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On a recent trip to a theme park, I was struck by how much non-value added activity I was willing to tolerate.  I thought to myself that only a Lean obsessed nerd like me would spend time analyzing what would otherwise be a carefree day at the park.  So, I decided to try out Lean thinking on my 11-year-old son to see if he could see the value in the roller coaster value stream.

After a two minute review of the principle that “value” is defined by the customer and that any activity that the customer would not be willing to pay for more of is “non-value added”, my son was able to identify that the value add portion of the coaster value stream was easily measured from the time the coaster left the station until it returned to the station.  This seemed intuitive but, he and I were both surprised when we did the value analysis of our morning at the park.  Maybe you’ll be surprised too…

After a little over two hours at the park, we had ridden two coasters: The Raven and The Voyage.  I’ll spare you the details but, what’s important to know is that both of these coasters regularly show up on lists of the best coasters in America.  The ride did not disappoint.  But here’s the value analysis:

The Raven:  station to station ride time = 77 seconds
The Voyage :  station to station ride time = 97 seconds
Total time to wait and ride = 8,100 seconds
Value Quotient = 2.15%

In the practice of Lean Healthcare, we are challenged to eliminate non-value added activity.  Sometimes it’s difficult to objectively see the value from the patient’s perspective.   This simple exercise helped me to teach the concept to my son.   Next time you are struggling to illustrate the concept of value, as defined by the patient, try this roller coaster metaphor as an illustration.

What other metaphors do you find useful in teaching this concept or facilitating a mapping exercise?  Share with us in the comment section.

Today’s blog was written by Jeff Wilson, a Director with HPP.

Jeff leads Lean design, new facility move-in preparation, and Lean transformation engagements with healthcare clients. He has developed Lean transformation plans, facilitated Rapid Improvement and 3P events and developed training materials for numerous client companies in healthcare. Throughout Jeff’s career, he has delivered and applied progressive management and process improvement tools to help organizations reach new levels of performance. 

Jeff has a Bachelors Degree in Economics from Western Kentucky University. He also holds a Certificate in Production and Inventory Management (CPIM) designation.

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In previous blog posts, Dr. David Munch used the model of a sports team to illustrate the importance of effective coaching in the leadership of our teams.  (In case you missed them, they are:  The Blind Spot: Part I and The Blind Spot: Part II).  Dr. Munch reminded us that Lean Healthcare coaching is done “in the work” and is predicated on leaders asking the right questions.

I’d like to continue the use of the sports team model to open a discussion about another important element of leadership that is often missing in the healthcare environment.  In order to provide effective coaching, we need some tools available to us.  One tool that is often missing is meaningful performance data.  Imagine if you were a player on a football team in a league where the score was kept but not known to either team (including the coaches) until the end of the season.  Imagine how ineffective it would it be to make changes in the team’s approach for next season’s games after this season was over?  Effective coaching requires that we know the score throughout the game.

In the same way, as Lean Healthcare leaders, if we don’t know how our teams are performing, we can’t provide meaningful and effective correction and support.  It’s true that we have a lot of data in our hospitals and clinics, but the assemby of that data into meaningful form often does not happen or happens way too late.  Even then, we as leaders often choose to focus on the wrong things.

Here are a few common pitfalls I see as hospital leadership struggles to put the necessary “scoreboard” in place:

1. Defining objectives or performance metrics at the wrong level.  I recently observed a pharmacy team metrics board that showed their goal to be Patient Satisfaction (at the hospital level).  This is not a good “scoreboard” for the pharmacy because this team can’t own this metric.  After some discussion, they agreed that they could rally around a metric that they can control or influence,such as first dose turnaround time.
2. Stale or expired data.  I recently learned of a hospital where meaningful Core Measures performance data was not available until up to 180 days after the patient was discharged.  There was no way to implement effective performance improvement efforts with data this old.  The lag in data also made it impossible to determine if process improvements were effective.  In cases like this, more timely proxy measures can be effective.  Sometimes we have to be willing to consider less than 100 percent precision on a metric in order to get more timely feedback.  This will empower the team to understand how they were performing and make adjustments.
3. Too much effort required to update the scoreboard.  Making the data difficult to get is a sure way to make certain that it isn’t compiled and reviewed at the lower levels.  It is common to see mid-level managers spend hours per week collecting and collating data from disparate information systems to generate a report.  As an alternative, find proxies for these metrics or automate some of the analysis.
4. Over complication of the metric on scoreboards.  The trend seems to be that leaders want complicated spreadsheets with detailed analysis for metrics.  This leads to a disconnect with the people who do the work.  As an alternative, consider a Visual Management board on the unit that gets updated with each day’s performance, forming a trend over time.  This will allow the teams better access to their performance and empower the leaders to meet at the board and review the data.

