This article caught my eye recently:
Skip the Fancy Towels, and Hire More Nurses
(via the NY Times)
I am still trying to learn more, but they will sell the book or, if you already own the book, you can just buy a quiz (that can be mailed to you or delivered online). One nurse I knew was excited because “21.5 contact hours for 30 bucks is a steal!”
In my time working with hospitals, I’ve always been very sympathetic to front-line nurses (and other staff). They are far too often overburdened and undersupported. Work is often more difficult than it needs to be — too much hassle and not enough time with patients. Nurses are forced to jump through hoops, fighting through bad systems, yet they too often get blamed when things go wrong.
It’s really easy to make statements like “patient safety is our top priority.” That same statement can be applied to hospital staff, as well.
Or, it should.
Happy June, everybody! Summer is here. We’ve actually had a delightfully long spring here in San Antonio, which means the temperature hasn’t really been above 90 yet, which counts as cool (and comfortable for us).
I saw this video last night on Paul Levy’s blog and it’s important enough that I want to share it here with a few additional thoughts.
In the Lean methodology, our mindset is that we respect people as individuals, respecting their human nature, and this means we appreciate that we are fallible and make mistakes. Therefore, we don’t blame and punish individuals for things that are systemic problems. There is a high degree of overlap here with “Just Culture” and the modern patient safety movement.
What happened? One nurse misread a patient’s glucometer, think
Thanks to my friends at the Lean Enterprise Institute for hosting a new article of mine on their Lean Post blog.
What is that question? Click to find out.
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.
I recently saw this headline in the London Evening Standard: “Nurses struggle to ‘get the job done’ due to staff shortages and lack of time on 12 hour shifts.” The article starts with jumping to solutions (needing/wanting more staff), but the problem statement is what we should focus on – and it’s an important one:
…almost nine in 10 nurses said that at least one “necessary activity” was not done on their last shift due to lack of time – despite the average shift lasting for 12.8 hours.
I’ve been to Saskatoon, Saskatchewan before — in February. It was a very cold, snowy place, to say the least! But, there are many warm, caring people who are using Lean management to improve the hospital working environment and patient care.
The CBC news had a nice story (with video): Simple hospital innovation saves time, money.
Here is an article from HealthLeaders Media about the Transforming Care at the Bedside program: “Rural Oregon Hospitals Implement Frontline Caregiver Program.” TCAB is a program that’s similar to the UK NHS program called Releasing Time to Care where nurses are taught how to analyze and improve their own work.
Eight hospitals in Oregon are implementing this programmatic approach to Lean-based improvement, engaging nurses and front-line staff. Similar to the approaches in our upcoming book Healthcare Kaizen, “Although [TCAB] aims to improve patient care, it also helps increase nursing satisfaction and a feeling of ownership among staff.”
Also from the article:
Mid-Columbia’s nursing staff launched the program by brainstorming ideas for process improvement, then voting on and prioritizing the best ideas. Since implementing the program in July, the staff has focused on patient days without falls, created an information board in the breakroom highlighting current pressure ulcers, initiated bedside handoffs during shift changes, and used lean methodology to reorgani
Her most recent video features video from her visit to Boeing and their 737 assembly factory. In the brief visit, we can see a few Lean practices in action, or at least alluded to.
Mark’s note: Today’s guest post is from Dr. Mark Jaben, an American doctor who worked in New Zealand, leading to this blog post. I have talked with Mark about Lean quite a bit over the past few years and we were able to cross paths at Cindy Jimmerson’s Lean Healthcare West conference in Montana last year.
In 2008 to 2009, I worked in New Zealand as an emergency physician and helped implement Lean concepts and practices at my hospital. During that time, we even received a visit from the then new Health Minister, Tony Ryall, who was interested to see what we had done. We were quite excited about the 6 hour rule, which mandated that the disposition of all ED patients should be achieved within six hours of arrival. In our small hospital, where we were already beating the 6 hour rule by a wide margin, it meant we could completely shut down at lunch and tea and still easily get our work done! Of course, we never did this, but it does speak heaps (kiwi speak for ‘a lot’) about performance measurements and incentives, a topic for another day.
“Use only reliable, thoroughly tested technology that serves your people and processes.”
Too many organizations, across multiple industries, think that software, robotics, or other forms of technology will be a “silver bullet” or what some call a “siren song.” I’m not anti-technology – I love gadgets and new technology in my personal life. But I think organizations and leaders are wise to follow the Toyota Way example of not using technology for technology’s sake. For example, too many hospitals invest millions in automation (including in pharmacies and labs, only to see things not improve) and Lean provides an alternative.
In this post, I’ll cover topics including GM and tweeting cars, technology approaches to preventing texting-and-driving, and a hospital that is using video cameras as a high-tech workaround to the problem of nurses not having enough time at the bedside.
I found this lengthy series of articles from the Las Vegas Sun, published under the heading of “Do No Harm: Hospital Care in Las Vegas.” The series serves as a good introduction to those who are new to healthcare and the types of systemic challenges that the industry faces. The stories in the series are perhaps frustratingly familiar to those who have been working in this world.
Here is a new reader question from Steve Palmreuter in Michigan. He raises a topic that I’ve been thinking about lately, so I’m happy to share it with you (with his permission). You might remember Steve as I blogged about a news story in 2009 that highlighted his shift from manufacturing to healthcare and we’ve communicated a number of times and I actually met him when I spoke at a Michigan Lean Consortium event a few months back.
His email begins:
We have begun experimenting with a concept we borrowed from manufacturing that we’re calling the “facilitator” role. I’ve heard it called many different things in manufacturing; team leader, line leader, zone leader, facilitator, etc. I’m sure you’re quite familiar with the concept.
Short post today, but a simple message, I think. One of the best lessons I’ve learned about Lean management is about the need to ask “why?” Don’t assume, don’t blame – ask why.
It’s a very common situation in a hospital to find hoarders everywhere. Be very careful when you enunciate that word, “hoarders,” or you’ll get in trouble…
There’s a long-standing argument that I’ve been dragged into with a group that calls itself “new systems thinkers.” They loudly criticize Lean as being altogether awful (with the alternative, predictably, being their services). One of them wrote a blog post about why nurses should reject lean – you can likely find it via this Google search).
I agrees strongly that sometimes Lean is “done badly” — these are instances of what Bob Emiliani calls “fake lean” and what I’ve dubbed “L.A.M.E.” This anti-Lean crowd says the existence of anything that’s done badly in a so-called “Lean implementation” proves that Lean itself is inherently bad. I think that’s hogwash and this post will explain why.