Lean Healthcare Exchange

As more and more organizations gain experience in the application of Lean Healthcare methodologies, I frequently find myself involved in conversations that lead to the ultimate question of Sustainability.  During one of these recent talks, I was reminded of a 2006 blog post on the Lean Healthcare Exchange regarding Newton’s First Law.  For those who could use a refresher, Newton’s first law is commonly stated as, “Objects at rest tend to stay at rest and objects in motion tend to stay in motion unless acted upon by an outside force.”  At the time, the intent of the blog  was to encourage leadership to set their Lean journey in motion and address “How do we get the ball rolling?”.  For those who have started that journey, the question now is how to keep the momentum going or “How do we keep the ball rolling”.

When asked about their Lean Healthcare journey, most leaders will begin the conversation by describing the amazing improvements in both process and people that they have witnessed in the past few months or years.  They recognize the value that Lean Healthcare has brought to their organization but many have seen other initiatives with just as much promise lose traction quickly once the “new wears off”.  They have already begun to see that there are “outside forces” in their organization acting on this “object” or Lean journey that they have worked so hard to build. 

Some of these forces, like gravity, are naturally occurring and are found to act in consistent ways across almost all organizations.  As leaders, you have confronted them in every role you have held throughout the years.  These forces include a natural resistance to, or fear of change.  Because any change (even good change) involves a loss of some kind, this force will remain intact just as gravity is always at work in the natural world.  The good news is, once we know the force that we are encountering and its predictable behavior, we can counter it.  Just as we’ve developed tools, methods or machines to “cheat gravity” (i.e. airplanes) or harness  gravity to our advantage (the free fall ride at Disney World) we should use Leadership Standard Work (the defined routines and processes that leaders fulfill in managing the Lean system), Daily Management (the process level daily routines & metrics that front line supervisors use to drive standard work), Daily Problem Solving & Coaching to combat these forces and “keep the ball rolling”.  Just as working in the gym allows us to jump higher and higher (some of us at least), these countermeasures put in place a structure that allows the organization to work against naturally occurring resistance that will always be present.

Keeping with the analogy of a rolling ball, there is another “outside force” to be considered – friction. Unlike gravity, friction is a direct result of the environment and it varies based on the smoothness of the surface that the ball is rolling on.  With respect to Lean journeys, we find that this force varies widely between organizations and facilities.  When encountering this resistance, most leaders initially mistake it for “gravity” in that the natural resistance to change is overwhelming the ability of the organization to change.  On further investigation, we find that these forces are more a function of the specific environment and can be controlled and “smoothed”.  Friction can be generated when support services are not aligned to support improvement efforts (i.e. response time to move a Pyxis station is 30 days vs. 1 day), or communication is unclear around changes/improvements to the work (i.e. the “what” is communicated, not the “why”) to name a few.  A detailed understanding of what is happening at Gemba (the floor) is required to identify these sources of friction, but once seen, they can be managed, if not eliminated.  Often, these issues can be alleviated with a simple change to process or standard work.

There are many factors that can affect the sustainability of your Lean Journey and understanding the “outside forces” that are currently working to slow your momentum is critical to your long term success.  As leaders, it is important to diagnose these factors as either naturally occurring (like gravity) or a product of the environment (friction).  With this knowledge, we can select the appropriate treatment and put in place the structures that will allow for that ever elusive goal of Sustainability.

This week’s blog was written by HPP’s Marshall Leslie. Marshall, a Six Sigma Blackbelt, is the Vice President of Operations at HPP.  As a former multiple year “top-ten percent” performer at General Electric, Marshall brings clients the much needed tools and techniques needed in any industry, including healthcare. Marshall is a graduate of General Electric’s Operations Management Leadership Program; he has experience in various supply chain capacities including quality engineering and global sourcing for both GE and Procter & Gamble. Marshall’s expertise in both Six Sigma and Lean enables him to apply a broad spectrum of process improvement tools tailored to the healthcare industry’s needs. He holds a degree in Industrial and Systems Engineering from Georgia Tech.

