Before I head out on vacation, here is a reader question that I am sharing for your input.I’m sharing this with permission and I’m obscuring a few details at their request.
Please read and leave a comment below the post. My approval of comments might be a bit slow after Tuesday evening as I start to travel.
I was quoted in two articles that appeared in “Today’s Hospitalist”:
- “Discharging Mr. Wood: Time to get serious about waste” and
- “Standardized work: Improving quality by reducing practice variation.”
The author, David A. Frenz, MD, points out that it’s a “collective delusion” that the U.S. spending so much more on healthcare leads to safer or higher quality care.
My guest for episode #220 is somebody I’ve wanted to interview for a long time, Dr. Robert Wachter, one of the leading voices in the modern patient safety movement. He’s most recently author of a brand-new book The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age. His book was excerpted in this New York Times Op-Ed piece, “Why Health Care Tech Is Still So Bad.”
When we introduce the idea of Lean to healthcare organizations, it’s very common for somebody (often a senior physician) to say something like,
“But we don’t want assembly line medicine.”
I recently saw an article about Avera Medical Group and Sanford Clinic in Sioux Falls, South Dakota: “Health systems learn to be lean.” Avera McKennan Hospital, in Sioux Falls, was featured in the 2nd edition of my book Lean Hospitals.
MP3 File (run time 35:10)
My guest for episode #193 is Mark Jaben, MD, talking about our brains, Lean, and change. Mark has been a guest blogger for me before and it’s great to talk to him today about his research and experiences. In our conversation, Mark talks about “the troublesome features of our brain’s operating system” (such as our “hidden brain”), how the A3 problem solving process fits with the way our brains work, and how to deal with “resistance” to change. Mark has also helped talk to some healthcare organizations about KaiNexus and we both presented at a conference last year.
For a link to this episode, refer people to www.leanblog.org/193. Also check out this “
In complex systems, like healthcare, is it overly simplistic to blame the surgeon? Probably. One could say the hospital system owns responsibility for the overall process and outcomes… but surgeons are often not employed by the health system, which complicates things.
Are we focused on learning and improvement, or blame and punishment?
Here’s a video interview with Dr. Peter Pronovost, author of the book Safe Patients, Smart Hospitals: How One Doctor’s Checklist Can Help Us Change Health Care from the Inside Out, via AARP.
I’ve re-read this article a number of times: “Cancer clinics are turning away thousands of Medicare patients. Blame the sequester.”
It’s a sad situation – the federal government, via Medicare, has cut the reimbursement to cancer clinics for chemotherapy treatment as a result of the across-the-board “sequestration” budget cuts. Root cause here? Lack of leadership in Washington D.C., perhaps, or blame the voters.
What’s sad is that some cancer patients are being TURNED AWAY from the clinics due to the cuts because the doctors say the patients are “unprofitable.”
First, do no harm?
In recent years, there’s been a movement away from having first-year residents work such long grueling hours – 24 hour shifts or longer, multiple days in a row on call, etc. The idea was that fatigued residents were making poor decisions and mistakes, leading to patient harm. It seems reasonable, since who performs really well when tired? And, that includes nurses at the end of a 12-hour shift.
A recent study suggests that error rates have gone UP with the shorter resident shifts… can we really conclude that from the available data?
Here is a short video clip from 2009… Dr. John Toussaint talking about the need to shift away from “White Coat Leadership” to Lean Leadership.
He’s still preaching this message as we try getting more healthcare leaders, physicians or non-physicians, to realize that culture change starts by looking in the mirror.
Click on the image below the video for a large view of John’s comparison between the leadership styles.
Here is a piece that I wrote exclusively for publication on LinkedIn (but you can read it without an account, I believe).
It’s not strictly “Lean” related, but I think it does speak to questions about the changing way customers (patients) will choose value (cost or quality in healthcare). As real quality and cost data becomes available to the public and patients can share their experiences without filters, will these lists go away?
