Archive for June, 2011
This is always a tongue-in-cheek warning, but there are times when I warn hospital leaders that they have to be careful when going to the “gemba” (gemba being a Japanese word used in Lean to describe the place where the work is actually done – the front lines, such as the point of patient care).
Lean Thinkers might wonder “what is bad about going to the gemba?” Well, going to the gemba could be a bad idea and could make things worse if leaders exhibit the wrong kind of behaviors.
This old urban legend helps articulate that in a cheeky way:
I’ve often blogged about Dilbert and “dilbert lean” is a fairly common search term, so I thought I’d do my best to compile all of the Lean or Six Sigma related strips that I could find into a single post, providing links to them.
As I’ve been working on my upcoming second book, Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Improvements, I’ve had “kaizen” (or continuous improvement) on the brain even more than usual.
One distinction between kaizen ideas and a traditional “suggestion system” is that, with kaizen, you maintain control of your own idea to see it through (with the help of your supervisor and others). You’re not telling others what they should do, you’re saying what you want to do (I appreciate Norman Bodek for making this distinction very clear over the past few years).
So how did I apply kaizen to my own desk and writing setup?
MP3 File (run time 20:09)
Today’s episode is a discussion with Mrinalini Gadkari, a Senior Lecturer at the Fisher College of Business. Today, we’re talking about the new Master of Business Operational Excellence (MBOE) for Healthcare Program that is starting this fall. We’ll talk about how the program is structured, who the intended students are, and delve a little into the curriculum that includes Lean, Six Sigma, and other improvement methodologies.
Mrinalini Gadkari is a physician trained in India. She practiced in India for three years as a family physician. She came to the US 9 years ago to pursue her passion in Process Improvement in Healthcare.
If you’re an Android platform user, please take a look at the app and let us know what you think.
This app is a collaboration of numerous lean bloggers, with content including:
Thanks to those of you who sent me the link to this Washington Post article called “The Pain of Wrong Site Surgery.” The piece highlights how the patient safety battle has not yet been won and “some researchers and patient safety experts say the problem of wrong-site surgery has not improved and may be getting worse.” A recent Health Affairs study found that medical errors affected one-third of hospital patients.
Why is it so hard to use checklists in the right culture (a “just culture,” perhaps) that makes so-called “never events,” such as wrong-site surgeries never happen? People might say “it’s not rocket science” to follow basic procedural steps.
“I’d argue that this really is rocket science,” said [Dr.] Mark Chassin, a former New York state health commissioner and since 2008 president of the Joint Commission.
But is it?
What’s wrong with Wally’s thought process?
Here is a great video by Masaaki Imai, author of the classic books Kaizen: The Key To Japan’s Competitive Success and Gemba Kaizen: A Commonsense, Low-Cost Approach to Management.
In the video, he emphasizes that kaizen means continuous improvement and he points out that a better definition would be everybody improving, everywhere, and every day.
MP3 File (run time 38:30)
Today’s episode is a chat with Jody Crane, MD, MBA and Chuck Noon, PhD. They are talking about their outstanding book The Definitive Guide to Emergency Department Operational Improvement: Employing Lean Principles with Current ED Best Practices to Create the “No Wait” Department.
Dr. Crane is an Emergency Physician practicing at Mary Washington Hospital in Fredericksburg, Virginia. From 2002 to 2009, he served as the Business Director of his group, Fredericksburg Emergency Medical Alliance. He currently serves as a faculty member in the Institute for Healthcare Improvement and is also faculty at the University of Tennessee’s College of Business.
Dr. Noon is a Professor of the Management Science Program in the Department of Management. He joined the faculty in the fall of 1987 after completing his Ph.D. in Industrial & Operations Engineering from the University of Michigan. He is also a founding member of the UT Physician Executive MBA Program.
For a link to this episode, refer people to www.leanblog.org/120.
For earlier episodes, visit the main Podcast page, wh
I’m a proud graduate of Northwestern University, industrial engineering class of 1995. Our ’95 commencement speaker was the newly installed president of the university… he delivered a pretty dry address and the students were pretty disappointed. That 1995 address was everything that the 2011 commencement address was not – this time delivered by TV’s Stephen Colbert, who studied at Northwestern (and left with an “incomplete”).
In the commencement speech (which you can view on YouTube here, well if your organization doesn’t block YouTube), Colbert tells a lot of jokes, including some inside-Northwestern jokes… but he has an important message in the last 4 minutes or so of the address – about service to others and life.
Last week, at the 2nd annual Lean Healthcare Transformation Summit, I moderated the CEO Panel discussion that featured four excellent Lean leaders: Jim FitzPatrick of Mercy Medical Center (North Iowa), Scott Armstrong (Group Health), Alan Gleghorn (Christie Clinic), and Dr. Gary Kaplan (Virginia Mason).
