I’m always happy to see success stories where healthcare organizations solve problems that matter through Lean concepts, practices, and principles. Today, I’m blogging about two articles I saw about this recently.
Today's podcast is presented with a heavy heart, after the recent passing of my friend Dr. Michel Téatrault, the CEO of St. Boniface General Hospital and a great Lean leader. He was a friend to many in the Healthcare Value Network and the broader Lean healthcare community. As I was remembering Michel, it occurred to me
Today, I’m sharing a 10-minute video that was shared by the Five Hills Health Region within the Saskatchewan health system. In the video, Heather, the director of women’s health unit and pediatrics, describes their kanban system for managing supplies and materials. They started in November 2013 with this approach.
I was thankful to find this CBC Radio news story / podcast from the program “White Coat Black Art,” hosted by Dr. Brian Goldman:
It’s just under 30 minutes long and I think it’s a “must listen.” You can also get this through iTunes and your iOS device.
I was recently interviewed by one of the reporters who put together this web article in Canada:
The article highlights Lean success stories and it also raises some interesting challenges and data that question the approach.
There have been plenty of headlines and updates since I first blogged about the controversy over Lean healthcare in the Canadian province of Saskatchewan (see my previous posts here).
From my outside perspective, there are some good things happening. I admire their adoption of a “patient safety alert system” and a blame-free culture (see Saskatoon Health Region CEO Maura Davies’ comment about this on a recent post of mine).
In 2009, I wrote about a nurses’ union in New Brunswick that supported Lean because they realized this methodology could help reduce waiting times and improve working conditions. It’s win/win.
Yet, as part of the recent politicized Lean healthcare brew-ha-ha in Saskatchewan (read more here), the Saskatchewan Union of Nurses (SUN) has been critical of the provinces’ efforts — with what I think are some valid questions, mixed with a few misunderstandings about Lean. So, I’ll address them here.
Since the healthcare improvement work I do is apolitical and non-partisan, I’m generally not one to butt into the political affairs of Canada or other countries. But, when I hear complaints about Lean or when it’s being called a “scam” and a “cult” by some in Saskatchewan (read here), my ears perked up and I started talking with some folks up there. My goal isn’t to blindly defend Lean, but to first understand, but also trying to clarify myths or misunderstandings where I can.
I’ve had some contentious discussions (a union president who arrogantly replied, “No, I’m good” when I offered to send links to medical journal articles about Lean), but also some lovely chats via Twitter and email. Yesterday, I had a long and interesting phone call with Murray Mandryk, a political columnist for the Regina Leader-Post. He apologized repeatedly (as polite Canadians do) for “dragging me into” this political fight of theirs. I told him that it was, if anything, my fault for diving in.
The start of the article:
After some supporters of the Saskatchewan Lean healthcare efforts reached out to me, I’ve been trying to follow everything that’s being said and written – which is hard to do (just try a Google news search). There are many facets to this story, some of which are discussed well by John Shook and Bill Waddell in their blog posts.
Somebody from Saskatchewan complained to me via email that “Lean’s gotten political.” Hmm… government-run healthcare system with elected politicians (and elected union officials to boot), it’s always political. The rooster crows when the sun comes up, the politician gets political. No surprise.
It’s easy for an organization to say they are “doing Lean” or they have “started a Lean transformation.” They might hire a consultant or put out a press release… or maybe there’s an optimistic (but premature) news article about how the hospital or health system is going to turn around with Lean.
The problem is the culture doesn’t change overnight. Leaders have years or decades of old habits (bad habits) that run counter to Lean thinking. They might be (might!) be trying to change, but people will still fall back into old habits, especially when under pressure.
To close out the year 2013, I once again need to close some browser tabs that are full of things that I was maybe going to write about, but don’t merit a full post. So, the latest in my occasional “What I’m Reading” series:
New York State Hospital Data Exposes Big Markups, and Odd Bargains (NY Times): The state of New York has made data available that shows the gap between what it “costs” a hospital to provide care and the price that’s actually charged to the payer (and the inconsistencies across the state). I’m not so certain most hospitals have cost accounting methods that really create an accurate view of what the cost (direct cost and overhead) of a certain procedure is for a particular patient. This is hard to do (allocating overhead). I think transparency can only help, but hospitals lamely argue that releasing such data only “confuses” people.