What are other pitfalls and corresponding countermeasures you have seen?  Next week we will continue this topic as Steve Taninecz walks through how to create a Visual Management board.

This week’s blog was written by Jeff Wilson, a Director with HPP.

Jeff leads Lean design, new facility move-in preparation, and Lean transformation engagements with healthcare clients. He has developed Lean transformation plans, facilitated Rapid Improvement and 3P events and developed training materials for numerous client companies in healthcare. 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. 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.

Jeff has a Bachelors Degree in Economics from Western Kentucky University. He also holds a Certificate in Production and Inventory Management (CPIM) designation.

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Too often I lead teams whose goal it is to improve the workflow of caregivers, only to find that the team is hamstrung by a facility design that doesn’t support that team’s vision.  There are all kinds of explanations for how these physical design barriers come to be, but I won’t try to list them all.  I would rather focus on one of these explanations and leave the other hundred or so for another blog posting.

By now, readers of the Lean Healthcare Exchange know that the focus of Lean healthcare is waste elimination.  It is also widely accepted that two of the most prevalent forms of waste in healthcare are motion and transportation.  A common cause of both these types of waste is searching for supplies and equipment.  It is my experience that the way we design our facilities creates an environment where we are destined to have significant searching.  Many well meaning healthcare designers have actually exacerbated this searching by using typical design paradigms regarding the use of casework and cabinetry.   Let me explain:

In healthcare design, there is a tendency to furnish most workspaces with plenty of cabinetry and casework.  Often, there seems to be a “more is better” approach and designers endeavor to squeeze as many cabinets and drawers as possible into a given space.  I want to challenge this approach.  The number and size of cabinets and drawers in a work space should be defined by the work flow in that space.  Sometimes this means that we will have fewer cabinets and drawers than the space will accommodate.  I realize that this is a counter-intuitive assertion.  I know because from care givers I hear, “we never have enough cabinets to store all our stuff.”  And from designers I hear, “in the interest of the staff, I look for opportunities to maximize the use of casework so that there will be plenty of storage.” 

Let me also clarify that for purposes of this discussion, I am referring to clinical care areas rather than public spaces or even areas where patients will spend a lot of time. 

Certainly, cabinetry serves a useful purpose.  It serves to hold the stuff that we wish to store near the point of use.  It can also provide a level of security and safety for our stuff and our patients.  Cabinetry also provides an aesthetical benefit by obscuring the negative appearance of clinical supplies.  But, in these clinical areas, where patients rarely go, safety, security and appearance are secondary or tertiary considerations.  The primary consideration instead, is quick and efficient access to care supplies for purposes of restocking and providing care.  In this case, more visibility to the supplies rather than less visibility is desirable.  Cabinetry and casework are tools that limit visibility.  The result is more searching and an unnecessary barrier to ensuring reliable replenishment. 

The design of casework and cabinetry should be purposeful.  There are certainly appropriate applications of casework and cabinetry but, its use should not be the default in all situations.  It is the front-line staff, with their intimate knowledge of the workflows in a workspace who should inform the placement of design elements.  Favoring more open, visible storage will provide for a more efficient workflow by easing access to the supplies and increasing the likelihood of proper replenishment.

Given that I have no architectural or design expertise, how can I recommend a new paradigm in healthcare design?  It is the front-line staff that I have worked with that have, through observation of their waste-filled current state processes, pointed out this built-in waste.  They have, on several occasions, recommended a more open and visible storage in work spaces such as Medication Rooms, Nourishment areas, procedure rooms and the like.  But, by the time these counter-measures are requested, it’s too late.  The prospect of replacing cabinetry valued at several thousand dollars is a non-starter with most leaders.  So, they continue to deal with an inefficient process and develop other workarounds.

What is the solution? Engage front-line staff earlier in the design phases of a hospital construction or remodel project.  By doing so, we can eliminate some of this built in waste.  This is just one example but there are many potential benefits that can be realized by applying Lean Healthcare principles during the design of a healthcare facility. 

Interested in Lean Design? Check out www.leanledhospitaldesign.com for more information on Lean-Led Hospital Design: Creating the Efficient Hospital of the Future, the new book from Naida Grunden and Charles Hagood, available March 2012.

