A Great Poster in a Lean Hospital Lab – Asking Why

As a student of Dr. W. Edwards Deming’s books and teachings, I’m not a big fan of slogans and posters in the workplace.

Last week, visting a hospital laboratory to do research for my upcoming book  Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Improvements, I saw the following poster hanging over a metrics display board where team meetings are held:

When they talk about “outliers,” they mean any test result that took longer than their threshold for a given department. Before the start of their Lean journey, the lab could measure the number of test results as a percentage of their daily testing.

Many years into their Lean journey, this is now expressed as an integer – often 0 or maybe just 1 or 2 tests a day that exceed the standards for excellent care. Each individual outlier is discussed by the team (in a timely manner) to understand what the problem was in the system or the process – not laying blame on any individual.

In the spirit of Lean problem solving, they ask “why?” and often pursue a “5 whys” line of thinking (a theme that’s common across Lean Healthcare, Lean Manufacturing, and Lean Startups even).

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After practicing this approach, they came up with the pictured sign. Asking why (a test result took so long) helps patients tomorrow (by reducing or eliminating those causes of delay and poor quality).

The same could be true in a startup – Asking Why Today Helps Customers Tomorrow.

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Mark Graban's passion is creating a better, safer, more cost effective healthcare system for patients and better workplaces for all. Mark is a consultant, author, and speaker in the "Lean healthcare" methodology. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. His most recent project is an book titled Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also the VP of Improvement & Innovation Services for the technology company KaiNexus.

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3 Comments

  1. Patrick Anderson says

    Mark,

    Thanks for bringing this provocative question forward. It gives me new questions to ask.

  2. Rob Worth
    Twitter:
    says

    Mark,

    I would suspect that now they have so few outliers then it is relevant to ask why for each one since I would imagine that they are now special events. When they started the outliers would have been common, so asking why for each one would have been tampering.

    But it begs the question, how do they define their threshold?

    (And to be picky, do you mean “integer” or “single digit”? 1,000,000,000 is an integer.)

    1. Mark Graban
      Twitter:
      says

      Rob – Yes, great point on these outliers now being (likely) due to a special cause, not a common cause.

      The threshold was defined collaboratively with their customers, based on their clinical needs. It’s not an arbitrary number.

      To be picky, 1 is both an integer and a single digit. The number of outliers they have each day tends to be both (including days when it’s zero). The number of outliers can’t be a negative integer, though :-)

      Thanks for the comment.

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