I was thankful to find this CBC Radio news story / podcast from the program “White Coat Black Art,” hosted by Dr. Brian Goldman:
It's just under 30 minutes long and I think it's a “must listen.” You can also get this through iTunes and your iOS device.
Here are the notes that I took and my comments.
St. Mary's General Hospital
They first visited St. Mary's General Hospital in Ontario and talked to their CEO, Don Shilton (they are a member of the Healthcare Value Network and Don was a CEO panelist at one of the annual Lean Healthcare Transformation Summits that I participate in.
At St. Mary's, Lean has meant:
- Less waiting better quality
- Lower mortality, less cost
- No patients waiting for bed in ED
Shilton says they couldn't have done it (gotten improvements on that scale) without Lean.
Dr. Goldman summarizes three key Lean principles:
- Identity the customer (the patient, not the doctor)
- Identify problems
- Fix only the things that make it better for patient
Next, they talked to an internal Lean facilitator, at St. Mary's, who came from the Toyota Cambridge plant with ten years of experience.
He said it's tough to take things that embedded in the Toyota culture to the new place and install it like a thing. He said, “At Toyota change is expected.”
There, any team member simply brings idea to team leader. Their standardized work can change in hours or days; at most a week.
There are hundreds or thousands of improvements a day in that Toyota factory, he said.
They talk to a heart patient, who they describe as a “Lean Sensei Black Belt” from heavy industry. Dr. Goldman says a “LSBB” is the “highest level” of achievement. What? Nobody stops learning or getting better. OK, end of my digression.
The patient said he could tell it was a Lean hospital because “you didn't have to beg for information.” Things were so consistent across shifts. Things seemed error proofed. It was a great relaxation to learn it wasn't a normal hospital. You feel part of the team.
The whole hospital (catering) isn't Lean yet, he said and “you might want to edit that out.” The attitude was “Here is a tray, eat it. There was no feedback loop”. The CEO Shilton said he wants to hear that feedback and there was no need to edit anything. The entire hospital can't get Lean overnight. They chose to focus on cardiac care areas before catering and dietary services.
Dr. Goldman says the CEO seems comfortable taking about unsolved problems. That's a big culture change from “don't go looking for problems.”
Visiting ThedaCare and John Toussaint
Dr. Goldmann next went to Appleton, Wisconsin. Dr. John Toussaint, former CEO of ThedaCare and now CEO of the ThedaCare Center for Healthcare Value said, “You're never done learning this” (as I suggested above). You're never done, but it takes “three to four years to get into the culture, sometimes up to seven.”
John said ThedaCare has been “learning from other industries. I don't know why weren't doing that [before].”
Dr. Goldmann asked what are the “wrong lessons” people take from a visit to ThedaCare?
John said it's when the CEO delegates Lean. This is about everyone's engagement from CEO to front line. Otherwise don't try this, he says.
Lean Healthcare in Saskatchewan
The discussion with Dr. Toussaint turned to Lean in Saskatchewan, with John saying they will hopefully prove this can be done at such a large scale.
A representative from the nurses' union said nurses were being told to take out trash and change linens because of Lean. That's puzzling, since that seems to be a waste of their talent. I've seen Lean drive hospitals to REDUCE the amount of time nurses are doing non-nursing tasks, which allows them to focus MORE on the patients. That's what I see as a “Lean approach” – having support staff let nurses be nurses, pharmacists be pharmacists, etc. The nursing union admits that “Lean has things to offer” but they are concerned about patient safety. Well, Lean has a lot to offer to improve quality and patient safety.
I still don't understand the apparent disconnects up there.
Steven Lewis, a professor of health policy was interviewed and was described as a ” fan of Lean, given the right circumstances.”
Lewis said, “Morale was already bad. Superimpose a big experiment implemented a certain way and that will be disruptive in the short term.”
He said their are many ways to try to get Lean and he described the consultants for Saskatchewan, John Black & Associates, as “militaristic” with a “my way or highway approach.” That doesn't sound very Lean to me, telling people what to do. We should be engaging people in the improvement process.
I thought it was a very balanced and interesting program. I hope, again, that everybody in Saskatchewan can focus on the goals that matter (safety, quality, waiting time, morale, etc.). Lean should help accomplish those goals and Lean should make people happy, not upset.
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