Over the past few weeks I have had many conversations with healthcare organizations that are in the initial stages of their Lean Healthcare journey and are actively seeking a Lean Facilitator for their facility. After much enthusiasm and many resumes screened, most have been discouraged to find that these resources do not “grow on trees”. Phrases like “searching for a needle in a haystack” and “Mission Impossible” have been used to describe the process. The current labor pool is filled with experienced Lean facilitators from other industries; however, many will struggle to translate this knowledge to the healthcare arena. Meanwhile, internal candidates must be taught Lean methodologies and may be too entrenched in “how things are” to see “how things could be. While the typical interview process focuses on past accomplishments as a predictor of success, our experience has shown that the presence of specific behavioral traits may be more useful in identifying the “right” (and “wrong”) candidates. Some of the most significant traits are listed below:

Energy:

Leading a Lean Healthcare initiative can be taxing work and energy is a must. Those who are selected must have the ability to energize teams, especially when the going gets tough. Likely candidates are known for exhibiting a passion for change and demonstrating a “Just Do It” attitude in the course of their daily work.

Interpersonal Skills:

An effective facilitator must be able to build relationships easily with teams. Candidates are often seen as informal leaders or “resident experts” within the organization. They are known for having the ability to “get things done” through influence rather than administrative mandate.

“Eye for Waste”:

The ability to identify all types of waste in processes is paramount to good Kaizen facilitation. Search for those with a reputation for constantly examining their own activities and eliminating waste. 

Learning Orientation:

Those selected to carry on the Lean work in your facility must have a strong desire to learn and teach Lean concepts. This will allow your organization to continue to innovate and truly become a learning organization.

Innovation/Creativity:

Truly great Lean facilitators have the ability to pull their view away from “doing what we do better” and drive towards “what could/should be”. A large majority of candidates are adept at optimizing your current state but few can create a vision for a radically different future state that can take your organization to the next level.

Facilitating a Lean transformation requires not only significant effort but also considerable skill. Often the answer to this classic “Make” vs. “Buy” question lies more in behavioral traits of the candidate than any past experience that could be considered a “head start”. While the previously mentioned qualities and traits are only a subset the criteria that must be considered in the selection of a Lean resource, it is our hope that applying these filters will assist in narrowing your search.

This week’s blog was written by HPP’s Marshall Leslie. Marshall, a Six Sigma Blackbelt, is the Vice President of Operations at HPP. He oversees various HPP projects and Lean Healthcare transformations for clients throughout the USA.  As a former multiple year “top-ten percent” performer at General Electric, Marshall brings clients the much needed tools and techniques needed in any industry, including healthcare. Marshall is a graduate of General Electric’s Operations Management Leadership Program; he has experience in various supply chain capacities including quality engineering and global sourcing for both GE and Procter & Gamble. Marshall’s expertise in both Six Sigma and Lean enables him to apply a broad spectrum of process improvement tools tailored to the healthcare industry’s needs. He holds a degree in Industrial and Systems Engineering from Georgia Tech. 

Every fall I have the distinct honor of participating in one of the most prestigious golf tournaments in the Southeast, known as the “Brawl in the Fall”.  In truth, this tournament is little more than some old college buddies getting together to hit golf balls into the woods of north Georgia, however; giving it a name does seem to add a level of “polish” to the event.  As we worked our way around the course this year (and through the woods, into the water, out of the sand, etc.) I could not help but think about the parallels between what I was witnessing on the course and what I see implementing Lean Healthcare every day.

In the interest of sportsmanship, we use a handicap system to allow even the worst players to have a shot at winning the trophy.  The system classifies each player as either an “A”, “B” or “C” golfer. 

“A” Golfers:
The “A” Golfers are the best players in the tournament.  They practice constantly, are the first ones to the practice tee and must hit practice puts before beginning their round.  As I watch them play (this means that I do not belong to this group!), it is evident that they have a method and process for how they approach each shot.  In effect, they have created standard work for every element of their game.  Most importantly, they know when they have created a defect (poor shot) and stop to fix the problem before moving on to the next shot.  We see these same characteristics in organizations who have implemented all aspects of the Lean Healthcare management system.  Standard work is present and in use, normal operating rhythms are in place, processes support the work and abnormal conditions are easily spotted to name a few.

