Hello from Las Vegas, where I participated in a wonderful event yesterday, the Lean Healthcare PowerDay. Here are a few key quotes:
“That cry for more is really a cry to fix our processes.” – Naida Grunden, co-author of the new book Lean-Led Hospital Design: Creating the Efficient Hospital of the Future, as she referred to hospitals and staff saying they need more money, more space, and more equipment. There are so many examples of how hospitals have, for example, used Lean to increase the throughput of a CT scanner instead of just having “a blank check” to go buy more just because they asked.
“Complexity will not be solved by the CEO.” – Dr. Rick Shannon, talking about the shift from an era where CEOs “divined” solutions that were pushed down on people from above. Dr. Shannon added that healthcare problems are too complex to be solving with just thinking. Instead, we have to work to discover solutions through action and the experimental process, engaging front-line staff at the gemba. “The leader isn't expected to have the answers, but to create a system of learning,” he added.
Dr. Shannon's main theme was that “We are living an economic crisis in healthcare” and that, instead of suffering through draconian cuts, that we can and should use patient safety and quality improvement as means for financial improvement.
There's the moral imperative to not harm patients – to never harm them, as the Hippocratic oath didn't say “only harm 1 in 1000 patients.” But, Dr. Shannon presented compelling data that eliminating infections is right for the patient and has a multi-million financial impact for the hospital, by freeing up bed capacity and reducing unreimbursed costs.
Dr. Shannon argues that “audacious goals,” like working to completely eliminate infections within 90 days will inspire more action (even with the snickering that will come from some) than targets of “let's reduce infections 10% each year.” He warned against benchmarking against anything other than your own goal of ZERO infections, as “You always find a benchmark to which you compare favorably” in healthcare.
Instead of resorting to traditional cost reduction (focusing on slashing inputs, like labor and supplies), we need to improve clinical and support processes to take out waste. Shannon said, “We never account for the costs of doing things wrong.”
“We can cut our way (which is not pleasant) or we can improve our way [to financial solvency]” — Dr. Shannon
Terry Howell, the Chief Quality Officer at Hennepin Medical Center in Minneapolis said, “I'm not interested in being a lean hospital, I want to be a great hospital.”
He's right, that being “lean” or doing lean things is not the primary goal – the primary goal is being the best organization that provides the best possible care, and lean is a means toward those ends.
He also added, “If you want improvement, you have to staff for it,” meaning leaders need to help make time available for people to work on improvement.
Dr. Dave Munch added, in his session, “No longer is the public blindly trusting [healthcare] quality.”
There's so much opportunity for improvement, but there are thankfully some pockets of amazing improvement. And we heard from many of those people yesterday.
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