Lean Healthcare Exchange

In 1847, mothers giving birth in hospitals began benefiting from Lean and Six Sigma techniques in healthcare. In fact, up to 30 percent of mothers giving birth in hospitals that would have normally died from puerperal (childbirth) fever lived thanks to swarming a problem, analyzing data to find the contributing factor, trying countermeasures and measuring impact.

Mothers were dying due to this hideous infection caused by something that no one could see with the naked eye. This was especially alarming since mothers were dying while being treated by experienced physicians in the world’s greatest academic medical centers more frequently than those mothers who were giving birth at home. Not to mention the devastation to the millions who were born while the mother died.

Fortunately, one physician 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: Hand hygiene.  The prophylaxis was simply washing one’s hands after performing surgery or an autopsy and prior to entering the mother’s hospital room. Dr. Semmelweis’ countermeasure reduced the death rate from an average of 12 percent to less than one percent. However, there is a sad twist to this story which we’ll get to later.

Lean healthcare succeeds today in part because of the same scientific problem-solving methods that Dr. Semmelweis practiced. Going to the Gemba — or where the work is performed — was essential in his correlating of a scalpel cut received by a colleague in surgery and his death from infection. Remember, one did not know what one could not see in the 1840s and without being there, Dr. Semmelweis and physicians before him had not connected infections with surgeries and the delivery of babies. Data collection was key to validating if hand hygiene really had an impact. Looking at the chart below, is there any doubt? Call it Six Sigma or whatever, the scientific problem solving in Lean Healthcare includes data collection and validating impact.

Now the sad twist: Dr. Semmelweis’ work was debated, poorly spread and did not sustain. Does this sound familiar in some of your problem solving work? Perhaps this is why a current colleague of mine, Dr. David Munch, and other Lean and Six Sigma practitioners from seven other leading hospitals joined my team at The Joint Commission’s Center for Transforming Healthcare to forever solve hand hygiene. The countermeasure of washing hands was essentially the same. We all know hand hygiene helps reduce healthcare acquired infections, yet it occurs fewer than 50 percent of the time. What we did differently is essentially:

1. Measure frequently. So we can better correlate hand washing and infections.
2. Manage to the measure. Dr. Semmelweis rewarded those who washed and reinforced others to do so. We call it Just-In-Time coaching and we, but we find we need to coach how to coach.
3. Make-it-easy to wash. Use spaghetti diagrams to show where hand washing dispensers should be placed. We even pioneered technology for gentle reminders, just as your car reminds you to fasten your seat belt.

Lean Healthcare works because it combines the science of problem solving with the “3Ms” as stated above. Dr. Semmelweis had the measure right, but despite seemingly convincing measures of success, the change management was lacking in managing to the measures and making it easy enough to do the right thing. Transformations are vital to sustaining gains because of the value of managing and making it easier. Try the 3Ms in your problem solving and see if you don’t experience improvement, too. Good luck, and please share your success stories with me and others.

This week’s blog was written by Rick Morrow, a Director at HPP. Rick has 25 years of leadership experience in healthcare, aviation, automotive, supply chain and technology. Prior to HPP, Rick held the position of Director, Business Excellence with The Joint Commission and led the Center for Transforming Healthcare. Prior to the Joint Commission, Rick held senior level Continuous Improvement positions with United Airlines, Motorola, SKF and Eaton. As Vice President at SKF, a firm known as a leader in reliability, his LSS was credited with achieving Zero Defect processes which he then rolled out internationally. At Motorola, he directed the quality turnaround of its safety product, OnStar. He wrote Motorola’s corporate-wide Lean courses and led the strategic and tactical planning using TPS globally. Certifications include Motorola Master Black Belt and a MBA from the University of Illinois’ Executive Program. He is an international speaker on Lean and Six Sigma at conferences including NPSF, ASC and ASQ. Rick is a contributing editor on safety publications.