In some “Kaizen Kickoff” coaching that I’ve been doing recently, I’ve been spending time with managers and other leaders as they interact with nurses and other staff members with the goal of finding problems, opportunities for improvement, and ideas.
One question that would normally get asked of busy staff members (who would almost always moving or in front of a computer) was:
“Are you busy?”
The managers were trying to be respectful (if the nurse was on their way to a patient room for something, we don’t want to interfere with the work being done), but the question was getting in the way of the Kaizen process.
Even if the nurse or staff member was NOT right in the middle of something, in a typical healthcare environment, staff want to look busy. If they aren’t busy, there’s the risk that they might be sent home early or that management might consider layoffs.
In every single case, “Are you busy?” was followed with a quick response, “Yes.”
I commented to the managers that nobody was going to volunteer information about not being busy. We needed a better, more engaging (and less frightening question).
This question was, “Can you take a few minutes to talk with us about ideas for improvement?”
We got far more “yes” responses to that question — and a few “Not right now, but in a bit” responses.
In a traditional culture (this is true in manufacturing or healthcare), managers place a very high value on everybody being busy all the time. It’s easy to see somebody who is not working at any given moment.
But, Lean thinkers realize that if everybody is busy all the time, then we have lots of delays and poor patient flow. If everybody in a unit is busy all the time, nobody can respond immediately to a call light.
If the emergency department is always 100% busy all the time, they can’t respond quickly to a trauma or a patient with chest pain.
We don’t expect the fire department to be 100% busy all of the time, do we?
In a Lean culture (which this organization is moving toward with Kaizen and other Lean principles and management methods), managers are more concerned about poor patient flow and the work not flowing well… instead of just being worried about everybody being (or looking) busy.
This is part of the culture change required with Lean and Kaizen. It’s not easy, but it’s important.
Are there other questions that you find are helpful or get in the way??
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 VP of Innovation and Improvement Services for KaiNexus.