This week’s blog was written by Jeff Wilson, a Director with HPP.

Jeff leads Lean design, new facility move-in preparation, and Lean transformation engagements with healthcare clients. He has developed Lean transformation plans, facilitated Rapid Improvement and 3P events and developed training materials for numerous client companies in healthcare. 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. 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. Jeff has a Bachelors Degree in Economics from Western Kentucky University. He also holds a Certificate in Production and Inventory Management (CPIM) designation.

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You might recall previous blog entries where we discussed the virtues of one-piece flow and cautioning Lean Healthcare practitioners to avoid batching within their processes.  Over and over again, we see the practice of batching throughout the process of delivering healthcare.

I want to share with you a recent example.  But before I do, I want to point out that batching is most often a workaround or “Band-Aid” to a poorly designed process.  Batching creates several of the eight types of waste, foremost of which is inventory waste.  Lean Healthcare practitioners are conditioned to recognize inventory as an indicator of a flawed process. 

During a recent Kaizen event to improve the process of administering nuclear stress tests for inpatients, event participants identified significant patient waiting time that was a direct result of batching of patients at key elements of the testing process.  In this hospital, there was an understanding that the stress lab staff would not call the Cardiologist to come administer their portion of test until two patients were ready to be tested.  This practice was perceived as essential to protect the time of the Cardiologist as he or she cares for other patients throughout the hospital.  The goal of this practice was to eliminate unnecessary interruptions and trips to the stress lab.

In this case the “inventory” observed was in the form of patients queued, awaiting the initiation of the EKG portion of their stress test.  These patients were gowned and prepped, waiting on a stretcher for all the right people to show up to initiate the test.  They were placed in an exam room rather than waiting comfortably with their family in the patient room.  They had not eaten since before midnight.  They are told by the nurse that everything is going well and they are simply waiting on the arrival of the Cardiologist.  During our observations, this waiting annoyed patients.  The nurses had done their best to prep the patients in an efficient manner, but now are left to field the barrage of questions and complaints from the frustrated patient.  The current state observations revealed that one patient waited 90 minutes.  During this waiting time another patient was prepped and the Cardiologist was called and arrived after finishing seeing a patient in the ICU.  This wait time was verified as commonly occurring waste within the process.  No one was surprised by this wait, except the patient who waited.

The good news is that by applying the principles of Lean Healthcare, the event team was able to eliminate the 90-minute wait time for patients.  In the new process, patients’ EKG portion of the nuclear stress test is initiated as soon as the patient is prepped, eliminating the 90 minute wait time that was observed in the current state.  Not only did this reduction in wait time eliminate a significant source of frustration for the patients but it also accelerated the delivery of the stress test report to the ordering physician so they could make a timely decision regarding the care of the patients.  (As a side, many of these patients were 23-hour observation patients, so the reduction of the 90-minute wait time had a significant impact on length of stay for these patients.)

I hope this example is helpful to you.  The key is to look for the inventory in your processes, in whatever form it takes (patients, supplies, specimens, reports to be signed, orders to be entered, etc.  The list is endless).  You will see the batching and thereby identify opportunities to eliminate the resulting waste. Eliminating the underlying cause of batching will go a long way to helping you know where to apply Lean Healthcare principles to improve your processes.

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.

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Recently, while facilitating a Lean Healthcare Kaizen Event in which we focused on the Medical Imaging department of a mid-sized acute care facility, I learned the hard way, about a failure in my own facilitation approach. 

At the outset of every Kaizen Event, I spend a couple of hours introducing the participants to the fundamentals of Lean Healthcare.  One of the fundamentals is a thorough explanation of the types of waste.  Since the definitions of these eight types of waste are a bit unconventional in the healthcare environment, we spend a good bit of time ensuring that the participants know them well.  This understanding is a foundational building block for them as they learn to see the processes around them differently and identify improvement opportunities that they have, until now, been unaware of.

During this event, I followed the same model.  Assuming that the participants had a thorough understanding of the eight types of waste, we moved on to evaluating the current state of their processes.  We went to the Gemba and collected lots of meaningful data through observation.  Then, the participants began to identify the waste within their process.  One of the most obvious was the waste of “Defects” in the image quality that was captured during exposure.   Great!  Now we have an opportunity to improve the process.  But wait, one of the techs in the room is visibly upset by this characterization of “Defects”.  Her body language tells me that she is not on board with making this reduction in defects a high priority or even placing an emphasis on it during our current state mapping.  My facilitator intuition tells me that continuing down this path without consensus among the participants that defects are important focus area is certain to cause issues and dissention later.  So, I offer the group a chance to quantify the impact of defective images.  Still the upset participant is not convinced.  So, I ask her to help the group understand how she perceives the frequency of defective images. 