“B” Golfers:
The “B” group can best be described as “descent”.  They play frequently on their home course, can score predictably well and when the stars align might even beat an “A” golfer.  These players take lessons occasionally and practice when they are getting ready for an event but do not make it a routine. Ultimately, they are the most frustrated player on the course because they have seen their potential on that magical day when they beat the “A” golfer but can’t consistently perform.  Other activities are a priority and as a result the golf score suffers.  Many who are in the early stages of their Lean Healthcare journey will find themselves relating to these players.  The standards, processes and operating rhythms needed to consistently excel have not been fully developed. While they experience great success in individual areas of their Lean Healthcare implementation, these accomplishments are dulled somewhat by inconsistent performance.

“C” Golfers:
The “C” players are an interesting group in that they are happy to be playing but complacent about their performance.  Hitting drives into the woods and earning triple boagies are a normal part of the exercise.  The “C” group happily rides around the course either not seeing the Waste that they create or not understanding that they don’t have to perform this way.  Their game is in such trouble; they don’t see a path forward to playing good golf and have resigned themselves to the “C” ranks.  Often we see organizations who have attempted to raise their performance in the past through Lean, Six Sigma or other improvement methodologies only to fall back to average.   They remain in this state either because they can’t see that better service could be delivered or they don’t have a clear vision/drive to get to “A” performance.

To take the analogy one step further, you must ask: “Which golfer represents your organization?”   If you are an “A” golfer, how will you continuously improve?  If a “B” player, what must be done to make your gains more sustainable and consistent?  If a member of the “C” ranks, are you prepared to take on the hard work needed to elevate the performance of your organization?

This week’s blog was written by HPP’s Marshall Leslie. Marshall, a Six Sigma Blackbelt, oversees various HPP projects and Lean Healthcare transformations for clients throughout the USA.  As a former multiple year “top-ten percent” performer at General Electric, Marshall brings clients the much needed tools and techniques needed in any industry, including healthcare. Marshall is a graduate of General Electric’s Operations Management Leadership Program; he has experience in various supply chain capacities including quality engineering and global sourcing for both GE and Procter & Gamble. Marshall’s expertise in both Six Sigma and Lean enables him to apply a broad spectrum of process improvement tools tailored to the healthcare industry’s needs. He holds a degree in Industrial and Systems Engineering from Georgia Tech.

Whether you are facilitating a Kaizen Event or completing a problem solving A3 in your department, a deep understanding of the Current State is a requirement of any well planned Lean Healthcare activity.  In the effort to define the existing process, we find, almost without fail, that there are as many different versions of the Current State as there are people involved in the activity!  I have witnessed many different reactions to this realization over the years including shock, complacency and pride in the independence of staff performing the work in their own unique fashion.  Through these different reactions, a second prediction can be made just as easily: no one will stop to ask “Why?”

While there are many factors that contribute to this condition, my first answer to the question of “Why?” would be a lack of documented standard work.  While the development, creation and maintenance of these documents rarely receives the fanfare of a Kaizen event report out or Lean project that shows significant savings, they are arguably more important.  One of my associates uses the illustration of giving directions to the airport as a quick point lesson on the importance of knowing the current state and having standard work.  He asks the group to give him directions to the airport and then allows the audience to proceed with detailed and sometimes accurate directions to the nearest airport.  He then follows with the question, “How could you give me directions when I haven’t told you where I’m starting from?”  It is the same with the Lean activities described above.  We can’t get where we are going if we don’t know where we are starting from.  We don’t know where we are starting from unless we have standard work in the Current State.

