It’s was a typical Tuesday morning in the Outpatient Service department. By 6:30am, the staff members have already pulled the supplies needed for the day, and organized their workstations to fit the needs of the patients. Patients’ orders and schedules, which were pulled the day before, have been verified and checked for errors or to see any potential delays that might be caused by lack of information, missing information, incorrect information, or orders that needed clarification. The smell of fresh brewed coffee and the sound of the morning news broadcast put calmness in the department. Everyone seemed calm, focused, and ready to “win”.
I couldn’t help but notice that everyone first checked with a nurse named Samantha before signing off to their work stations or assigned areas. Her role seemed to be the “captain of the ship” so to speak. Like everyone else, I too checked in with Samantha. I introduced myself and proceeded in asking Samantha a few questions. She replied, “Follow me, young man, and talk to me as we walk.” Wow! I like Samantha already.
I asked her about the processes and if she could walk me through the Value Stream.
“Sure,” she said, looking at me with a smile. “You see, things weren’t like this several months ago. Our patients were complaining that they were waiting too long to get registered and processed. Things were really disorganized, the staff was frustrated, and it just seemed that we couldn’t ‘win’ on a daily basis.”
My antennas went up when I heard the word win. “‘Win?’ What do you mean by ‘win,’ Samantha?” I could tell that Samantha was well aware of all the potential breakdowns and how easily things can become undone.
“Well,” she said, “one of the first things we did was to fix the things that were very obvious and we could fix right away—the low hanging fruit. We also relied on an internal patient survey. We wanted to know what our patients were saying and where to spend our energy. Alex, please excuse me while I help this patient.”
As Samantha proceeded in assisting a patient, I started glancing around the department and noticed evidence of improvements. The one that really caught my attention was a small board that indicated each patient time from arrival to completion of registration. The board also indicated the reasons for delays, who, when, what, where, and other features that told the staff if they were winning or losing per their set goals. All this information was available at a glance. What really impressed me was the simplicity of the board. The staff updated it, communicated through it, and managed it. It clearly highlighted the areas for improvement. Very little to no technology was needed to maintain the board. No worries if someone forgot their password or the system was down, the staff just kept on marching. All that was needed was a marker and pen to generate the information to execute action.
I started having déjà vu from my many Lean events which I have facilitated and teams I have coached over the years on similar solutions and outcomes. Often in Lean Healthcare, many teams and leadership members feel or believe that the solutions will become too expensive to solve or too deep to dive into, that adding more staff would be the most helpful, or that installing the latest technology device on the market will completely resolve the issues.
While these concerns may be valid in some circumstances, in many cases the opposite situations are true. This team demonstrated that by visually posting metrics so the entire department can see where attention is needed, a target was set for each member to want to achieve the set goal. The board itself may only be a board, but the information it exposes are real issues in real time that navigate and guide the staff in which direction to shift or study the process to “win.”
“What do you think?” Samantha asked me with a confident smile.
“About what, the board or the information?” I replied.
“I mean the entire process, and especially the board.”
“I really like it, Samantha,” I said. “I’m proud of you guys for exposing the data and making the numbers visible for the entire staff to see.”
“Well, Alex,” she replied, “I will be honest with you. At first it was difficult to get the staff to see the need for posting the information and updating the board. They thought it would take more time and cause further delays in the processes by writing down information and managing the board. However, it was the only simple tool that we could try immediately and see if the changes were working or not, without adding cost and resources. We went from patients waiting an average of 22 minutes to now only waiting an average of 6 minutes. Today no one in the department has to ask another for information and data or wait for the monthly staff meeting to get this information.”
“Samantha,” I asked, “Were you and the staff a little hesitant at first about posting the data? And, was the staff worried about you posting information?”
“Yes, and yes! However, when they saw that we were acting on the issues and involving them in the improvements, and the numbers started to improve, their beliefs started to change. The board and information input is owned and managed by the staff, and in fact they have also added others’ information that they thought would be helpful and important. It did take some time, Alex, and there’s still much more to do. But you can see that some standards have been put in place.”
Posting metrics or exposing issues in the work areas can be an uncomfortable practice to do. The fear of people knowing what your breakdowns are—or that you might highlight that your department is the bottleneck in the process—is a scary thing, and you may feel that it may insinuate that you’re a poor leader. In fact, it’s a big part of a leader’s development. Samantha and her team made a decision that they were going to do everything to improve and exceed patients’ expectations.
Since then, they have not looked back.
This week’s blog was written by Alex Maldonado, an associate with HPP. Alex’s professional experience includes process improvement, operational, and leadership positions in the medical delivery systems and appliance manufacturing industries with Baxter Healthcare and Whirlpool. Alex has had a successful track record in improving results-driven processes with an emphasis in personnel training, project leadership, and operating systems designed to improve customer service and sustainability. He has led the development and implementation of processes to support Lean initiatives that reduce critical path lead-time, reduce expediting costs, capital improvement projects, inventory reduction, and trained and educated staff/employees in Lean Methodology. He has a B.S. in Industrial Technology Engineering from Mississippi State University and has also completed the Six-Sigma black belt program.