Lean Healthcare Exchange

One of the essential elements of the foundation for an effective Lean Healthcare transformation is the implementation of a Workplace Organization or 5S system.  In my role as coach and facilitator I am often asked by leaders why their 5S initiatives are failing. My first, internal, response is “why don’t you ask your staff”?

Of course, I sanitize this terse response before putting it back to the questioner.  But, the message is always the same.  The key to improvement in 5S performance, like any metric, lies with the staff.  Go to the Gemba and ask them.

Assuming that all the pieces of a 5S program are in place, including a healthy audit system that yields quantifiable, actionable 5S results, leaders are ideally prepared to address 5S performance in the same manner that they might any of the other initiatives they are charged with. 

Leaders often make the mistake of assuming that failure to follow 5S standards is simply, at worst, an issue of non-compliance on the part of the staff or, at best, an issue of lack of training to the standard.  But, the root cause of failing to follow standards is almost always more complex.  Getting to the root cause requires a disciplined approach to problem solving.  The ideal tool to use when seeking to improve 5S performance is the A3. 

In one recent case at a Lean Healthcare facility, a leader noticed a downward trend in one her department’s 5S score.  She scheduled a stand-up meeting with some members of her staff to address the issue.  She chose to use an A3 approach.  She used the data from the department’s recent 5S audits to explain the issue and the background.  After some problem analysis, the team was able to hone in on one source of the point deductions but they still weren’t at the root cause.  They had learned that a consistent problem area is the improper storage of blood pressure cuffs on the headwall.  The standard was for these cuffs to be stored in casework in the exam room.  Further problem analysis, using the “5 Why” tool revealed that the some staff members had begun to store the cuffs on the headwall to avoid congestion.  (The casework is on the opposite side of the exam room, where another member of the team is often blocking access to the cuffs while using the computer to chart at the same time vitals are being taken.) As a countermeasure, the team decided to change the standard so that cuffs are now stored on the headwall.  Appropriate storage, with labeling, has been added. This change has been communicated throughout the staff and the team is no longer having points deducted on its 5S audit. In this case the audit findings pointed to a need to improve the standard.

When 5S performance, as measured by audit results, fall below the acceptable level, employing an A3 approach will help to point the staff to the true root cause and a solid countermeasure.  Nearly every failure to follow a 5S standard should elicit this type of problem solving approach.  Shortly, the failures to follow standards will fall away.  You can be reasonably sure that if your staff is failing to follow standards, it due to a hidden issue that can often be addressed at little or no expense.

This week’s blog was written by Jeff Wilson. Throughout Jeff’s career, he has delivered and applied progressive management and process improvement tools to help organizations reach new levels of performance. The industries span from healthcare to manufacturing, financial consulting and accounting. He has developed Lean transformation plans, facilitated Kaizen events and developed training materials for numerous client companies. Jeff has a Bachelors Degree in Economics from Western Kentucky University. He also holds a Certified in Production and Inventory Management (CPIM) designation.

I recently attended a large meeting of business executives where the presenter was using PowerPoint and a projector.  As he prepared, and the gathered crowd waited, he realized that he was unable to display his presentation.  After a few moments of nervously fidgeting with the connection and configurations, he quietly asked for help from a couple of folks who were near the podium.  They, including a couple of “IT types” moved to the front of the room and began to unsuccessfully trouble-shoot the problem.  A minute or two more passed and the meeting participants grew fidgety.  Tick tock, tick tock….  Participants became impatient, side conversations were initiated, emails are suddenly very important.  A few participants even saw this as an opportunity to make phone calls.  The audience was losing interest fast!  All the while, the well intentioned crew gathered around the laptop nervously tried the same or similar fixes over and over, with only the same dismal results.

After several minutes, a colleague of mine realized that he may have seen a similar problem in the past.  He confidently strolled to the front of the room, and asked if he could give his idea a try.  He leaned over the laptop and took an analytical look at the screen and keyboard.  Three keystrokes and less than five seconds later, the presentation appeared on the overhead and order was restored.  The waiting crowd literally cheered the results and suddenly, this man is a “rock star”. He had saved the day.

In the same way that my colleague became a rock star by finding an adequate work-around to the PowerPoint problem, many frontline care-givers achieve “rock star” or “super-performer” status by finding adequate work-arounds to the problems that plague the efficient and effective delivery of care.  Worse yet, healthcare leaders often expect all employees to work at this “rock-star” level.

With the application of Lean in healthcare, leaders must change their paradigms about who the real “rock stars” in their organizations are.  In fact, working around a problem or defect should become an unacceptable practice.  By identifying and solving the problems or defects that cause work-arounds in our processes, we can eliminate the waste that is embedded into our delivery systems.

When properly applied, Lean Healthcare offers a methodology to help your staff see the waste in their processes differently.  They will think differently about each step in their processes.  They will learn to ask why more often.  They will learn to identify and eliminate the root causes of defects—and eventually become true rock stars.

Organizations that succeed in their Lean Healthcare transformation are those that focus on supporting a cultural change in the way all staff members see their processes.  Organizations that struggle and eventually fail in their Lean Healthcare transformation are those that continue to celebrate the effective work-arounds and fail to support those who seed to eliminate root causes of waste.

