Service and Quality Start with Who?
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)
Here is the poster:
Compassionate service is certainly a great goal. I appreciate that the hospital tries to focus on this.
The organization's Excellence program slogan has a curious slogan:
“It starts with me.”
I'd say “It includes each and every one of us,” but as Deming said, we can't just rely on everybody's best efforts. We have to work on the system. And management, especially senior leaders, own the system.
Deming said, “Quality starts in the boardroom,” and I think this is true in healthcare.
The sign says, “I strive to exceed my customers' expectations…” but is the system capable of that (the “system” meaning everything from the building, processes, equipment, staffing levels, training, the management system, etc.)?
Staff are encouraged to say “I have time” to the patients. But do the staff REALLY have time? Are they fighting too much waste on a daily basis? Can we really put that burden on staff?
Organizations that practice Lean, like St. Elisabeth in Holland, focus on reducing waste to free up staff time for more caring caring… or “Loving Care” that is more compassionate. This sort of transformation requires the direct involvement and leadership of senior leaders.
Quality starts with me? Compassionate care starts with me? No, it starts with senior leaders.
Also, I think the idea of “visuals” – really expressed as “visual control” or “visual management” is about far more than posters.
A cute sign reminding staff to wash their hands is a poster, not a visual control.
A visual control is something that allows us to do the right thing (like painted lines in a parking lot). A visual control is something like a visual kanban system that tells us to re-order supplies when they physically get down to a certain level, like an empty bin or a taped lined on the side of a cabinet.
“Visual management” is something that prompts management or staff to make a decision. There's no point in seeing a problem through a visual control if we don't take action when we see a problem – both the short-term reaction and longer-term process improvement.