Today is the start of the 2014 World Cup, which means much of the world will be talking about goals.
I'm not really a soccer, I mean football, fan but I'm all for goals. In the Lean management system, we generally have five high-level goals. These were the goals taught to us in the auto industry, where I started my career, and they apply in healthcare.
Some organizations (in many industries) might have goals that include:
That's not a very balanced set of measures.
In Lean, we talk about “SQDCM” — or what was originally “SQDC.”
These balanced goals… essentially in order of priority (although we need to – and can- accomplish them simultaneously) are:
Those are pretty self-explanatory… “Delivery” means getting the customer what they need when they need it… on time, all of the time.
Morale was added onto SQDC at some point to become SQDCM. It's hard to say Morale comes last… it's not the least important thing. But, I think in the auto industry, people got so used to saying SQDC that it was more natural to say SQDCM instead of SQMDC or such.
Employee morale (and engagement) tends to lead to Safety and other measures… and arguably, focusing on Safety will improve Morale. In healthcare, we know that employee engagement leads to better Safety and Quality…. and that leads to better performance in other areas.
“Delivery” in healthcare can translate to Access and waiting times. We're trying to get the patient the right care at the right time when they need it. Reducing waiting times, such as emergency department Length of Stay (LOS), leads to better Safety and Quality. Better Safety and Quality leads to better Cost. Improving all of these measures leads to better Morale… and we're back to another virtuous cycle.
Cost is usually listed fourth not because it's not important… but Cost is the end result of doing everything else well. That's why Lean isn't a “cost-cutting” methodology. Cost is an end result, not a primary goal.
So here's my question to you: do you have clear SQDCM goals for 1) your organization as a whole and 2) for your department? Do you have clear measures in each of these five areas of Safety, Quality, Delivery, Cost, and Morale? Do you update and review them daily or weekly instead of monthly or quarterly? Do those goals and measures drive your improvement work?
Do you have SQDCM or is it CCCCC?
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