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.
What we find is that our nurses on the front line continually use their workarounds because there's no structure in place to help with solving these issues. As a result, the workarounds just become “the way it is” and we come to accept it as part of the process rather than viewing it as waste or a problem.
The facilitator role is one where an Rn facilitator supports 4 front line Rn's on an inpatient unit. The job is twofold:
- serve as first responder to potential delays in patient care
- apply PDCA thinking to resolve the delay issues or other observed wastes.
We're making progress in our experimentation and have learned a great deal about how to do this; however, I'd love to springboard off someone else's learning curve. Do you know of anything which has been written (books, articles, etc.) on this topic?
Here is my response back to Steve…
That's one thing that was painfully clear when I recently visited Autoliv in Utah with a group of 25 healthcare leaders from around N. America — Autoliv has WAY better support structures and support staff in place to react when
front-line associates have a problem, compared to most hospitals. And they have the mindset to really fix the system, not just workarounds in place. Pull an “andon cord,” put up a simple flag – the system should provide support to those doing “value added” work (in this case, nurses, RTs, etc.).
I've recently talked to some Seattle healthcare people who were incredibly impressed with that similar support and response when they visited Japan to learn from their best manufaturers. Virginia Mason has tried to put in a “Patient Safety Alert” system to move closer toward that ideal of giving people support and help when and where it's needed, instead of relying on monthly metrics.
But you're right, a typical charge nurse doesn't operate like a team leader in a Toyota plant. I think we can change that in healthcare, it would require a concerted effort from a healthcare organization.
I've personally helped some hospitals learn structured PDCA responses to problems so that manager support doesn't become a different level of workaround. The manager can't be chief fire fighter. Using the A3 methodology or a structured “idea card” that prompts PDCA thinking (problem statement, countermeasure with hypothesis, measurement, and followup) can be very helpful.
I would love to hear your thoughts and experiences here as well — leave a comment!
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