Consider an organization that never reinvented the wheel, could move staff into new roles with minimal ramp up time, and always produced a predictable and quality outcome.  This vision is often the reason that healthcare facilities begin their Lean journeys and creating and maintaining standard work is an essential part of reaching these goals.  Maintaining standard work enables consistent knowledge transfer and lays the foundation that is necessary to accelerate organizational learning and ultimately leads to consistent quality outcomes. 

Does your organization use standard work?  Do you have a method for maintaining and improving this work?  Without it, we will continue to see many different versions of the Current State and struggle to achieve the quality outcomes that the organization works so hard to deliver.
 
This week’s blog was written by HPP’s Marshall Leslie. Marshall, a Six Sigma Blackbelt, oversees various HPP projects and Lean Healthcare transformations for clients throughout the USA.  As a former multiple year “top-ten percent” performer at General Electric, Marshall brings clients the much needed tools and techniques needed in any industry, including healthcare. Marshall is a graduate of General Electric’s Operations Management Leadership Program; he has experience in various supply chain capacities including quality engineering and global sourcing for both GE and Procter & Gamble. Marshall’s expertise in both Six Sigma and Lean enables him to apply a broad spectrum of process improvement tools tailored to the healthcare industry’s needs. He holds a degree in Industrial and Systems Engineering from Georgia Tech.

Workarounds, Band-Aids and “It works for now” solutions are a common occurrence in any almost environment, but they are especially prevalent in the healthcare arena. While at times we recognize them for what they are, we often find ourselves marveling at the creativity and the ingenuity required to develop these much needed “solutions” to the problem at hand.  In almost every facility we visit, there is at least one staff member who has built a reputation for their ability to create workarounds and gained the respect of others for this talent.  In the course of Lean implementation, we are challenged to eliminate the waste that is created by these process deviations and create sustainable, high quality, flexible processes.  As Lean Healthcare practitioners, we must also resist the urge to create workarounds ourselves in the name of making progress in the short term.  Why are workarounds so contrary to Lean principles and what’s so wrong with them?  To answer that question, we must first understand the true nature of the beast.

At their core, workarounds are caused by processes and systems that do not support the work that must be completed.  While they are typically temporary fixes, workarounds are also testaments to the creativity of staff that are not equipped with the tools needed to accomplish the job at hand.  So often we commend these actions as brilliant displays of “out of the box” thinking.  In reality, workarounds represent a glaring example of tradeoff thinking.  In order to achieve performance in one area, another key element (Satisfaction, Quality/Safety, Time/Utilization, or Financial) is sacrificed.  Take the example of medication overrides.  While valiant efforts are being made to reduce or eliminate override occurrences, workaround processes still exist that allow deviation from the approved (and safest) process for medication administration.  Allowing this deviation reduces the need for the real time problem solving efforts that will eventually lead to the resolution of the issue.  A short term need has been met, but long term patient safety has been degraded.  When the system is stressed, failures will likely occur.

The waste that is generated by workarounds is not only experienced by those creating them.  Every process or activity involves a customer and supplier who ideally interact in a defined way to ensure quality and efficiency.  When either participant in this pair deviates from the process, waste is created for both parties.  In keeping with the medication theme, take the example of the floor nurse who has faxed their medication order to the pharmacy and is now waiting for delivery of the first dose.  As wait time builds, the order is scanned again and the nurse finally picks up the phone and calls the pharmacy.  The pharmacist offers to have the medication waiting at the door if the nurse will come to the pharmacy and pick up their med.  Problem solved or problems created?  If we look at this interaction through Lean eyes it is fraught with waste.  Multiple connections were required to complete the process.  The nurse had to leave their patients in order to get the medication and the pharmacist will lose valuable time due to the interruptions caused by the request and the work required to remove excess scans from the system.  Finally, we must consider the impact of this workaround being used by all of the staff in the facility.  How much of the wait time that forced the workaround was created by others using the workaround as well?

