The BBC radio program “The Science Hour” recently aired a program with a segment where an unexpected person (Dr. Kevin Fong) to an unexpected place (UCLA Harbor Medical Center) to look into “Lean.”
You might remember UCLA Harbor from my 2014 blog post about their use of Lean to reduce waiting times for patients in their eye clinic. They were also featured last year in a video that Toyota produced about “The Toyota Effect” and how they helped.
There was also this 2015 story on NPR about them here in the U.S.
You can listen to the program and you can jump to 34:08 in for the segment on Lean that lasts about 10 minutes. Some of my notes will follow.
Or listen to the segment using this player:
Notes (with Links and Commentary):
Are these two things (a car factory and a hospital) really that different? The car factory is spotless, clinical…
Saving time means saving lives… the model of efficiency and process is used, like the car plant
Medicine has been learning from manufacturing, namely the Toyota Production System
TPS includes a commitment to continuous improvement… Kaizen
They visited the Toyota Georgetown plant in Kentucky
The reason we have standardized work is so we can identify normal vs. abnormal (Mark's commentary: this is also a key goal of “visual management“)
Employees are empowered to stop the line via an “andon” button and a Team Leader will respond in a very short period of time
TPS is all about flow, time, and efficiency process
The host says it's been difficult to make work in healthcare because the emphasis has been in the wrong place?
Zoe Radnor — called the “Queen of Lean”??? — says Lean / TPS is really about:
- Flow, and
- Reducing in waste…
But there's been too much focus only on the reduction of waste? Consultants promised quick results and cost savings…
I'd add there's too much focus on cost and that's not really Lean.
Radnor says there's “not just low hanging fruit, but rotten apples on the ground in healthcare.”
She says we need to focus more on flow and value and CI (I'd agree!)
Lean hasn't been as successful as we've hoped in healthcare because of too much cost savings focus instead of also value and quality
UCLA Harbor is a good example (not just the eye clinic)
Susan Black runs the Kaizen Support Center there, she's talking about their work in the E.D.
Yvonne, an ED RN supply room shows him around… Dr. Fong says “it looks a lot better” than what he's used to “hunting for pieces of equipment where you needed some magical knowledge of where things were.”
UCLA has organized and color coded things in the supply room.
Dr. Fong: “Seems like a really obvious thing to do… but I hadn't done it…”
Why isn't this generally being done in hospitals?
The nurse says, “We were so busy, this didn't seem important, where to put things – saves time, the most important thing, so you save lives.”
In an Internal Medicine clinic, they have visual management, a whiteboard and charts, boxes for people to write positive comments and suggestions.
Teams gather here weekly, focused on standardizing care and saving time.
There's a Taiichi Ohno quote posted – “Where is no standard, there can be no Kaizen” (quite possibly something that's really only traced back, in print, to Masaaki Imai)
They observe the MDs and RNs and give green or red based on following the standardized work or not (This is very important, and to do so the right way, because standardized work is a living system, not just a document to write).
A UCLA doctor says, “The great thing about observation is that it's supposed to be a transparent process. After observing, you have a conversation with them (not in an accusatory way) and talk about the parts of the work the missed. What happened? Need to go back and re-evaluate standardized work or give a fresher course. It's not about judging.“
(This is a critically important part of the Toyota mindset, as is the next statement):
The doctor says the “standardized work was developed by the people who do the work.”
Dr. Fong – It's quite enlightening to see how they've embraced TPS. I'm generally quite skeptical about things… because standardizing of processes seems to be at odds with the uniqueness of healthcare and all the patients you see. But I understand it now. The enduring theme here is about saving time through SW, which frees them up to further individualize care and save lives.
That's a great message to spread throughout healthcare. Lean isn't about stifling people's ability to provide individualized care… Lean enables that. Standardized work doesn't mean doing everything exactly the same way or turning people into robots. We standardize what we can to make it easier to be creative when that's necessary.
Now, it makes me wonder, what's going on in the NHS these days? Why did Dr. Fong have to travel all the way to Los Angeles to make this point instead of a British hospital?
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