I recently saw a tweet that referenced a May 2014 that was sent to President Obama and his administration: “Report to the President – Better HealthCare and Lower Costs: Accelerating Improvement Through Systems Engineering.”
Today is the first day of the 5th annual Lean Healthcare Transformation Summit. Follow along on Twitter with hashtag #HCSummit14 to see my tweets and thoughts from others. I will be adding updates to this post during the day, as well. These are not meant to be complete notes or a transcript… but quotable and interesting thoughts or comments from each talk.
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).
Look at the System, Not the Individuals
I’ve been wanting to blog about the “VA Scandal,” but have avoided it because
- it is somewhat politicized (as tends to happen),
- the allegations and story are moving quickly, and
- the whole thing just makes me sad, so I stop writing.
Building on Monday’s post… when the news first broke about scandals at the VA (the Veterans Health Administration), a lot of the focus was on “secret waiting lists” and individuals in Phoenix “gaming the system” (or fudging the numbers):
I sometimes torture myself by watching webinars given about “Lean Sigma.” I hear a lot of claptrap about Lean… things that are just demonstrably wrong. These aren’t differences of opinion. These are statements that are factually incorrect and can be proven as such.
If you ever hear somebody say some variation of this phrase:
“Lean is all about efficiency”
“Lean is only about increasing speed and reducing cost”
Then please just stop the video or run, don’t walk, out of the room via the nearest exit, to avoid being further misinformed by the speaker.
Following up on yesterday’s post that talked about “the old GM” putting cost ahead of quality, I sometimes I get flashbacks to my days working for General Motors.
I’ve been in healthcare for 8.5 years now, but at the start of my career, I was an entry-level industrial engineer at the GM Powertrain Livonia Engine plant from June 1995 to May 1997. This plant was in my hometown, Livonia, Michigan and was located exactly 1.3 miles from the house where I grew up. The factory opened in 1971, two years before I was born. The factory closed in 2010 due to the GM bankruptcy and sits empty today as part of the “rust belt” (here is a picture I took fairly recent of the plant and the old sign that used to say GM Powertrain):
Please indulge me with this story that I’m going to tell. I often think about this story, usually when hearing somebody talk about a situation where they are not being allowed to make quality the first priority in their workplace. I recently cringed when I heard GM CEO Mary Barra remind employees that the customer comes first. In my experience, most of the front-line employees knew this – it was leadership who needed to be reminded.
Sadly, people often complain about not being able to make quality the first priority in healthcare. Well, I complained about it when I worked in manufacturing. I have to write the story to get it off my chest (Warning, it’s loooong).
As a former GM employee and a GM customer, I’m really fascinated by the reaction of the public, the media, and Congress to the recalls and scandal over ignition switch problems in some GM small cars from recent years.
This leads to a great public outcry. As happened with Toyota, the CEO gets called on the carpet to explain themselves and the company to Congress (with lots of politician showboating taking place). It’s good to examine what happened, to see what companies, regulators, and the public can learn to prevent future problems. Or, it might just be unhelpful political theater.
There are anywhere from 44,000 to 400,000 preventable deaths a year in the U.S. as a result of medical errors and systemic problems in healthcare. Not that it necessarily helps, but why aren’t hospital and health system CEOs testifying in front of Congress each day? Why is this not regular front page news? Are people more concerned about vehicle safety than healthcare safety? Which is a bigger risk?
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:
Mark’s note: Today’s guest post is an excerpt from the book Remarkable by Toby LaVigne. Toby’s bio can be found at the bottom of this post. In this chapter from the book, Toby writes about a good friend of mine and of this blog – Karl Wadensten, the President of VIBCO. You can watch or listen to a podcast I did with Karl a few years back or listen to a public radio story about them.
By Toby LaVigne:
As the founder of Lotus sports cars once said, “Add Lightness.” Lean is about “Adding Lightness,” which, as you know, is really not about “Adding” at all, but about SUBTRACTION. But subtraction is trickier than addition, especially in a society that loves its pills and bandaids. So how do you get employees who are continually soaking in the bandaid paradigm to shift their attention to subtraction?
The word that comes to mind is “Pull.” You can’t push water, and you can’t push people, but you can create a vacuum that draws them toward you. And that vacuum is something I call Remarkability. I’d like to offer this case study on Vibco from my book titled Remarkable as it paints a beautiful picture of the “Pull effect.”
The ‘Pull Effect’ leads people to embrace the challenge of transforming themselves from clock punchers to experts at “adding lightness.”
Mark’s Note: I’m away on vacation through November 6… there will be some guest posts in this post during that time. Today’s post is by Brian Buck, a long-time friend of this blog and a frequent contributor of some very funny Lean Memes! Check out his blog, Improve with Me.
By Brian Buck:
Before I get into the topic of today’s post, let’s start with a little test using the images below.
Wartzman cites ThedaCare as an organization that is successfully reforming itself AND trying to participate in broader national reform efforts – including transparency and payment reform.
Results cited include:
- Quality: “Nearly 100% of its patients now rating their experience a 5 out of 5”
- Cost: “down 25% since 2007”
I recently received two emails that are worth sharing, in anonymous form here. One was from somebody I know who just quit a Lean role at a major academic medical center after a few years there, as he’s looking to join an organization that has a “deeper commitment to profound change” (spoken like a reader of W. Edwards Deming’s work).
The second email reads as follows (again, edited and anonymized):
I’m an industrial engineering graduate with a few years of experience in the field. I’ve been following your blog, podcast, and tweets for a little over a year now. Your content has helped me stay connected to the larger Lean community. For example, I picked up The Essential Deming after seeing your post about the book.
I’ve had trouble drawing personally relevant useful ideas out of your stories on Lean in healthcare. However, this past week, I spent a day in a hospital to support my mother.
I recently read an article (a case study) about “Lean Six Sigma” in a publication. It’s not online, so I can’t link to it, nor do I really want to call them out by name.
I didn’t like the article, in part, because it used the old, tired (and wrong) idea that “Six Sigma is for quality” and that Lean is only about “faster and cheaper.”
Good gravy, how do people NOT realize that the Toyota Production System and Lean are about both flow AND quality? For direct evidence that Lean/TPS is about both, see Toyota’s website on “jidoka” and “just in time.”) The article I read is, unfortunately, an example of L.A.M.E. or “Lean As Mistakenly Explained.”
The article talks about a scenario where a city government wants to reduce traffic accidents at one particular intersection. Since an accident is a “defect,” they called on the Six Sigma belts to gather data do a bunch of statistical analysis (assuming, it seems, that a quality problem must be the domain of Six Sigma). It took time and a bunch of meetings to plan for this formal exercise. It’s a “hard problem” that’s “hard to solve,” the author said.
Following up on my previous posts (here and here) on a recent visit to the Northern California Wine Country, I’m going to share a few more ideas and thoughts based on what I saw during the trip (when I wasn’t tasting wine with my wife).
What’s the Right Pricing?
As in any industry, a winery should sell at a price the market can bear (prices are determined by the market). Just because you have higher production costs in a given year or compared to other wineries doesn’t mean you can charge a higher price.
Growing grapes and making wine is certainly an art… but when you look into it there’s a lot of process involved. As I wrote about a bit last week, my wife and I recently spent two days in Sonoma County and two days in Napa County, California. She would cringe if I called these “gemba walks,” but you learn quite a bit about not just the wines, but also how they are made.
And, as I’m pretty bad at vacationing, I saw many things through a Lean lens that I thought were interesting… maybe there’s something here that’s helpful or thought provoking to you. Or, maybe you like wine, as well. Click on any of the photos for a larger view.