I received a question from a physician I know in Canada and I'll try to address it here (although the answer might not be as definitive as he or his leaders would like). I think the discussion here applies to the U.S. and other countries, not just Canada.
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I'm getting a few wins within my department as a way of showing what disciplined team based problem solving can do. People higher up want to see more. We have lots of problems and some interest – but lack skills and time.
How do I estimate the needs for the department and the hospital to help make a case to show the investment to be serious about improvement:
1. How many lean experts/facilitators will they need globally or per department to build a learning/improvement system?
2. How much time will they need to free up:
A) for a manager or
B) front line worker
on a weekly basis to allocate time to improve
(not just get stuck doing the daily waste-filled work).
Are there easy answers to these questions? Based on benchmarks? Rules of thumb? I'm not sure.
I've always said, being serious, that you need as many people as you need… and no more and no less. There's no perfect rule of thumb for how many facilitators, no magic answer. It depends on what those facilitators are doing, the type and size of organization, etc. There are many factors involved.
I'd suggest framing and testing a hypothesis about how to determine this number. At a department level, can you get dedicated resources for improvement? This is common in manufacturing (you have engineers, etc. even before possibly having a “Lean person” — I've played these roles in factories before moving to healthcare) but it's pretty rare in healthcare to have “process engineers.” You basically just have people doing the work… and there's lost potential as a result.
Can you add one person to a department and see how that helps? Or, should people be on loan from a central improvement group to help facilitate larger projects and to coach managers on a daily basis?
Or, if executives insist on an absolute knowable number, tell them ThedaCare has 25 to 30 and they should just copy ThedaCare (or shouldn't they?). ThedaCare has had a different number of facilitators over time. Was any of those the right number? The right number for them at that time? The right number for that organization at that time?
What Do Cleveland Clinic Improvement Leaders Say?
Nate said the number of people and resources you need depends partly on the answer to this question:
“How fast do you want to go?”
Lisa agreed with my sentiments expressed here and she, coincidentally, used the same phrase I've used here in my post.
“There's no magic number.”
How Much Time is Needed?
The second is a bit easier to answer, but again there's no magic number. Should managers be spending 30 to 60 minutes each day rounding for improvement? Or more? Daily huddles of 10 minutes are generally not enough time for meaningful improvement. That's barely enough time there to triage ideas with people.
Do you need to give staff permission to work on improvement in a dedicated block or just suggest they take advantage of time as it's available?
When I ask people at my co-author's health system about this, and they've been practicing Kaizen for 10 years… how much time do you spend on improvement? They have no idea because it's so integrated into what they do on a daily basis. They don't track “improvement time” per se.
Here's one of their managers talking about making time:
I know one department chief at an organization I coached who told his staff that they wouldn't be punished for taking time away from “real work” for improvement work.
He chose a somewhat arbitrary number of 20 minutes per day (per person) for improvement. But that seemed realistic to him:
I should check in with him… was 20 the right number? I'd hope they'd tweak that number over time in the spirit of Plan-Do-Study-Adjust. If they can't find 20 minutes, how can leaders help? If they free up time through initial small Kaizens, can they now do 30 minutes of improvement each day?
How does that time spent on improvement free up time for them to put more patients into the transplant process? How would freed up time help you and your team?
Nate and Lisa also had some thoughts on this question that I'll leave for that future podcast episode. Subscribe to the podcast so you get notified when it's released (or subscribe to learn about new Lean Blog posts via email).
Does This Help?
I hope that helps… probably not as much as a definitive answer, but I don't think there are definitive answers to questions like these… just experiments to run and things to figure out locally.
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