special cause variation in demand. You should rarely have a need to use safety stock and when you do “dip” into safety stock it is critical that you understand the root cause of the variation.
Would you answer any of questions differently?
Full disclosure: The publisher sent me a review copy of the book.
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.
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).
As someone who helps people improve their processes and quality for a living, being a consumer can sometimes drive me batty! I think there will always be a need for the lean principles to be applied (although some companies do not recognize the need). My wife and I recently purchased new windows for our whole house and have had cascading problems since.
The sales person did a quote while we were at work and mailed it to us. To understand what the windows he quoted were, we visited the showroom and the sales person showed us a double-hung window where both the top and bottom opened. We advised we wanted the energy-efficient and gas-filled glass. We pointed out the measurements on the quote weren’t correct so he was going to send someone out again and provide us with a more accurate quote.
The updated quote came and the price was good so we agreed via telephone.
During the day of the first installation I stayed out of the way from the crew. I popped out at one point to see one of the windows that was finished. It was a single-hung window where the top did not open like I ordered!
I called the salesperson who was very rude stating it was on the quote I agreed to. I advised it was not the window my wife and I saw in the showroom. He said that was just a demo of the window brand and we were not clear to him we wanted double-hung. I asked where it said on the quote that it was single hung to alert me as a customer that I might not be getting what I expected. He said next to each measurement is the code “SH” for single hung. I advised him that as the window expert, I would have expected him to explain technical codes to me the consumer and asked why he would not have tried to up-sell me on the more expensive window anyways. We eventually came to agreement to get the correct custom windows installed. This was truly a test of my respect for people principle!
Besides the obvious upset customer (me!), there was a lot of waste for the sales/installation company and the manufacturer:
The installers have to send their crew out twice (you will find out it will be three times in part 2!).
The single-hung custom windows are now scrap cost to the installer and/or manufacturer.
The time the salesperson spent fixing our problem took time away from him to generate new business for the installation company.
Potential counter-measures: 1) Train salespeople to ask customer’s the right kind of questions to ensure their needs are met prior to ordering. 2) Make quotes visual with descriptions with explicit explanations with no code so the customer can understand what they are agreeing to. 3) Don’t blame the customer when problems happen but own the issue.
I will share part 2 next week. Any other wastes or counter-measures you see in this story?
My 2009 Hansei: Scarcity inspires creativity and innovation. How can I help harness that inspiration?