Fortunately, for me, she is willing to share with the group that she is deeply offended by the use of the term “defects”.  She takes ownership in her work and feels that she and her co-workers do the best job possible.  Ah!  A Breakthrough!  Now I know that I have not adequately communicated to this participant, and perhaps others, that when we use the term “Defect”, we are not pre-judging the cause of the defect.  We are simply identifying that the process is not delivering what the internal or external customer expects or needs.  It’s a completely safe term.  We know that when a defect occurs, there can be myriad root causes.  But, there seems to be a proclivity, particularly among folks in healthcare, to assume that the very next step is to blame the worker.  I then explained to the participants that in the practice of Lean Healthcare, the contrary is true.  We always look first to how the process failed the worker rather than how the worker failed.  With this understanding, my very upset participant found comfort and agreement that we could and should focus on the frequency of defects.  She now knows that we will look beyond the typical blame game and seek the root cause of defective images.  (She also did make a compelling argument for using a term other than “defect”.)

So, how should I, as one who facilitates Lean Healthcare events regularly, respond to this experience?  It is an opportunity for me to practice what I teach.  I will start with a simple, non-judgmental statement of the problem:  My explanation of the term “defect” did not yield the understanding of the term that my participant should expect and needed.  Simply put, my process of explaining the term “defect” yielded a defect.  So, now I am perfectly situated to respond to this defect with the problem solving tools that we use when applying Lean in Healthcare or any industry.  Fortunately, I have standard work for explaining the eight types of waste.  The process will begin with an assessment of whether I followed this standard work.  If so, then I will evaluate the effectiveness of the standard work and revise, if necessary.

Maybe in another blog posting, I’ll talk about how this turns out.  But for now, I need to get busy improving my facilitation processes. 

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.

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I’m beginning to think more and more that eliminating the practice of batching and attempting to approach one-piece flow is more than just a fundamental tenet of Lean Healthcare.  I’m beginning to think we should elevate this principle to Law of Nature status.

Everywhere we look, we can see examples of how one-piece flow, or even reduction of batch sizes, is better than batch flow.  Here are some examples:

• Traffic congestion is often caused by peoples’ schedules syncing up so that many of us attempt to travel the same route at the same time —in batches.  If we spread out our schedules and driving patterns, delays are limited.
• Exercise is more beneficial to our bodies when done consistently, in smaller increments, over a long period of time.  It’s absurd to think that we could batch all of our exercise routine for one month into one day-long exercise period.
• Antibiotics can help our bodies heal from serious infections.  Antibiotic regimens are rarely one single dose — or batch — of medicine; rather, we take several small doses over an extended period of time.
• An escalator is often a better solution to moving a large group of people up or down a few levels.  Elevators move people in batches and introduce a lot of waiting into the process.  The continuous flow of an escalator ensures that our wait is minimized (obviously, this solution has its limits).
  Restaurants are crowded and wait times are extended when diners batch themselves after a major event, such as a football game.

So, if this approach of reducing batch sizes is so effective and applicable in other areas, how can it be applied in healthcare?  I’d like to invite readers to share your experiences of how reducing batch size has improved the delivery of healthcare in your organizations.  I hope we can build an extensive list that can be helpful to all readers.  Add your examples in the comments sections.  Here are a few examples to get us started.  These are fairly common in most organizations.  I look forward to seeing your out-of-the-box examples.

• Charges are entered immediately following the patient exam, rather than being held until the end of the day and processed in batches.  This allows for immediate resolution of any billing or coding issues while the right source of correct information is available, preventing interruptions to do so later.
• Stat lab orders are processed immediately through the centrifuge and analyzer rather than batching these orders with other orders to fill the centrifuge.  Thus, needed results are delivered sooner.
• Patients are assigned to exam rooms only as the caregiver is ready to see them, rather than batching and filling all rooms as the previous patients exit.  This means that exam rooms are not unnecessarily tied up and that patients can wait in more comfortable environments.

This week’s blog was written by Jeff Wilson. Jeff is a Senior Associate with HPP. 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 has a Bachelors Degree in Economics from Western Kentucky University. He also holds a Certificate in Production and Inventory Management (CPIM) designation.

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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.

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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.

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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.

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