Whenever we face a decision to deviate from an existing process, there is an opportunity to create a workaround.  To avoid this trap, test the change against fundamental Lean Healthcare principles.  Consider asking these two simple questions:

• Am I giving up something (Satisfaction, Quality, Time, Financial) in order to meet my goal? (Tradeoff Thinking)
• Why am I considering deviating from the process? (Use the 5 Why’s)

Answering these two questions should assist in exposing the proposed solution as a workaround (if it is one) and exposing the root cause of the issue.  Once exposed, the waste can be eliminated without tradeoffs and the creative energies of your organization can be applied to improving the business rather than creating temporary solutions.

This week’s blog was written by HPP’s Marshall Leslie. Marshall, a Six Sigma Blackbelt, oversees various HPP projects and Lean Healthcare transformations for clients throughout the USA.  As a former multiple year “top-ten percent” performer at General Electric, Marshall brings clients the much needed tools and techniques needed in any industry, including healthcare. Marshall is a graduate of General Electric’s Operations Management Leadership Program; he has experience in various supply chain capacities including quality engineering and global sourcing for both GE and Procter & Gamble. Marshall’s expertise in both Six Sigma and Lean enables him to apply a broad spectrum of process improvement tools tailored to the healthcare industry’s needs. He holds a degree in Industrial and Systems Engineering from Georgia Tech.

So often in the Lean Healthcare community we speak about the importance of evaluating all activities as they relate to the customer, both internal to the organization and most importantly the patient.  We spend hours of effort and energy in Kaizen Events labeling processes and steps as either Value Added or Non Value Added based on whether our customer will value that activity. Often the answer to the question, “What do patients want?” is self evident. No, they do not want to wait any longer than necessary. Yes, they do want a timely response when they hit the call light (intentionally that is!).  Yes they do want the correct medication given on time, every time.  Sometimes, “It’s just that easy”.

It’s Not That Simple
Even so, there are many other questions that are not so easily answered.  For example, do patients want to use a restaurant style “buzzer” to be called for registration?  Would patients prefer to have access to their records and test results through the internet or would they prefer a call from their doctor’s office?  The answer to many of these questions is often, “It depends”.  It depends upon your patient population.  It depends on the nature of the process you are reviewing.  It depends on many other factors that are difficult to quantify but are significantly relevant to the question of “What do patients really want?”

Dig Deeper
If we are truly honest with ourselves, many times the criteria that is used to determine what patients want is more so based on our own wants/desires for what the process should be than what our customers are asking that it be. Our own experiences with the healthcare system coupled with “tribal knowledge” of what has worked in the past are powerful forces that can cloud our vision of what today’s patient is asking for.  Certainly, significant time, energy and resources are spent surveying patients on different elements of their experience. This data is extremely valuable but it often fails to answer many of the specific questions about the patient’s wants and needs that are raised in the effort to remove waste. If we want to truly place the patient at the center of the Lean implementation, we must take a fresh look at how we determine what patients really want.

Now What
While there is no simple answer to fully understanding each patient’s individual needs, there are some actions we can take as Lean practitioners to ensure that we place the patient or customer at the center of each decision.

• Use the information available.  Rarely do I find that there is a shortage of data around the patient’s perception of their experience with a particular facility or process.  Just as rare are organizations that use this data to drive specific, proactive improvement activities. 
• Include considerations of customer satisfaction (patient, physician, staff, etc.) in the business case for all improvement activities.
• Ask the 5 Why’s.  When statements are made that reflect a customer or patient’s perception, challenge them.  Ask why we think the patient values this step or service and continue this line of questioning to root cause.  You may be surprised at the result.
• Incorporate customers in your Kaizen activities.  So often we ensure that all internal customers are included when improving processes but rarely are external customers (patients, suppliers, etc.) asked to participate.  This is a major leap for most organizations and requires a level of trust between all parties, but it can be extremely effective.

The list of possible ways to better understand your customer’s requires is endless, either through data analysis or just walking the Gemba.  The important thing is that we constantly and earnestly ask the question, “What do patients really want?” When this core principle becomes a part of the culture, you can be assured that decisions will be aligned with the mission of your Lean Transformation.

