I really enjoyed having the chance to be in Cincinnati yesterday to participate in a Lean Healthcare workshop put on by TechSolve, a non-profit consultancy that teaches process improvement methodologies, including Lean, across multiple industries. We had well over 100 healthcare attendees from Ohio, Kentucky, and Indiana in attendance.
My main theme was talking about “Bridging the Gap” – the gap between where we are today and perfection and the gap between today’s healthcare culture and a “lean culture.” I talked about some of the key mindsets of Lean that apply well in healthcare.
The themes I covered were:
Lean is Obsessively Customer (Patient) Focused
Lean is very customer driven. You might ask, what the heck else would healthcare be OTHER than patient focused?
Unfortunately, many healthcare organizations have structure and organized things around the convenience of the organization, the convenience of surgeons, etc. An example of not being patient focused would be a real example of a hospital only performing trauma surgery on Tuesday and Thursday? They’ve eliminated traumas from occurring the other five days of the week? We need to make sure that our improvement efforts are also focused on things that are important to the patient (like waiting times) instead of just focusing on trivial, easy problems.
Silos. Are. Bad.
More important than value stream maps would be having the mindset of looking at end-to-end patient flow and to focus on value and value streams, rather than suboptimizing departmental silos.
No Technology Silver Bullets
Quoting Principle 8 of “The Toyota Way“:
“Use only reliable, thoroughly tested technology that serves your people and processes.”
I shared an example of a hospital lab that had, unfortunately, automated a bad process – saving labor but more than likely increasing turnaround time for the lab (as I’ve seen in other labs). The lab tore out the technology and used creativity instead of capital, creating a “cellular” layout that reduced turnaround times while not requiring a major increase in staffing levels.
Problems are Treasure
As opposed to problems being something that would be hidden or covered up. We have to honestly recognize problems before improvement can occur.
Lean Ends “Command and Control”
We had a good discussion, as part of this section, about standardized work not being coercive in a Lean setting. We shift our leadership style from auditing and policing people to a style of coaching and challenging and mentoring – and asking “why?” instead of writing someone up when they aren’t following a standardized process.
Stop Jumping to Solutions
People generally love jumping to solutions,. It shows that we’re action-oriented… but we often don’t understand the real problem and we don’t understand the root cause. Here, we talked about the discipline of the A3 problem solving process and the PDCA mindset.
Go to Gemba
This is a very common Lean theme – hospital leaders are as prone as anyone to be away from the gemba, due to meetings and email. Before I talked, a Senior VP from a health system talked about his personal transition away from just waiting for reports to going to the gemba. He went from being “90% focused on results, 10% on process” to having a more 50/50 view.
Problem solving, leadership, and kaizen can’t be done effectively from an office or conference room.
You could almost call Lean the “No Tradeoffs System,” as following these principles leads to reductions in errors, waiting time, and cost. Cost is an end result of improving quality and providing better service and reducing waste.
As I shared on Monday, there are many examples of applying Lean to clinical care – improving quality is the way to cost reduction – it’s far more effective than “cost cutting” as a primary focus – and it helps win hearts and minds in healthcare.
Stop Jumping Through Hoops
Instead of fighting the same fires each and every time, it’s time to focus on improving systems and processes – investing time in preventing problems instead of always reacting. And I love this imagery:
And, as Dr. Deming taught us – don’t blame. More than 90% of defects and problems are the result of the system. Instead of being biased toward blaming an individual, we have a bias that it’s likely the system, unless proven otherwise.
I recorded, on this topic, a great podcast with Aubrey Daniels, the co-author of the new book Safe By Accident?, where one of the points is emphasizes is that blaming and punishing individuals doesn’t improve safety – although management might feel good for “doing something.” Look for that podcast 2/17 or so.
Those are the main themes I presented. It’s not an all-encompassing list, I realize. What mindsets would you add? What examples or stories about the mindsets I shared would you add?
Thanks to TechSolve for organizing a fantastic event – we had a very engaged audience today, so thanks.
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.