Last week, while in Canada, I saw this article in the Globe & Mail: “The power of the startup mindset.”
I was surprised that the word “Lean” didn’t appear in the headline (there was physical space for it in the print edition). It was basically an article about the “Lean Startup” methodology, but it didn’t mention Lean and it didn’t cite Eric Ries and his book The Lean Startup: How Today’s Entrepreneurs Use Continuous Innovation to Create Radically Successful Businesses.
Last week, I was a guest of NorQuest College to give a talk on Lean management and Lean healthcare as the inaugural participant in their Lean Speaker series (my friend Paul Akers will be there in April). It was a nice opportunity to talk to an audience that included people from healthcare, manufacturing, and service sectors.
Thanks to the organizing sponsor Protegra and other sponsors, including my friends at LeanKit, for having me give a keynote talk about the Software Development and Evolution Conference (SDEC) 2013 Conference in Winnipeg yesterday (Storify summary here).
I always enjoy being around a group of developers (it dredges up memories of my childhood coding on a TI 99/4A computer with a cassette tape storage drive), especially when they are talking about new ways of managing and trying to create a better workplace.
I asked the audience, tongue in cheek, at the start if I was at the wrong conference for two reasons — 1) I was talking about healthcare and 2) I’m an American… but I think there was agreement that the general Lean management principles are applicable across our different domains.
MP3 File (run time 48:40)
My guests for episode #185 are Karen Dunn Skinner and David Skinner and our topic, for the first time on the Podcast, is Lean in law firms and the legal profession. David and Karen are husband and wife, attorneys, from Quebec, and consultants for their firm Gimbal. I had a chance to meet up with them in Montreal earlier this year, after connecting via social media, and they’re a delight to talk to – in person and in our podcast.
I think there are a lot of fascinating parallels between Lean in healthcare and Lean in law. There are opportunities to focus on payment for value instead of activity, big opportunities to reduce waste and errors, and to make sure people are doing the right work for their job level. “The way it’s always been” seems very powerful in both professions and the “but we don’t make cars” objection can be powerful.
In the episode, we discuss topics including:
- How do Lean methods apply in a Law firm?
- What are some benefits to the clients and the firm itself?
- How do you get past the “we don
“Approximately 8 to 10% of the individuals who walk through our doors are being hurt by us,” says David Musyj, CEO of Windsor Regional Hospital. That’s one of the first things you hear in this CBC program “Rate My Hospital,” which aired earlier this month in Canada. See also this page on the investigative report.
The patient safety challenges are pretty universal across modern Western countries. This isn’t just a Canada problem. You see similar estimates of patient harm in Canada, the U.S., England, Germany, the Netherlands, etc.
I’ve got a number of upcoming events where I’ll be speaking or attending. You’re welcome attend, depending on where you live or the size of your travel budget. Pardon my batching, but I’m going to put them all in this one post. I hope to see you at one of these events. I’ll also be volunteering at the AME Southwest Region Conference here in San Antonio next month.
Denver – April 11 & 12
I am running a public registration workshop the afternoon of April 11 on “Healthcare Kaizen” – space is still available. I am also helping a friend by being on a Lean Healthcare panel the morning of April 12 at this CHSM event. The panel also includes Dr. David Munch (a podcast guest of mine) and Dr. Arthur Gonzalez, the CEO of Denver Health. Register for my workshop (with a 15% discount) or the CHSM event.
Kevin, from BC, shared this video with me about Lean healthcare. It’s only 2.5 minutes long and it has a fun visual style.
I’ll give it +1 for focusing on improving being driven by the people who do the work. +1 for saying they don’t need a radical system overhaul, just lots of incremental improvements. My only constructive criticism is that the video seems to focus mainly on efficiency and not directly on quality and safety. Although efficiency can lead to better care, a form of quality, it’s unfortunate to leave the impression that efficiency is the sole focus. Still, it’s a fun short video.