This week’s blog was written by Jeff Wilson. Throughout Jeff’s career, he has delivered and applied progressive management and process improvement tools to help organizations reach new levels of performance. The industries span from healthcare to manufacturing, financial consulting and accounting. His experience with Six Sigma and Lean goes back to the early days of his career while working with Colgate Palmolive. Jeff had the opportunity to use process improvement tools as a participant on project teams and was so impressed with the effectiveness of these tools he began to further develop his understanding of and expertise in the implementation and use of them.  Throughout his career as a front-line Supervisor, Materials Manager, Logistics Manager and Plant Manager, Jeff has used and championed the use of Lean tools to deliver exceptional results.  Most recently, Jeff served in a consultant role with the Manufacturing Extension Partnership where he had the opportunity to support other organizations as they seek to improve processes by implementing Lean.  He has developed Lean transformation plans, facilitated Kaizen events and developed training materials for numerous client companies. Jeff has a Bachelors Degree in Economics from Western Kentucky University.  He also holds a Certified in Production and Inventory Management (CPIM) designation.

When I buy a Coleman tent, I am the ultimate judge of satisfaction with the product that Coleman offers. I decide, based on a number of factors, whether I will buy another Colman tent (if the one I have ever wears out).

When I purchase a Lexmark printer, I will ultimately judge my satisfaction with the printer. When the time comes to buy another printer, I will decide whether to buy another Lexmark.

When I go to Carrabba’s Italian Grill and enjoy the Pollo Rosa Maria, I will be the final arbiter of the quality of the meal. I will decide whether to order the Pollo Rosa Maria when I return to Carrabba’s. (Noticeably absent from the discussion is any question about whether to return Carrabba’s. That’s a foregone conclusion. My wife made that one.)

And so it is with most consumer goods and services. Coleman, Lexmark, Carrabba’s and all other producers must ensure they are listening to the customers. To be successful, they must ensure that they are constantly in tune with and responding to our collective voice.

Not so, in healthcare. Here are a couple of personal examples. I’m sure you could add several of your own.

When I go to Jewish Hospital Medical Center East for out-patient surgery, I am so pleased with the services provided by the excellent care-givers there. But, no matter how great my experience, I am not necessarily the decision maker for whether I return. Ultimately, others will make, or at least heavily influence my decision about whether to return to Jewish East for future procedures. My physician may choose to practice elsewhere. My insurance company may no longer include the Jewish Hospital system in its covered providers group. And myriad other factors may prevent me from choosing Jewish Hospital Medical Center for future procedures.

When I had labs drawn at LabCorp in advance of a procedure, I was so pleased with the friendliness of the staff, the cleanliness of the facility, and the minimal wait time that I would certainly choose LabCorp for future tests. But, it will not likely be my choice. A contract negotiated with very little consideration given to my satisfaction will likely determine where I go for future testing.

One of the fundamental tenants of Lean healthcare is to focus on the customer. These examples illustrate that in the application of Lean Healthcare, the patient is not always the customer. Every successful Lean Healthcare improvement event must include a proper consideration of the voice of the customer. Unfortunately, in health care, the customer is often not easily identified. A partial list of “Customers” can include  the patient, the patient’s family, the patient’s physician, the payer (private or public), numerous regulatory agencies (private or public), other caregivers and so on.  In some extreme cases, these customers have opposing criteria for evaluating the quality or value of a service. Criteria that are important to these customers may be of little or no concern to the patient. So how do we, as practitioners of Lean healthcare proceed?

It’s obvious that if we fail to properly consider the impact of our process improvements on patients, we will fail. So the voice of the patient must always be valued highly. But, Lean healthcare purists, who insist on focusing only on the voice of the patient, while ignoring the voice of other customers, run the risk of alienating those on whom they depend for success. 

For these reasons, it is important to be disciplined to include the full range of customers when implementing Lean healthcare solutions. Recognizing, early in the improvement process, that your customer may include more than just the patient, will help your organization to reach a solution that is mutually beneficial to all your “customers”. Engaging these other interests and considering their voices will help ensure that your team’s efforts optimize a greater part of the healthcare delivery system.

This week’s blog is written by Jeff Wilson. Throughout Jeff’s career, he has delivered and applied progressive management and process improvement tools to help organizations reach new levels of performance. The industries span from healthcare to manufacturing, financial consulting and accounting. His experience with Six Sigma and Lean goes back to the early days of his career while working with Colgate Palmolive. Jeff had the opportunity to use process improvement tools as a participant on project teams and was so impressed with the effectiveness of these tools he began to further develop his understanding of and expertise in the implementation and use of them. Throughout his career as a front-line Supervisor, Materials Manager, Logistics Manager and Plant Manager, Jeff has used and championed the use of Lean tools to deliver exceptional results.  Most recently, Jeff served in a consultant role with the Manufacturing Extension Partnership where he had the opportunity to support other organizations as they seek to improve processes by implementing Lean.  He has developed Lean transformation plans, facilitated Kaizen events and developed training materials for numerous client companies. Jeff has a Bachelors Degree in Economics from Western Kentucky University.  He also holds a Certified in Production and Inventory Management (CPIM) designation.