On January 24, 2012, USA Today printed an article in the Travel section on the growth of people-watching in airports. Yep, more and more people are “watching” other people while sitting in an airport (you know you do it!). It is acceptable now—you can watch other people without feeling guilty. What an interesting new American pastime when you’re stuck in a place you can’t get out of, you have nothing to do, and your flight is delayed… again.
Watching people in an airport is a lot like “observation” in Lean Healthcare improvement efforts. Using your eyes and ears to observe people walking, shopping, struggling with their luggage, noticing how many people ignore the little motorized carts rolling down the aisle blowing their horn, and counting how many people are wearing red shirts is all similar to watching people do their work… or as we say in Lean, watching the work being done.
In Lean Healthcare observation, there are some important differences between people watching with no real objective and watching work being done with the objective of making the work easier to do. In Lean Healthcare observation efforts, you should be looking for certain things:
1. 8 Wastes common to all processes:
- Defects – We make it incorrectly (or, “it doesn’t work!”)
- Overproduction – We make more than we need (or, “why do we have so many…”)
- Waiting – We are waiting for others to complete their tasks (or, “the lab is so slow!”)
- Not Clear (Confusion) – We don’t know what to do (or, “I thought that was your job.”)
- Transporting – The things we need travel great distances (or, “the meds are on their way…”)
- Inventory – We store too much (or, “throw it away, it expired”)
- Motion – Our people move around a lot to get things done (or, “we’re not ready for Mr. Jones now. Wheel him back.”)
- Excess Processing – We are duplicating efforts (or, “someone else already asked me those questions.”)
2. Broken Connections between work tasks – Where is Mrs. Smith?
You may ask, “Why stand here, in one place, watching work being done?” Good question. Have you ever wondered what your work looks like from the customer’s point of view? What part of your work do they experience? How do they experience it? What does it feel like to them? They fill in a lot of blanks when you’re not in their direct line-of-sight.
It just so happens that observation is the beginning of most scientific studies and research, including Lean Healthcare continuous improvement efforts. Observation is always the beginning of process improvement.
“What does the current situation look like and how does it work?” We don’t need to know how it is supposed to work. What we really need to know is how it really does work. The only way to really know, is to watch the work, observe it, and keep an eye out for the eight wastes, the connections (or lack thereof), and how the work or customer flows through the process.
Until we know what’s happening now, we will not know how to make it better. Any improvement effort will be a shot in the dark. As Will Rogers once said, “People’s minds are changed through observation and not through argument.”
True observation watches with purpose looking for certain happenings, or absence of happenings. Lean Healthcare observation sees the process from the customer’s point of view, oftentimes actually following the customer through the very process being observed.
If you have ever done any Lean observation, you can’t help observing work and processes being done everywhere you go. Being a customer of many processes myself, as soon as I hit a “No Value” segment of a process designed to serve me, I immediately begin to observe what is going on, what is not going on, and wondering if anyone in the process knows what is going on. In the meantime, as the customer, I wait.
In Lean Healthcare, we take the time to observe so we can make the process better. Making the right work easier to do should be the order of the day. Where is it written that excellent service or patient care requires processes that are complicated and hard for staff to do?
Try some observation in the area you oversee. Spend an hour or two observing by going to where the work is being done. Let your staff know you are not watching them, but watching the work they have to do. Let them know you want to help them make their work easier to do. What did you see?
This week’s blog was written by Matt Hanrion, Senior Manager with HPP.
Matt has more than 30 years experience with Lean and provides consulting services in a variety of areas within healthcare. He is a lead trainer with HPP and has coordinated TQM teams within every area of a hospital system, developing and rolling out TQM education to staff. Matt has a B.A. from Westminster University with a double major in Computer Science and Biblical Studies, and a M. Ed. in Education from Columbia International University. In addition, Matt served in the US Pacific Naval Submarine Fleet as a Missile Launch Systems Petty Officer and is a Vietnam Veteran.