Stuff I’m Reading May 2016: Bad Patient Experiences, Bad Workplaces & Burnout, Lean Sigma in the VA


As is often the case, I have too many open browser tabs full of articles that I was going to potentially blog about. This slows down my Mac (thanks, Chrome!).

So, it's time for me to clear out my backlog and a little mental overhead… to share some articles I've been reading with some quick notes, instead of doing full blog posts. Well, I'll get my backlog down a little.

Why Giant Hospital Systems Might Be Getting it Wrong

Michelle Chaffee writes about her poor experience and delayed care at a fancy-looking, high-tech hospital system. There's no mention of Lean, but I'd point out that a truly Lean organization intimately understands the needs of the customer (the patient) and prevents the types of frustrating miscommunications and delay that she suffered through.

“I need people who at least appear to give a damn about me.”

Gadgets and (in other situations) overly busy or stressed out staff can't be kind, caring, or loving. Lean is meant to address all of this.

Resiliency Training – Important but Not Nearly Enough

Dr. Paul DeChant writes about the problem of burnout amongst physicians and other healthcare professionals. Are we really getting to the root cause by asking people to be more resilient or giving them training about how to be more resilient?

“Unfortunately, they are missing a huge opportunity by not including a focus on fixing the work environment.”

If people are getting burned out by bad systems, we need to fix or improve the things that are causing burnout or contributing to it.

Lean can help “create an environment that nurtures community, flexibility, and control” for the people working in the healthcare system.

I agree with Paul, when he says:

“Health care leaders must do more. It's wrong to take our best and brightest and put them into training and work environments that make it hard for them to the right thing for their patients, and burn them out in the process. And now we have documentation that the problem is getting worse.”

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‘Lean Six Sigma' comes to the VA; Collins cheers

In a news story, the head of the VA Robert McDonald talks about their embrace of Lean Six Sigma:

“We started training leaders on Lean Six Sigma last month,” McDonald said at a National Press Club luncheon. “By December 2016, we intend to have 10 percent of leaders trained.”

I know there are pockets of the VA that have been practicing Lean for years. I did training for leaders and staff in one region a few years back.

I wonder why McDonald has chosen Lean Sigma over just focusing on Lean? And is training people really enough? What else is McDonald going to change the culture and the management system, given the old system was about setting “unrealistic” targets and then cheating the system?

The article adds:

“The “lean” management techniques, pioneered by Toyota, “improve service speed or lead time by eliminating the waste in any process,” according to the Lean Six Sigma Institute. Meantime, Six Sigma – developed by Motorola – “improves the quality of products and services by eliminating variability.”

Lean is just about speed? No no no.

That's, unfortunately, the type of misinformation that's spread by many Lean Sigma books and consultants.  As I wrote about yesterday, that's flat out incorrect. Lean is about flow / speed AND quality. Six Sigma doesn't have a monopoly on quality improvement methods or goals.

McDonald adds:

“To make the VA more efficient, McDonald is combining Lean Six Sigma with another management technique called Human-Centered Design.

“Great customer service companies use Human Centered Design to understand what customers want and need, and then design customer experiences to meet those needs,” he said in his speech. “Lean Six Sigma makes these processes effective, efficient and repeatable.”

Lean organizations ALSO understand what customers want. There's probably a high degree of overlap between Lean and HCD, but it shows a lack of understanding about Lean to think you need to pile other programs on top of Lean to get customer focus. Lean IS customer focus.

McDonald says we need to bring “best practices” from the business world, but let's not bring “common misunderstandings” along for the ride.

Rotarians tour hospital to see improvement model

This article from Washington talks about a visit to Kittitas Valley Healthcare.

“Lean is a management philosophy that emphasizes maximizing customer value while minimizing waste and inefficiency. It's been used in a variety of industries and organizations as an example.”

That's a better definition than saying Lean is all about efficiency, speed, or cost.

Lean at Kittitas “puts the patients first,” she said. “Everything flows around the patient.” Good.

“Smith said he and other Rotarians were impressed with Lean's focus on making things as efficient as possible for the benefit of patients.”

No, not just efficient. This is also about better care for patients and a better patient experience. If “efficient” is defined as keeping all healthcare providers and resources fully busy, that's not necessarily good for the patients as high utilization means long waiting times. If efficient means better flow and fewer delays, that can improve one aspect of quality (timely care) but we also need to work to reduce errors and harm.

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


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