MP3 File (run time 26:38)
My guest for episode #163 is Dr. Gregory R. Johnson, the Chief Medical Officer at Parkview Health in Fort Wayne, Indiana. In this episode, we talk about how Parkview is using Lean to cope with today’s challenging environment, how Dr. Johnson encourages Lean thinking among physicians, and the role of standardization in medicine. Dr. Johnson says Parkview is moving toward “having everyone operating in a Lean way, all 8200 co-workers” instead of just doing “Rapid Improvement Events.”
This episode is produced in partnership with the Healthcare Value Network. Dr. Johnson and I also talk about Parkview’s participation in the Network, including hosting a “gemba visit” by other members.
For a link to this episode, refer people to www.leanblog.org/163.
Learn more about the Healthcare Value Network
MP3 File (run time 29:48)
My guest for podcast #160 is Joseph S. Guarisco, M.D., FAAEM, FACEP. Dr. Guarisco is currently Chairman of the Department of Emergency Medicine and System Chief of Emergency Services for the Ochsner Health System. Dr. Guarisco is a keynote speaker at the upcoming Society for Health Systems conference (which I’ll be attending) and we are both part of the American Academy of Emergency Physicians annual scientific assembly in February (where I’ll be co-presenting with my Healthcare Kaizen co-author Joe Swartz on E.D. process improvement strategies). Here is a Q&A, hosted by SHS, with Dr. Guarisco.
In this episode, we talk about Dr. Guarisco’s process improvement efforts at Oschner and how that was made necessary by Hurricane Katrina and the aftermath, where demand TRIPLED in their E.D. We also chat about standardized work and variation reduction fit in with the practice of medicine and improving E.D patient flow.
For a link to this episode, refer people to www.leanblog.org/160.
As we enter the new year, it’s a great time to reflect back on 2012 – what worked and what didn’t work… what do we plan to do differently in 2013? Those are some of the core questions found on a “strategy A3” as often used in the Lean methodology.
Individuals and organizations often try to find one major improvement – a “home run,” if you will. Someone might say, “I want to lose 50 pounds” or “we need to develop a new product that doubles revenue.” Goals like that might be scary… and for good reason, as described in the new book by Robert Maurer, PhD: “The Spirit of Kaizen: Creating Lasting Excellence One Small Step at a Time.”
There’s one action that can lead to lots of little improvements (and, eventually, to innovation) – the adoption of the “kaizen” mindset.
Recommended Webinar on Monday: Lean in an Academic Medical Setting; U-M Health System Faces Challenges
If you liked my January 2011 podcast with Jack Billi, MD, from the University of Michigan Health System and Medical School, be sure to check out this free webinar on Monday, December 10, delivered by MIT:
I’m sure it will be well worth your time. Click here to register.
Times are tough, however, at U of M – as they are at many hospitals around the world (read about the health system problems in Greece…). From AnnArbor.com on Thursday:
Here is a commentary written by Gary S. Kaplan, MD, the CEO of Virginia Mason Medical Center: “The Lean Approach to Health Care: Safety, Quality, and Cost.”
More than a decade ago, Kaplan and the team at VMMC realized they had to focus “on three things: 1) the safety of patients while in our care; 2) the quality of the care we provided; and 3) the cost of delivering care.”
Their approach for this?
We found the necessary tools in the Toyota Production System (TPS). TPS is often referred to as a “Lean” management method, because it focuses on reducing waste while improving quality. We call our version the Virginia Mason Production System, or VMPS.
Updated 11/8 to include a link to the recording and changing the post to past tense.
Gregory Jacobson, MD, co-founder and CEO of KaiNexus (disclosure: I’m on the management team) gave a free webinar next Tuesday, November 6 at 3 pm EST. The webinar was produced by Gemba Academy, an official partner with KaiNexus.
Greg talked about his own journey – how he was introduced to Kaizen while a resident at Vanderbilt University Medical Center and how his passion for continuous improvement, combined with a method, led to a lot of exciting improvements and what eventually became KaiNexus.