This week’s blog was written by HPP’s Marshall Leslie. Marshall, a Six Sigma Blackbelt, oversees various HPP projects and Lean Healthcare transformations for clients throughout the USA.  As a former multiple year “top-ten percent” performer at General Electric, Marshall brings clients the much needed tools and techniques needed in any industry, including healthcare. Marshall is a graduate of General Electric’s Operations Management Leadership Program; he has experience in various supply chain capacities including quality engineering and global sourcing for both GE and Procter & Gamble. Marshall’s expertise in both Six Sigma and Lean enables him to apply a broad spectrum of process improvement tools tailored to the healthcare industry’s needs. He holds a degree in Industrial and Systems Engineering from Georgia Tech.

A recent news report from NPR (6/27/08) touted the World Health Organization’s (WHO) use of checklists in 8 different hospitals around the globe to reduce surgical errors.  According to the report, a simple checklist of 22 items has helped these facilities improve the rate at which they performed surgery without error or omission from 33% to approximately 66%.  The checklist covers all aspects of the patient’s procedure and is divided into three phases: before anesthesia, before incision and before the patient leaves the room.  With over 230 million major surgical cases per year, these results reveal opportunity on a massive scale.  The checklist is reminiscent of those used in the airline industry almost religiously to ensure the safety of the aircraft prior to takeoff.  While this concept is not new in the surgical arena, the report did spark a few thoughts on a key Lean principle, error proofing.

First, the power of the checklist lies in its simplicity.  In a world in which complex devices and systems are typically the first line of defense, it seems almost unconscionable that a sheet of paper and a pen could be the remedy for so many errors.  As the story reports, many questioned the initial effectiveness of the tool because of its simple nature until they personally experienced the benefits of the checklist (i.e. avoided significant errors through the use and verbalization of the tool).  However, it is through these new experiences or “saves” that new beliefs are formed which ultimately result in new actions/behaviors.  Many of the checklist’s original detractors have now become its greatest champion.

As a community of continuous improvement practitioners we must also ask, “How do we get from 66% to 100%?”  It is this question and many like it that challenge us as we work with surgical staff across the country to improve the safety and quality of care.  Certainly, there is more in the error proofing toolbox than checklists.  A deep dive into the root causes of error can lead to an array of error proofing devices and process changes.  Once processes are stable and standard work is in place, Six Sigma methodologies should also be considered to further drive out variation, the precursor to defects and error.  While the WHO’s success is unquestioned, there is much work ahead to translate potential to reality.  The use of a wide array of error proofing methodologies will be one of the keys to realizing these goals as we continue to make strides toward the ultimate goal of defect free healthcare. 

For more information on NPR’s coverage of the WHO, follow the link below: 

http://www.npr.org/templates/story/story.php?storyId=91945517
(Follow links from this page for an audio report from NPR and free downloads of the WHO’s checklist and implementation manual).

This week’s blog was written by HPP’s Marshall Leslie. Marshall, a Six Sigma Blackbelt, oversees various HPP projects and Lean Healthcare transformations for clients throughout the USA.  As a former multiple year “top-ten percent” performer at General Electric, Marshall brings clients the much needed tools and techniques needed in any industry, including healthcare. Marshall is a graduate of General Electric’s Operations Management Leadership Program; he has experience in various supply chain capacities including quality engineering and global sourcing for both GE and Procter & Gamble. Marshall’s expertise in both Six Sigma and Lean enables him to apply a broad spectrum of process improvement tools tailored to the healthcare industry’s needs. He holds a degree in Industrial and Systems Engineering from Georgia Tech. 

In my travels to facilities across the country, I often meet caregivers and front line staff who are not empowered to insist on quality in all aspects of their jobs.  Whether it be a nurse receiving an incomplete report on their patient or a chart being passed on in poor order, the predominant culture in healthcare organizations today is one that allows defects or errors in what is delivered and expects that those receiving defective materials, information, etc. do the best that they can with what is offered.  At the root of this issue is a lack of well defined customer/supplier relationships and a culture that typically insists on quality only as it relates to a perceived direct impact on patient care.

