Archive for September, 2011
As I’ve talked to and worked with hospitals and their leaders about Kaizen, or continuous improvement, the concepts, mindsets, and methods make sense to people. They understand how Kaizen is different than the outdated and ineffective suggestion box method.
A common response is “Mark, that makes sense… but we just don’t have time….”
I’d like to make the case that “lack of time” should not be an excuse that shuts down the possibility for Kaizen, but rather it’s the first problem statement to which we can apply our Kaizen thinking…
The 2nd revised edition of my book Lean Hospitals can be pre-ordered from Productivity Press for a 25% discount. The book should be available in early November. Click here for more details on the discount offer.
Karen and I both wondered if this modification to the grates was proactive or in response to an incident or injury?
Lately, there have been many stories in the news about supermarkets ripping out self-service checkout scanner, stories like this: “Supermarkets start bagging self-serve checkouts.” 10 years ago, the supermarkets saw this technology as a clear cost savings – reducing labor costs. But, some costs increased, including “intentional and accidental theft, including misidentifying produce and baked goods as less-expensive varieties,” not to mention customers being slowed down or confused. Robots (like these scanners) can’t be a smiling face… but I don’t believe, for a minute, that the supermarkets are ripping the scanners out because they want to provide better customer service. I would guess that the cost savings didn’t really materialize.
So what are the lessons and parallels for hospitals?
As I’m reading the new book by Eric Ries, The Lean Startup: How Today’s Entrepreneurs Use Continuous Innovation to Create Radically Successful Businesses, I’m reading it with an eye for concepts that can be applied more broadly than traditional startup settings.
There’s a segment on page 21 (readable via Google Books) that talks about driving a car versus launching a rocket ship. Ries writes that driving a car includes a feedback loop between the driver and the steering wheel that’s “so automatic that we often don’t think about it.”
Is starting a planning a Lean program for your organization more like driving a car or launching a rocket?
I volunteered to give a presentation last Friday for the North Texas Society for Healthcare Risk Management, where I was able to debut some new material from our upcoming book, Healthcare Kaizen. These continuous improvement methods are a great way for front-line staff and leaders to both identify risks, allowing them to take action to prevent those problems from occurring.
I asked the audience a question that was answered by show of hands. I think we had about 200 people in the room and maybe half were from healthcare (the rest were attorneys). I asked how many had some sort of formal idea or suggestion program for front-line staff.
Some people might find this graphic inflammatory, if they are feeling defensive about the state of healthcare and if they feel like they are being blamed personally.
The data in this infographic represents the current state, to the best of the ability of researchers to estimate the impact of poor healthcare quality. To improve, we have to recognize the problem.
The title says, “Why US Hospitals Aren’t Nearly as Safe as You Think” but there’s nothing here pointing the finger of blame at the hardworking, intelligent, caring, well-educated healthcare professions. It’s the processes and systems that are broken, not the people. The people can fix this.
I’ve been reading the book Obliquity: Why Our Goals Are Best Achieved Indirectly and, while it’s really interesting, I tend to agree with some of the reviews that said there was a lot of repetition of the book’s core concept – that the best way to achieve something is to take the indirect path.
The main point of the book is pretty well covered in this article on obliquity by the book’s author, John Kay.
It’s a project that my co-author, Joe Swartz, and I have been working on all year… the manuscript is finally complete and sent (as a big batch!) to our publisher. I’m talking about our upcoming book, “Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements.” It will likely be out in April 2012, but you can actually pre-order it via Amazon.com. Sign up for email updates and be one of the first to get the free PDF preview of Chapter 1.
Joe and I will both be blogging a lot about Kaizen and continuous improvement for healthcare over the next six months and beyond. I’ll share a little more about the book here in this post.
This is the first Lean article or case study I recall seeing about a German hospital: “JACR: Lean Six Sigma increases MRI productivity.” The article clearly articulates the benefits for patients, staff, and the hospital – University Hospital Giessen and Marburg.