The CEOs shared a lot of insights, but one theme that came up was the idea, introduced by FitzPatrick, of a leader’s long shadow and how you have to be careful with where it lands.
Dr. Muda sent me an audition tape after his experience at last week’s successful Lean Healthcare Transformation Summit. As we chatted, we both agreed that the Summit was great… but what it lacked was a professional stand up comedian. He reinforced this by pointing out how groan-worthy my “give peas a chance” quip was during the CEO panel (more on that tomorrow). Fair enough.
Dr. Muda would like to be an “opening act” for the 2012 Summit, dates and location TBD. He hopes it is in a city with a good standup comedy scene. Here is his tape:
Today, I’m announcing an evolution of my work life: doing less with the Lean Enterprise Institute, doing more consulting and speaking, and starting to help build an exciting startup company, KaiNexus.
The first 16 years of my career has been an interesting journey: General Motors, Dell, Honeywell and a total of 10 years in the “lean manufacturing” world, with a transition in 2005 to “lean healthcare” consulting and writing. From 2001 to 2004, I had a detour through a lean-focused startup company, Factory Logic, and I’ve always enjoyed the small organization setting and the opportunity to build new things, like the Healthcare Value Network that I’ve helped build over the last two years.
So, please forgive me for writing a blog post about myself. Since I often get asked, usually in a friendly way, “So, um, what exactly do you do?”, this blog post is a chance to talk about that…
Yesterday, we lost a great guru in the process and business improvement worlds, Eliyahu M. Goldratt, who passed away at the age of 64. Goldratt is the author of many books including The Goal: A Process of Ongoing Improvement.
I’m sure this is a thought shared by many readers, but Goldratt, The Goal, and his “Theory of Constraints” were incredibly influential to me and my career.
Goldratt’s consulting firm put out this statement on their website on Saturday about his death:
Goldratt Consulting deeply mourns the loss of our beloved visionary father, chairman, and above of all mentor. Dr. Eliyahu M. Goldratt March 31, 1948 – June 11, 2011 Rest In Peace
I was first exposed to Goldratt’s work when I read The Goal as part of professor Mark Spearman‘s industrial engineering class back in 1994. It sure felt s
I met Newt Gingrich at the Ontario Hospital Association conference in late 2009, as I blogged about here: “Meeting Newt Gingrich, a Lean Champion.”
Yesterday morning, I was told that Newt had given an endorsement of the use of Lean and Six Sigma methods to help reduce waste in government, as reported here: “Newt Gingrich first Six Sigma pledge signer.” Later in the day, news broke that there was a mass exodus of his campaign staffers, all quitting his presidential campaign team: “Gingrich Aides Quit en Masse Over Conflicts.”
Let this be an exercise in not confusing correlation and causation! :-)
We had a great first day at our Lean Healthcare Transformation Summit in Seattle (with lots of tweets from attendees you can follow along with). The Summit concludes with Day 2 today.
One of the plenary presenters was Dr. Michel TÃ©treault, President & CEO of St. Boniface General Hospital in Winnipeg. In his talk, some of the key themes were the dual purpose of using Lean to help create perfect patient care AND a better workplace environment for their staff and employees.
There was an interesting article in the most recent Inc. Magazine called “Domestic Medical Tourism: How one company is saving businesses big bucks on employee medical treatments.”
Much of the talk about “medical tourism” has focused on patients flying halfway around the world to India, Thailand, or other low-cost / high-quality destinations, where hospitals are typically built to American and Western standards. The employers who pay for healthcare benefit from lower costs and employees often get incentives to choose such care, including 5-star accommodations for the patient and even a family member.
But are we missing an opportunity that’s right in front of our faces in the U.S.?
Mark’s note: Today’s guest post is from Dr. Mark Jaben. I first met Mark in person at Cindy Jimmerson’s Lean Healthcare West conference in Montana last year. I’m happy to publish this new guest post to follow up his previous post, inspired by New Zealand.
This is really born out of a recent medical trip to Bolivia, reading Drive by Daniel Pink, my wife’s struggle as curriculum director in a pre K-12 private school and the faculty’s frustration at students’ seeming lack of motivation, and a dinner I had with Ricardo Peyerda, a Bolivian businessman who works with large corporation boards. His main focus is to help these boards think about how they develop relationships. As an emergency physician and in trying to promote Lean concepts and practices in health care, I have struggled with how to help people take the leap from an attraction to Lean ideas to being willing to carve out some time and effort to devote to their use. It seems that, despite their interest, nobody has any time or energy.
In Bolivia, I watched as my 13 year old son, David, and a retired engineer, named Dick, both without any medical experience, gradually become more and more involved in figuring out ways to help our eye surgery go better in our makeshift operating room.