The remedy for this is certainly not a shortcut or quick fix.  What is needed is a shift towards the “Stop the Line” mentality that is frequently referenced in discussions about Lean but rarely practiced in the healthcare.  All too often, concerns about emergent situations and difficulties driving accountability across departmental boundaries stop us short of adopting a true defect free quality standard.  In order to drive closer to this key Lean principle, we must begin with some basic questions:

Q: Is Quality defined?

Q: Is it culturally acceptable to “create” a defect or pass it on to the next step in the process?

Q: Are staff empowered to reject incoming defects and “Stop the Line”?

While tactical improvements in process and clear communication of standards will assist in driving toward this goal, the critical element of culture change cannot be ignored.  Initially, strong leadership support will be needed to empower staff, bridge interdepartmental boundaries and ensure that the focus remains on providing better service to patients and families.  In addition, staff must begin to adopt a new way of thinking about their work and redefine the concept of who their customers are before sustained success can be realized.  Ultimately, the organization’s goal must be that these behaviors are driven not through mere compliance but by a facility wide respect for patients, people (other staff and facility partners) and process.

This week’s blog was written by HPP’s Marshall Leslie. Marshall, a Six Sigma Blackbelt, oversees various HPP projects and Lean Healthcare transformations for clients throughout the USA.  As a former multiple year “top-ten percent” performer at General Electric, Marshall brings clients the much needed tools and techniques needed in any industry, including healthcare. Marshall is a graduate of General Electric’s Operations Management Leadership Program; he has experience in various supply chain capacities including quality engineering and global sourcing for both GE and Procter & Gamble. Marshall’s expertise in both Six Sigma and Lean enables him to apply a broad spectrum of process improvement tools tailored to the healthcare industry’s needs. He holds a degree in Industrial and Systems Engineering from Georgia Tech.

As Lean continues to become the improvement methodology of choice in healthcare, we see that many leaders in the industry are working to define the relationship between Lean and existing quality initiatives at their facilities.  Is Lean a replacement for PI? Is it just another tool to use on PI projects? The short answer is that ongoing quality efforts will complement Lean, but Lean is not a subset of PI, nor does it replace the need for PI or quality initiatives. 

This relationship becomes clearer once the goals and structure of the Lean operating methodology are truly understood.  While the typical quality or PI approach seeks solely to identify specific problems and employ tools (i.e. PDCA, FMEA, etc.) to realize the desired improvement, a true Lean transformation seeks to change the underlying operational thinking and methodology of the organization. 

While quality is certainly one of the key tenants of Lean, and its methodologies are firmly based on a “right the first time” mindset, true Lean transformation is not isolated to the quality arena.  Lean seeks to holistically improve the organization through improved service, flow & utilization (time), and financial performance.  Every effort should be made to align existing quality initiatives with the Lean transformation work so that these activities do not conflict.   Both Lean and existing PI initiatives can occur in parallel to further the common goal of defect free care.

It is important to continue existing PI efforts, especially at the beginning of the Lean transformation, as not all Lean events will focus specifically on quality improvements. When you eliminate waste in any process using Lean; service, quality, time and financial performance should improve, even if the primary focus of an event is not a Quality metric.  Lean improvement events should be selected based on business case needs, which will never compromise quality, but may focus on creating flow in processes or improving service rather than directly impacting quality outcomes.

Ultimately, PI and quality initiatives will support the overall Lean transformation but we must be careful not to limit the scope of Lean efforts to the quality arena.  While there are improvement tools associated with Lean, its power is not in the toolkit itself but rather in the implementation of the entire system and a fundamental change of the organization’s operating methodology.

