Posts Tagged healthcare

Undercover Hospital Sensei’s Diagnosis – “Healthcare is Broke” [guest post]

Normally, I introduce the guest post author at the conclusion of the post. However, this one needs a little pre-post explanation. Believe me.

First the introduction. This post was earnestly written by my friend, Jeff Fuchs. He is Director of the Maryland World Class Consortia, a lean non-profit assistance organization in the mid-Atlantic. He is also president of Neovista Consulting, working with large and small organizations on lean, leadership, and organizational change. Jeff has participated in the development and expansion of SME/AME/Shingo Prize/ASQ Lean Certification.  He is Lean Bronze Certified and serves as Co-Chairman of the Lean Certification Oversight Committee.  Jeff received his B.S. in aerospace engineering from West Point.  He is a veteran, and a member of the Shingo Prize Board of Examiners.  His current projects are in lean for personal time management, job shops, and lean government.

Now the explanation/background. At the moment, Jeff is the instructor for three lean training programs.  Recently, a trip to the emergency room interrupted one of his training sessions. Subsequent to the “interruption,” Jeff sent out an apologetic and, ever the sensei, instructive email to his session participants. He also shared the email with some other folks. Unfortunately for him, I was one of those folks. Jeff has graciously agreed to let me post his email (with some slight editing) within Gemba Tales. I think his entertaining letter drives home some of the not insignificant opportunities within health care, the importance of customer focus, and the power of direct observation (even when wearing something lent to you by the hospital). That, and Jeff managed to read a great lean book during his “incarceration” and then give it a plug.

The subject line of Jeff’s email –“I’m just fine!” Wish I could say the same for health care in this country.

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Dear Class,

“Rumors of my demise are greatly exaggerated.” Please accept my sincere apologies for throwing your day off last Thursday. Unfortunately, I had to bring my body into the shop for some unscheduled maintenance.

As we all heard Sir Ken Robinson observe on Wednesday’s video, some of us just view our bodies “as a way of getting our heads to meetings.”  Proper upkeep falls by the wayside from time to time, and this is what happens.  A bit of detail is in order.  I was up to answer nature’s call at 4:15 a.m. on Thursday, and instead of the usual heartbeat, “thumpita-thump, thumpita-thump, thumpita-thump…,” what I felt was more like “thumpita-thump, eeerrk! thumpita-eeerrk! thumpita-thump…errkk!…”

I grabbed my keys, wallet, cell phone, and a good book and drove to the emergency room.  You may have missed your day of training, but let me tell you that “class was in session” at the Baltimore Washington Medical Center ER when I showed up for school at 5 a.m.  Four hours later, (Let me say that again, “FOUR HOURS LATER”) we were still monkeying around with forgotten paperwork, twice redone blood draws, shift change meetings over my bed, staff that was making three trips to my room to restock inventory, and rolling me through a series of three “patient inventory” transactions between some lab and back to my ER bay of “move, wait, process, wait, move, wait” for X-ray, sonogram, and ECG, respectively.

I told you folks.  I TOLD you to your face!  “When I am through with you, if I am successful, I will make you as miserable a human being as I am.  You will see broken processes all around you.”  Welcome to my world.  Behold, the sad customer/piece of meat-inventory:

Now seriously, don’t he look sad?  Pity the poor victim of broken process.

Naturally, in a case like this I couldn’t resist going into Consultant Mode.  In spite of being hooked up to the monitor, IV, oxygen, etc. like a marionette, the monitor kept losing my continuing thumpita-errk heartbeat, so the nurses had to keep walking back to the main desk an average of every 11.3 minutes (but who’s counting) to see if I was dead yet and to reset the monitor.  How thoughtful of them to give me an ER bay where I could see their goings on.  Their wasted motion, their absence of mistake-proofing or visual controls, their failed attempts to communicate with each other, failed service opportunities, excessive patient transportation, and more.  How very thoughtful.

