Today and tomorrow, I’m attending the Lean Startup conference in San Francisco (the event produced by Eric Ries, the author of The Lean Startup). I’ll be learning a lot of ideas, by attending presentations and networking, that will be applicable over at KaiNexus. I’ll be taking notes in this open Google Doc.
I was accepted to give a talk about the Lean principles of continuous improvement and respect for people, as experienced in healthcare (3:40 pm in the Fairmont Hotel Crystal Room, if you’re here). But, I’m also giving the talk because I hope to help spread the message that Lean, in factories, hospitals, or startups, is not just a matter of tools and techniques – it’s also a culture.
I’ve built my presentation around my experience serving as a consultant to the MRI area of a children’s hospital. I was coaching them on a Lean project that aimed to reduce the quoted outpatient MRI waiting times for patients who needed sedation (and, being children, this was most of them) from the baseline of 12 weeks. This 12 week waiting time was not good for the patients and families – and it wasn’t good for the hospital since the waiting time was half that at the competing children’s hospital across town.
I’ll tell the story of Lara, a nurse and team member on our project, who shared her frustrations about her previous attempts at process improvement being effectively squashed by the prevailing culture of the organization that thought front-line medical staff should just do their jobs and not worry about improvement.
I’ll talk about how they, within a year, reduced waiting times from 12 weeks to two weeks… and how they’ve sustained that performance over the five years since the project. They had the major project that looked at systemic fixes across the “value stream” – meaning the entire process from the initial scheduling request through all of the steps of the outpatient visit to the hospital to get the MRI done.
The team also used a daily Kaizen process to identify and fix dozens of smaller improvements that improved the patient experience, made work less frustrating for staff, and reduced quality problems and safety risks. Some of these examples were shared in our book Healthcare Kaizen, like this one, pictured below:
I recently checked in with the department director and was VERY happy to hear that they have sustained the two-week waiting time even here in 2013, almost six years since the initial project started. One thing they put in place was a process for charting and tracking the patient waiting times on an ongoing basis. The director said that the one time that waiting times creeped up to about four weeks, they detected that from their performance measures (that were instituted in the initial project) and they engaged staff members to figure out how to get that waiting time back down. They’ve also increased their MRI volume by 26% since 2008 without adding another MRI or adding more people.
It’s a great story and I was glad to play a small role in it. The power of Lean is that it’s a culture of both:
- continuous improvement
- respect for people
You can’t have one without the other. We are driven to continuously improve because we respect our patients (and their families) and we respect our employees, physicians, and other stakeholders who want to do their best. We get sustainable continuous improvement by respecting everybody involved. Engaging people in the Kaizen process is one way we practically demonstrate “respect for people” in the workplace.
Before Toyota, there was a separation between “doing work” and “improving work.” Improving work was the responsibility of “experts” like engineers, consultants, and managers. Toyota helped create a new workplace responsibility that everybody has two jobs, as illustrated below:
Can we create the same environment in startup companies? Can we maintain that culture as a startup becomes a larger, more established company?
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