The year was 1847 and mothers who gave birth in an Austrian clinic began to reap the benefits from Lean Healthcare and Six Sigma practices. In fact, up to 30 percent of mothers, who would have died from puerperal or childbirth fever, survived thanks to the problem solving work of a Hungarian physician who swarmed a problem by analyzing data to find the contributing factors, tried countermeasures and measured the impact.
Mothers were dying due to this hideous infection casued by something that no one could see with the naked eye. Dying after giving birth in hospitals was especially alarming because mothers were dying while being treated by experienced physicians—while mothers assisted by midwives survived at a much higher rate.
Fortunately, the physician mentioned above applied a scientific approach to this problem. You may know the problem solver to be Ignaz Semmelweis (1818 – 1865). Dr. Semmelweis was a Hungarian obstetrician and the life-saver who introduced antiseptic prophylaxis into medicine, a.k.a. hand hygiene. The prophylaxis was simply washing one’s hands prior to entering a mother’s room after performing surgery or an autopsy. Dr. Semmelweis’ countermeasure reduced the death rate from an average of 12 percent to less than 1 percent. However, there is a sad twist to this story which we will get to later.
Lean Healthcare succeeds today in part because of the same scientific problem-solving methods that Dr. Semmelweis practiced. Going to where the work is performed (Gemba) was essential in his correlation of a scalpel cut received by a colleague performing surgery with his colleague’s death from infection. In the 1840’s and earlier, no one knew that pathogens passed from the morgue to the mother because the pathogens could not be seen. Dr. Semmelweis saw the scalpel incident because he was there. Physicians before him had not connected infections with surgeries and the delivery of babies. Data collection (remember our discussion on data) was key to validating if hand hygiene really had an impact. Looking at the chart, is there any doubt? This same practice of measuring the current state to know if improvement really occurs is the core of Lean Healthcare, Six Sigma, and any scientific problem-solving approach.
Now the sad twist: Dr. Semmelweis’ work was debated, poorly spread, and did not sustain. Does this inertia sound familiar in some of your problem-solving efforts? The countermeasure of washing hands to reduce the cross contamination of pathogens is achieved in many hospitals today, yet there are many that continue to fail to achieve 90% compliance and most do not sustain.
What is common in healthcare organizations that succeed and sustain? They utlilize the 3Ms: Measure, Manage to Measure, and Make-it-Easy.
- Measure frequently. We have yet to see sustainment if measurement is stopped.
- Manage to the measure. Dr. Semmelweis rewarded those who washed and reinforced others to do so who did not wash. We call this Just-In-Time coaching. We also found we need to teach how to coach for better stakeholder acceptance.
- Make-it-easier to wash. Often, it could be easier to wash or sanitize hands. We use spaghetti diagrams to show where hand washing dispensers should be placed in the path of the healthcare professionals. There are even easier ways to measure eliminating all excuses for measuring what hand hygiene compliance really is.
Lean Healthcare works because it combines the science of problem solving with the “3Ms” as stated above. Dr. Semmelweis had the measure right, but, his ability to lead change was lacking in managing to the measures and making it easier to do the right thing. In Lean Healthcare, we focus on all three Ms, and especially on managing and making it easier. Try the 3Ms in your problem solving and see if you don’t experience improvement too.
Today’s blog was written by Rick Morrow, Executive Director at HPP.
Rick has 25 years of leadership experience in healthcare and other industries as a leader in performance improvement and safety. He leads HPP client engagements in the U.S. and Europe. Prior to HPP, Rick held the position of Director, Business Excellence with The Joint Commission and led the Center for Transforming Healthcare. In this position he was the Deployment leader for the Joint Commission’s Lean Six Sigma initiative leading teams in developing solutions across America and launching globally. Rick developed The Joint Commission’s Lean Six Sigma belt and leadership training, and leading collaboration in improving hand hygiene and reducing wrong site surgery. He is an international speaker on Lean and Six Sigma. Prior to the Joint Commission, Rick held senior level Continuous Improvement positions with United Airlines, Motorola, SKF and Eaton.
Rick holds an M.B.A. from the University of Illinois’ Executive Program.