This week’s blog was written by HPP’s Marshall Leslie. Marshall, a Six Sigma Blackbelt, oversees various HPP projects and Lean Healthcare transformations for clients throughout the USA.  As a former multiple year “top-ten percent” performer at General Electric, Marshall brings clients the much needed tools and techniques needed in any industry, including healthcare. Marshall is a graduate of General Electric’s Operations Management Leadership Program; he has experience in various supply chain capacities including quality engineering and global sourcing for both GE and Procter & Gamble. Marshall’s expertise in both Six Sigma and Lean enables him to apply a broad spectrum of process improvement tools tailored to the healthcare industry’s needs. He holds a degree in Industrial and Systems Engineering from Georgia Tech.

In past editions of the Lean Healthcare Exchange we have discussed the complementary use of Lean and Six Sigma to solve problems and improve process performance. For many who are in the initial phases of their improvement journey, Lean methodologies are all that is needed to drive significant change throughout the organization.  However, as you continue in your Lean journey, some issues may survive initial Lean efforts and linger unresolved.  Our experience has shown that Six Sigma is the complementary toolkit best suited to drive improvement for these more complex, multivariable issues.  Ultimately, the question is not If you will need Six Sigma, but When.

Read the Instructions First……

With Christmas on the horizon, it is likely that many of us will receive a myriad of electronic gadgets in our stockings.  For example, new digital cameras will be found under many Christmas trees this year and if you are like me, you will open the box, find out where the batteries go and begin experimenting without ever looking at the User Manual.  At my house, there is a high likelihood that the manual will be thrown out with the discarded wrapping paper later that morning!  The problem: I’ll be able to take pictures immediately but I’ll never learn how to do more than point, click and download my photos.  All of those wonderful innovations and features that could have made me the Picasso of modern photography have gone to waste because I didn’t take the time to learn how and when to use the tool properly.

It is common to see organizations that make the same mistake in utilizing Six Sigma.  All too often we are guilty of attempting to apply an improvement methodology in an “across the board” fashion without thought for which tool is best in a particular situation.  Just as you don’t use a 10 pound sledge hammer to hang pictures in your home, Six Sigma is not always the most direct avenue to your goals.  The key is to know when and where the use of Six Sigma is appropriate and best suited for the task.  In many cases, it is helpful to seek the help of someone with a deep understanding of both Lean and Six Sigma to assist in project selection and overall guidance of the initiative.  Typically the projects most ripe for Six Sigma application are those in which “common sense” solutions have failed (in some cases multiple times) and intense analysis of performance data is needed to discover hidden interactions driving the true root causes.

It’s being done…..

With a working knowledge of how and when to properly utilize Six Sigma, some healthcare organizations across the country are finally solving many of those nagging problems that were thought impossible to solve.  In one documented case, a lab used Six Sigma methodologies to conduct a Design of Experiments targeted at accessioning errors.  The issue had survived many other improvement efforts, but using Six Sigma the facility was able to identify hidden interactions and drive dramatic improvement. 

On the other side of the equation, insurance providers have used Six Sigma to attack issues such as mental health related readmission rates.  In one documented case an insurance provider discovered previously unknown correlations that lead to recommendations of more proactive and effective interventions for mental health patients. The end result was cost savings for the insurance provider and increased satisfaction for the patient.

These are only a few examples of successful Six Sigma application within the healthcare arena.  Six Sigma has proven to be a powerful problem solving tool in almost any transactional process and can serve as the perfect complement to any ongoing Lean initiative.

What issues have survived your facility’s process improvement efforts and defied all “common sense” solutions?  Is it time to consider Six Sigma?

This week’s blog was written by HPP’s Marshall Leslie. Marshall, a Six Sigma Blackbelt, oversees various HPP projects and Lean Healthcare transformations for clients throughout the USA.  As a former multiple year “top-ten percent” performer at General Electric, Marshall brings clients the much needed tools and techniques needed in any industry, including healthcare. Marshall is a graduate of General Electric’s Operations Management Leadership Program; he has experience in various supply chain capacities including quality engineering and global sourcing for both GE and Procter & Gamble. Marshall’s expertise in both Six Sigma and Lean enables him to apply a broad spectrum of process improvement tools tailored to the healthcare industry’s needs. He holds a degree in Industrial and Systems Engineering from Georgia Tech.