Last week, I received a few questions from somebody at a hospital system and I thought I'd address one of them here. If you have questions you'd like me to answer (or at least try to answer) in a blog post or a podcast, contact me.
“Can you suggest any “quick wins” to get staff engaged in a Lean culture?”
I think this is a great strategy. Rather than telling people that Lean is a good thing, demonstrate that in real life.
I can't directly answer the question about what the “quick wins” might be in a particular hospital or a department.
The “quick win” I can suggest is asking the staff what they think some “quick wins” would be. That's the classic advice for how to start with the “Kaizen” approach to improvement and how to start building a culture of continuous improvement.
Ask people what bugs them. What gets in the way of you doing your work? What frustrates you? What would allow you to provide ideal patient care?
Then, ask “what can WE fix?”
You're not asking them to dump work on the department manager or director. You're not asking them to give suggestions to executives or other departments.
QUICK win. What can we fix today?
I often tell the story of a primary care clinic that I was coaching. We were trying to figure how to engage the physicians in the Lean improvement process. We asked one podiatrist about problems that he saw and he couldn't really identify anything.
People can become blind to waste when it's a daily occurrence. It's not waste, it's work.
A nurse and a medical assistant shadowed the podiatrist (with his permission) to look for barriers in his daily work (NOT to tell him how to do his job better).
They drew this “spaghetti diagram” that showed where he had to walk in the clinic.
It was 670 feet of walking and motion. The patient was left waiting in the exam room. The podiatrist was walking around for 10 minutes.
Not because he was lazy or a bad doctor!
He was doing his best… fighting through a bad system. That bad system included the clinic being disorganized and supplies and equipment not being stored in convenient, consistent places. He was “hunting and gathering” what he needed to do a simple toenail procedure (one that had a value-added time of about 30 seconds).
Gauze… scalpel… freeze spray. Why was it so hard for him to find what he needed to provide patient care?
He worked in four different clinics on four different days of the week. Why was each clinic set up differently?
Once the team and I showed him the spaghetti diagram, it opened his eyes. Before, all of that walking around was seen as “work.” It was “necessary.” He viewed it as “doing his job.”
But, it didn't have to be that way!
What was the quick win? The team in the clinic put together a cart that contained had all of the podiatry supplies that were needed. Even before Dr. Atul Gawande's book The Checklist Manifesto became popular, they created a checklist that could be used to make sure the cart was restocked the night before the doctor was coming. It was a form of “standardized work.”
Here's a photo of that cart and checklist:
The doctor LOVED the cart. They parked it just outside the two exam rooms that he would use. It saved so much time for him. It meant the patients didn't wait as long. He could actually start seeing more patients per day, which was good for everybody involved (shorter waiting times, more revenue for the clinic and the doctor).
He went, within the course of a week, from:
- Not noticing the waste
- Realizing things could be better
- Recognizing that Lean (and Kaizen) was something that could make his job easier
The podiatrist got a “quick win.” He was engaged.
He then asked, “How quickly can I get one of those carts at the other three clinics?!?!?!?”
At first, the clinic team created a solution for him (out of service to him). Solving a problem for somebody is often a great way to get them to directly participate in identifying and solving problems.
So, don't just train people about what Lean is. Help them improve. Solve problems that affect their daily work lives. Create a better system.
The first Kaizen implemented at my Healthcare Kaizen co-author's health system was a simple “quick win” identified by a member of the housekeeping staff:
What was her quick win? A plastic container to keep coffee filters in.
This didn't require an A3 or root cause analysis. It didn't require a project charter or a capital improvement request. It wasn't a Rapid Improvement Event. It was about as simple as a “just do it” gets. It was a quick win.
That small improvement helped set the stage for about 30,000 more that have been implemented and document at Franciscan St. Francis Health. Some of their ideas, about 10%, save money. Some of those save large amounts of money.
A related question that I often get:
“How do we use Kaizen to reduce costs?”
Sometimes we get better results (more cost savings) by not demanding that every improvement directly save money. We don't ask for an ROI analysis or a particular ROI threshold for each improvement. We're trying to build a culture. That means finding a way to say “yes” to virtually every improvement idea. Franciscan has documented millions of dollars of hard cost savings (verified by finance).
This demonstrates the concepts of “Obliquity” or the indirect path toward a goal, as I've blogged about before:
What “quick wins” can you help people find this week? What do you think about this? Post a comment below or join the ongoing discussion on LinkedIn on this question and topic.
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