maandag 21 maart 2011

Go see, ask why, show respect

Also available in Dutch

For years lean principles have been going through the back of my mind. Every once and again I would come upon a Lean tool and use it. Eliminate a waste of some kind. Since I have set out far more consistently on my lean journey, some two years ago, I have found out about some very fundamental values which I have become passionate about to spread.

Guilt instead of improvement
I truly believe no one gets up in the morning to make a mess of his or her business day. Deming (our PDCA-founding father) said: a bad system will defeat a good person every time. Apart from the one off exception I do believe that is ever so true. When thing go wrong I therefore consciously only try to ask WHY as opposed to WHO (unless I need to find out who to ask WHY). I have found that that is quite a fundamental change in healthcare.
Patient treatment techniques become more complex over time. Almost every day large but mainly very many small changes are applied to protocols, techniques en work instructions. We ask our frontline workers to keep up with all of these changes. We ask them to work harder, to cut corners so to ‘push’ patients through the process in time. And if they’re then spinning out of those corners and crash we’ll tell them to pay better attention next time.

Ops meeting setup process

Ops meeting to increase patient flow
Only two weeks ago we started meeting daily with team members form all working station in our patient setup process. We discuss all patients with risks of falling behind entering or going through the process. Can we still make it or do we need postponement? “Pull’ is being created to get staff to deliver on time. And thus we are creating a controlled and calm setup process.

That very thought is even found in our quality registration systems. Mostly the suggestion for improvement when a quality issue is put forward is to ‘pay better attention next time’ or ‘being distracted so avoid distractions next time’.

But essentially our business processes in this increasingly complex environment are not up to par any more. The large number of steps en often highly technical activities must be supported by new kinds of systems. And those systems are not to be confused with new or more computer systems! It’s about new management systems that truly support frontline staff. That help people to create real value for patients. Things like visual management. Standards that help decide whether delivered work is up to set quality levels. Standars to improve upon. Less troubleshooting and searching for materials through better workplace organisation. Built-in error proofing (any deviation from standard is being fed back immediately).

Subservient leadership
A couple of monts ago I was involved in an improvement effort with one of our teams. Goal to that improvement was to see wehter we could find a way to do the work we did with three as opposed to four people. The team was eager to try out new ways of working and entered a simulation. From the simulation it soon became clear there were all kinds of practical considerations which made it impossible to reach our goal during that improvement session. Things needed for patient treatment wasn’t in the right place, information wasn’t available when and where it should be, etc. I got quite frustrated about the situation. Pressure was on and we weren’t going to make the target I set out to make. I thought the team should just get on with all practicalities and make it happen.

Workplace organisation fixation masks
Workplace organisation
One of our team members went about creating a locating system for our fixation masks. It took her just one full day. Before this time masks were kept outside the treatment area and were unsorted. Now, the location number is registered on the patient form and every team member can find the right mask instantly.

After the team and I had banged our heads at this our process facilitator told me ‘to get hold of the practicalities preventing us from reaching our goal as ‘treasures’. Treasures of information. Then it finally dawned on me: we set upon making a (long) list of all open issues. And started tackling those one-by-one. And we were all convinced our goal was realistic and achievable.

This lesson has taught me that we, managers and all others who are not directly involved treating patients should be subservient to those who do. Go see, ask why, show respect. Helping them by looking for information treasures. Help the by giving them time, coaching and training to attack problems one-by-one. Their problems, not ours! To give them the opportunity to create value for patients as opposed to fixing the system they have to work in.

It’s kind of a scare to managers in healthcare. But it works for sure!

2 opmerkingen:

  1. Hi Freek, nice work and great insight.

    What if in addition to eliminating waste you created flow? What if in addition to creating flow you considered the values of the patient and payer and looked at creating patient experiences that were less Victorian sanatorium and more like an expensive hotel?

    What if we looked at a clinical pathway end to end or even an entire therapy area and saw it through the eyes of the patient, identified cosmetic and systemic waste, articulated future value and designed a future state that enabled better services to be delivered through a less wasteful system design?

    Up for the challenge?

    Chris Ellins

  2. Chris, Thanks for your feedack an I'm in full agreement. And the way you're looking at it was the way I set out a while back when I started out on my own lean journey and that of the department I'm working in.

    I wanted to use all tools I found out about right away. But then I found it is not possible to take on all of them at once. And that lean is even more powerful as a shift of culture, mentality and business philosophy as it is through using the tools.

    So we're taking things one at a time. We just started with our ops board, visualising problems our workers are coping with every day. And because they start seeing we're taking their problems seriously they join in the effort of continuous improvement. And because we're taking each other seriously we can address patients needs better. And, in a while, get patients involved in the improvements we're making.

    Next step: we're taking a multidisciplinary team on a journey to get though a current state and future state value stream map of a clinical pathway. Not just to use the tool but to get them to get into the same spirit of continuous improvement.

    It's been slow going to get the fundamentals in. But we're now really ready to gear up!



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