LeanHealthcare_Rules-in-useI had a recent experience with my father needing care in a hospital – it was less than IDEAL.  In Lean Healthcare, we strive for IDEAL – defect free, exactly what the patient wants, one by one customized to each patient, on demand exactly as requested, no waste, and safe for all patients, staff, and clinicians.  When hospitals fail to achieve IDEAL, it is due to violation of one or more Rules In Use (The Mysterious Four Rules).

All four rules-in-use were clearly violated every day of my father’s stay.  The specialist did not talk to the hospitalist.  The hospitalist did not talk to the therapist.   And no one spoke to the family regarding his length of stay and anticipated date of discharge.  Healthcare workers are genuinely caring people who only want the best for their patients and we saw that one-on-one with each caregiver that touched my father.  It was the behind-the-scenes activities where the violations occurred. It is so important that the care be given in a manner that keeps the patient moving toward recovery and discharge.  When violations of rules 2 and 3 occur, the patient’s progress is impeded and often times this results in a readmission.

My father is now home and recovering well but his journey was a tough one, and my family is grateful for each and every healthcare worker who performed heroic deeds to minimize the impact of the systemic flaws. Let’s strive to implement systems which allow for IDEAL with no violations of the Rules In Use during patients’ hospital stays.


Today’s blog was written by Dan Littlefield, director at HPP.

Dan has 30 years of healthcare experience in many clinical and leadership roles. He leads Lean and process improvement consulting engagements for HPP.  His experience includes deploying Lean across numerous healthcare disciplines including imaging, laboratory, nursing, pharmacy, and physician offices.  Dan began his healthcare career as a nuclear pharmacist and has also served as director of operations, responsible for 13 facilities.  He has been a featured speaker at a variety of healthcare industry events.

Dan holds a Master’s Degree in Business Administration from the University of Pittsburgh, a Bachelor’s Degree in Pharmacy from Purdue University and a Specialty Certification in Nuclear Pharmacy from Butler University.

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