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 Lean_Healthcare_Metricsfor 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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