After three hours of fear, boredom, and frustration cocktail, I used a pen left behind by one of the nurses and began sketching out a nurse/patient spaghetti map of my morning on the back of an IV wrapper I found on the floor, along with a crude value stream map.  (There are a few things wrong in that last sentence.  Please use a black or blue ink pen to circle them.  We’ll review your answers next session.)  The ER staff found my doodles and efficiency ravings…amusing.  I’m sure they did not have much time to be interested in the “bored consultant in room six” at the same time they had to deal with the cut up guy the cop brought in handcuffs, the construction worker who just fell off a scaffold, the guy sleeping on a gurney in the hall who nobody knows where he came from, or the other poor folk who needed their full attention.

The attending physician diagnosed me with “atrial fibrillation,” an eminently treatable condition.  We’ll see in a couple weeks what the follow up says.  They admitted me for observation, where I was subjected to other process design and systems management horrors which I shall not relate to you with at this time.  Suffice it to say, I got an education in that fourteen hours.  The lesson for me: Healthcare is broke.  It’s broke bad.  I mean, if I had a clone army of a thousand Lean Jedi Knights, we’d be swinging our Lean Lightsabers for decades trying to unhose healthcare in this country.  Lean Facilitator Certification Program students, your future in this industry is secure.

By the way, one final note on my lean healthcare field trip.  The “good book” I mentioned that I snagged on my way out the door was Toyota Kata, the one I described with such admiration on Tuesday morning, lamenting that I had not had the time to read it.  Well, there you go.  I plowed through half of it.  Would have gotten further, but had to watch a really good Jerry Springer and eat my tasteless hospital food (Overcooked mac and cheese, gray asparagus, canned pears, and a drink that arrived completely frozen solid.).  So, remember what I said: “A true lean leader is a lifelong learner.”

Put your left hand on the computer screen, raise your right hand, and repeat after me: “A-true-lean-leader-is-a-lifelong-learner.”

Here’s me “enjoying” my incarceration:

Pick up a copy of Toyota Kata.  Will change your life.  It’s an easy and interesting read.  You can finish it in a weekend.  Or two bad Emergency Room visits.  Whichever.

Related posts: Beyond Toast Kaizen – Lean Breakfast Concepts, Circa 1937, Lean Management Systems and Actionable Empathy…or, “How Was Your Day?”

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Lean Management Systems and Actionable Empathy…or, “How Was Your Day?”

We have all experienced significant stress. You know, the feeling that you’re treading water after just being dunked by more than a few unforgiving waves… and more waves are coming…and it’s dark.

There’s nothing worse than giving maximum effort and knowing that it might not be good enough. Well, actually there is something worse – feeling like you’re all alone and no one cares.

Primary care physicians can experience that kind of stress. Often they are a pretty autonomous lot. This can enhance the feeling of isolation. Enter the benefits of tiered meetings as part of an effective lean management system.

Tier I meetings, typically a short (5 to 15 minute) daily  meeting, fosters communication and helps focus the natural work team on process performance, improvement opportunities that have been surfaced in the last 24 hours, and planning for  the next 24 hours, etc. But, I never really thought too hard about the role of empathy within the tier I…until I heard a doc, a recent lean convert, describe how it has helped change everything.

His team of nurse, medical assistant and secretary, within what they appropriately reference as a tier I “huddle,” regularly starts with the staff asking the doc the important question of, “How was (is) your day?” Now, this didn’t start as part of the tier I’s standard agenda, but instead was an intuitive question asked by a caring staff.

As the physician described the tier I, he focused on the discussions around schedule, patient wait times, rooming performance, and team implemented improvements, but he also talked about how he no longer felt like it was him against the world. The question of, “How was your day?” seemed to change so much. His team cared, wanted to help and regularly did.

Patient satisfaction has improved dramatically over the last several months and so has provider and staff satisfaction. It all makes sense.

Related post: How to Audit a Lean Management System

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