In hospitals, there’s a big emphasis on healthcare professionals always checking TWO patient identifiers to help avoid getting the wrong patient. You might have two patients with the same name, so you should also check the birth date (since it’s less likely to have two people with the same name and birth date… but not impossible!). This “always” checking two identifiers, sadly, doesn’t always happen.
I’ve been writing for a long time that I think it’s inappropriate and ineffective to ask patients and families to inspect or police hand hygiene in hospital settings. It’s the job of healthcare leaders to create systems that include enough time for nurses, doctors, and others to properly practice hand hygiene in the name of protecting patients.
Hanging more posters and cuter signs doesn’t work… lack of hygiene is not an education or awareness issue – it’s a systems, processes, and leadership issue.
For years, I’ve gently mocked the “ask me if I’ve washed my hands” buttons that some staff are asked (or forced) to wear. I’ve pointed out that no other industry puts this quality inspection burden on their customers.
So, I’ve created a website, www.AskMeIf.com with parody buttons that seem silly in other situations… so hopefully the “ask me if I’ve washed my hands” buttons will seem silly, as well – and we can try things that might work. Read more about the new site here. And see the other buttons, including “Ask Me If I Will Not Operate on the Wrong Side.” See the other buttons here.
Rather than Blaming Employees, Managers Must Take Responsibility for Problems – in a Taco Joint, a Hospital, or a Factory
I published a piece on Monday over at LinkedIn as part of their “Influencers” series:
QHSE Focus, an iPad magazine, asked me to contribute a piece on Lean healthcare.
They published my piece titled, “Employee & Patient Safety: The Only Moral Place to Start with Lean in Healthcare.”
You can read a PDF of the article, thanks to the publishers at QHSE Focus. The PDF also contains the table of contents to the publication, which includes an excellent piece by Michael Balle on the “irreconcilable differences between Lean and Six Sigma”). You can get a free issue of QHSE via the iTunes store (further issues by paid subscription).
A Lean thinking friend’s wife had emergency surgery (she is going to be fine) and my friend sent some pictures of Lean-related things he saw at the hospital. The good included:
- Sheets posted on the wall to get staff input on some proposed process changes
- In-room patient info whiteboards that were actually being used and updated (who is my nurse? what is my care plan for today?)
- Evidence of 5S improvement work taking place (with the goal of reducing wasted time for staff)
Last week at the Lean Healthcare Transformation Summit, I really enjoyed the presentation by Jamie Bonini, General Manager of the Toyota Production System Support Center (TSSC). Jamie started his career at Chrysler (where he knew Jamie Flinchbaugh, a good friend of this blog) and both Jamies, like me, are graduates of the MIT Leaders for Global Operations program.
Jamie shared great insights on what we might call “Lean culture” as Toyota aims for and others have emulated.
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?
I’d read before that Apple’s supplier (Foxconn) was having trouble assembling iPhone 5s to Apple’s standards… but this article contains some shocking stats: “Apple Returns Millions of Defective iPhone 5 Smartphones.”
Millions… 5 to 8 million defective phones returned. Foxconn has only been able to achieve an 80% quality rating… suggesting 2 in 10 have some sort of problem. What were Apple’s expectations? Shockingly low.
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?
I always get annoyed when people spread the false dichotomy of “Lean is about efficiency and Six Sigma is for quality.” Replace the word “efficiency” with “speed” or “flow” and it’s still wrong.
Here is an example of this falsehood in a book from a major publisher… this author refers to Lean addressing the first six types of waste, with Six Sigma addressing the waste of Defects. Ugh. Wrong.
The author repeats this falsehood in different ways throughout the book. The book also incorrect states that Virginia Mason Medical Center used Lean/TPS *and* Six Sigma. At least the VMMC CEO Dr. Gary Kaplan and other leading Lean healthcare CEOs learned correctly that Lean (coming from Toyota) is about Cost AND Quality, as we’ll read about below.
Kudos to Mike Micklewright for putting together this clever parody of the Chrysler ad that aired during the Super Bowl – Paul Harvey’s “So God Made a Farmer.”
Here is “So God Made a Quality Manager”:
MP3 File (run time 26:21)
My guest for episode #168 is Carolyn McCulley, from CityGate Films, and she is a co-director and producer of the upcoming documentary called “Breaking the Wall of Silence.” Through March 31, you can sponsor this project through the Kickstarter website (with a minimum contribution of $15) and I hope you’ll join me as a supporter of this important work.
As Carolyn discusses with me, the film does not just focus on the problems of patient safety and poor healthcare quality… it focuses on the positive steps that MedStar Health (a large system in the Washington DC area) is taking to transform its culture to reduce systemic patient harm. This focus is why she calls this a “hopeful film” as opposed to being alarmist.
Here is the trailer for the film:
As a reminder, I am giving a free Gemba Academy webinar tomorrow (Tuesday 3/12) on “Stories about the Eight Types of Waste in Healthcare.” Click here to learn more and sign up.
I’m going to tell some stories from my own work and other stories that have made the news about different forms of waste in healthcare. I think the most important type of waste is “Defects” — or process problems that harm patients. We have to focus on safety first, especially considering what a serious problem this is around the world.
“A bad system, will defeat a good person, every time.” — W. Edwards Deming
Would you polish drinking glasses at home with the furniture cleaner Lemon Pledge? Of course not – it’s got to be poisonous or at least harmful. Would you use Lemon Pledge to polish the glasses if you were a hotel housekeeper? No?
So what would make somebody do that?
Last year, the Institute of Medicine released its latest report titled, “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America.” The report endorsed Lean as one strategy for improving the problems in our health care systems around the world.
From the full report (available as a free PDF download, with registration required), based on the Steven Spear “rules in use”:
One notable strategy for improvement is the Toyota production system (Bohmer, 2010; Kenney, 2011).
Thanks to ASQ for posting an audio interview they did with me last month about my book (with Joe Swartz), Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements.
ASQ also posted a free link (registration probably required) to the journal article that Joe and I co-authored for Six Sigma Forum Magazine (although our article has no real connection to Six Sigma):
You can find links to other related articles on healthcare quality improvement via this online archive of their email newsletter, or click on the image below.
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.
Last week, while flying back from my trip to Japan, I watched a video that had been recommended to me a few times (including by my local San Antonio IHI Open School friends): “Escape Fire: The Fight to Rescue American Healthcare.” It’s available on different video download / streaming services, like Amazon and iTunes.
The movie does good job of documenting the problems in healthcare – poor quality and lousy patient safety, all at an expensive price tag. In fact, the movie gets a bit tiresome, spending the first 75 minutes on the problem (or different forms of healthcare problems) before talking about solutions. The discussion of the problems is a bit too scattered and unfocused (for example, problems in military and VA medicine could probably be their own documentary), as the film covers a lot of problems and identifies many villains.