The hospital, using “Lean Six Sigma” was able to “double the percentage of patients receiving an MRI scan within 24 hours, thereby increasing scanner productivity by one-third and probably saving hundreds of thousands of dollars a year.”
It’s been nice to see the “lean design” approach taking hold in healthcare the past few years. I think the first book on the subject was a “manifesto” by an architect, David Chambers: Efficient Healthcare – Overcoming Broken Paradigms
My good friend Naida Grunden has a new book out next year called Lean-Led Hospital Design: Creating the Efficient Hospital of the Future and I was able to contribute an essay for the last part of the book. There is also come material on the work done by Seattle Children’s Hospital in their book Leading the Lean Healthcare Journey: Driving Culture Change to Increase Value.
Mike Wroblewski, who you might know from his blog “Got Boondoggle?,” is now with the Kaizen Institute and they have posted an introductory lean design, or “3P” video that’s part of their Gemba Academy subscription series. Mike provides a nice introduction:
Thanks to Jamie Flinchbaugh for sending this funny video my way. It’s the comedian Louis C.K. in his show “Louie” (or maybe it’s from the earlier “Lucky Louie“). It’s a clip where, after an initial question, his young daughter does nothing but ask “why” maybe a dozen times.
Update: I edited the post title to add “Or Does He?” See the CEO’s comment below, suggesting that the TV report gave the wrong impression and that he wasn’t really “undercover” in a sneaky way like the CBS TV show. See also the text from a memo where he announced this program to staff. My apologies to Mr. Musyj for wrongly concluding that he had been shadowing staff as anybody other than the CEO.
The Canadian CBC News had a story (with video) about David Musyj, the CEO of Windsor Regional Hospital called “Hospital CEO goes undercover.”
My initial reaction, as I tweeted it was this:
“Dear hospital CEOs, if you are going to the gemba (and you should), don’t do the corny undercover thing. Be real, be present. Help. Lead.”
The whole idea of the CBS-style “Undercover Boss” approach is deceitful and nowhere near as effective as real “gemba leadership,” as practiced by CEOs like Dr. Gary Kaplan at Virginia Mason Medical Center and Dr. Dean Gruner at ThedaCare. Kaplan and Gruner don’t need to go undercover, nor do I think they would want to!
As I’m working hard this week to finish, with my co-author Joe Swartz, the manuscript for our upcoming book “Healthcare Kaizen,” I’m not taking much time to blog.
Congrats to Eric Ries as his book The Lean Startup: How Today’s Entrepreneurs Use Continuous Innovation to Create Radically Successful Businesses officially goes on sale today. I will post a formal review once I have read the entire book (disclosure: I received a free copy from the publisher).
Eric was nice enough to let me read parts of his manuscript before publication to give some feedback and to contribute a few healthcare examples of “batching” that he incorporated into the book.
The long history of Industrial Engineers helping in healthcare goes back 100 years to one of the “fathers of Industrial Engineering,” Frank Gilbreth — and his wife, Lillian! It was Gilbreth who noticed that surgeons spent more time searching for instruments than they spent working on the patient. Gilbreth suggested a “surgical caddy” who would find instruments and hand them to the surgeon.
Today, IEs often take more of a coaching and teaching role, rather than being the expert with the ideas, but the core I.E. principles live on. Credit goes to Todd Schneider of Ohio Health for compiling this list and posting it on the Healthcare Management Engineers Yahoo Group.
A guest post from Steven J. Spear on this solemn day. You can also read it here.
Ten years ago, I watched on television as a plane- stolen from the city in which I live-slammed into buildings in the city that is my hometown. I later learned that among the thousands killed were former colleagues, a neighbor, and a high school classmate. We all had such terrible experiences.
Today, 9/11/11, we should mourn-we have to mourn-those who perished.
But we should also remember, Bin Laden lost this contest. Not just on the day that Navy Seals shot him, but on 9/11/01 when he was likely most sure that he had won.