In Healthcare, we do lots of audits. Audits require inspection. But, did you know that each inspection is only about 80% effective? Audits may not be concurrent and are sometimes very after-the-fact. It is difficult to provide timely, accurate feedback to change outcomes when we are auditing the process so after-the-fact. It is also very difficult, if not impossible, to find the root cause of the problem after some time has passed.

By using source and self-checks, we can prevent errors at the start of a process and defects in outcomes. Successive checks shorten the feedback loop. By utilizing this concept, there are redundancies that can correct errors at the source and immediately as the process is taking place instead of providing feedback at some later time. But wait a minute – this all sounds like WASTE! In fact, it is a form of waste. However, until we have eliminated all of the causes of errors in a process, it is each supplier’s responsibility to deliver DEFECT-FREE service to their internal customers. Therefore, in Lean, we accept these temporary countermeasures until we find permanent solutions to the causes.

One obvious example of source, self and successive checks is implementation of the Universal Protocol to prevent wrong person and wrong site/side surgeries. The redundancies may seem annoying, however you can begin to see that the 20% ineffectiveness of audits is overcome by the successive checks, by checking everything at the source and doing your own self-checks.

Looking at the drawing, the person in operation “A,” begins the process by first inspecting everything at the source: are all necessary elements/materials present at the start? If not, the self-check provides immediate feedback that something needs to be corrected.

As the process is handed off, the person in operation “B,” begins their part of the process by inspecting everything from their source: are all necessary elements/materials present for their part of the process? If not, they can and should provide immediate feedback to Supplier A. Customer/Supplier B does a self-check of their work and prepares to handoff to Customer/Supplier “C,” who does the same.

This is why we do it, even if it feels like we do the same thing multiple times! Do those successive and, yes, sometimes redundant checks. If there is an error or issue, provide timely feedback to your source. This is how we achieve 100% percent inspection of the process and move toward 100% quality while relentlessly working to eliminate root causes.

 This week’s article was written by Bill Lowstuter. Bill has been a Sr. Consultant with HPP since its inception, and has worked with healthcare clients throughout the USA. Bill previously worked with HPP’s parent company, The ACCESS Group (TAG) for seven years prior to joining HPP. Bill has overseen the implementation of Lean within numerous facilities and industries, and has a Bachelor of Science degree in Engineering from the University of Illinois. He has also conducted numerous seminars and conferences in Kaizen principles and Lean.