I received an email from a reader that I’m sharing and commenting on with permission.
“Dear Mark: I am a lean coordinator for a manufacturing company and it was a real shock to see some of the waste during a recent hospital visit to see a dying family member. He was 92 years old and had a DNR in place. He was having trouble breathing and a Rapid Response Team was called into place. Now, again, he was dying, so my first thought was that this seemed unnecessary. But, as they were preparing to treat them, the waste and confusion was obvious.”
At two different points, nurses (I think they were nurses) were opening their cart (which seemed like a good point-of-use inventory method) and they couldn’t find what was supposed to be in there. Two different times, they had to leave the room to go find some tubing and to find some pads.
What is the point of the cart and the team if they don’t have what they need when they need it???
Thanks for writing about lean healthcare. It was always just a curiosity, but last week’s experience made this very concrete and real to me and our family.”
That sounds like an unfortunate situation, one that might have caused stress for the family and the hospital caregivers. Ideally, it should be viewed as a “nugget” – an opportunity for improvement so that came problem doesn’t occur again. What is the root cause of why the cart wasn’t properly / fully stocked?
It seems like it shouldn’t be that hard to keep a cart properly stocked so that it’s ready for use. If I were in the situation, I wouldn’t go looking for blame – I’d look for process (or the lack thereof) as I’ve seen in so many healthcare settings.
- Why wasn’t the cart fully stocked? Keep asking why and address actionable causes and root causes (don’t look to blame an individual).
- Is there a formal process or standardized work for how the cart gets restocked after items are used?
- Note: Don’t tell me “who” is supposed to restock it (a specific name), tell me the process that ensures this happens regardless of which individual is working that day.
- How do we know if the process is being followed? Is there a management checklist or verification to ensure that the cart has been restocked?
- Are spot checks done at the start of the day or shift to ensure that the cart is ready to go when needed?
- When there is a problem (such as missing tubes), what is the follow up other than running to go get the missing item.
- Are we moving from only fire-fighting to also focusing on prevention and process improvement after the “fire” is out?
The questions I’ll pose for you, the readers:
- If you have direct ongoing experience working with RRT carts, what process do you use to ensure 100% availability of items?
- If you’re generally a Lean person, what others questions am I missing?
About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as the new Executive Guide to Healthcare Kaizen. Mark is also the Chief Improvement Officer for the technology company KaiNexus.