What is the most important resource you have and how do you manage it? 

Before you read any further, take your eyes off of this page and stop for a moment to reflect on this question and then read on.

What was your answer?  It may be interesting to pose this question to some of your colleagues and see what they come up with.  It could be a very interesting discussion and could lead to some interesting actions.  Also, did you answer this from a personal perspective or a professional one?

Let me pose to you that the answer to this question both professionally and personally is time.

From the lyrics of “No Time to Kill” by Clint Black, my favorite country artist:

If we had an hourglass to watch each one go by
Or a bell to mark each one to pass, we’d see just how they fly
Would we escalate the value to be worth its weight in gold?
Or would we never know the fortunes that we had ’til we grow old?
And do we just keep killin’ time until there’s no time

How many of you thought that the most valuable resource is people?  People are extraordinarily important in what we do in healthcare but it is what they do with their time that really matters to our patients.  Interestingly, our patients are also investing their time as well, not only for the time they spend in the experience of care but possibly with the time they have left on the planet.

So, are you measuring time with respect to your people? With respect to yourself?  Can you tell me how much of your day is spent in the various categories of tasks and responsibilities that you have by percentage without guessing?  Can you tell me how much of your time is spent in value-added work and non-value added work?  How much of your time is spent in meetings and how much of that time is value added to you? To your patients?  Is there any measure of the effectiveness of all those meetings you go to?

One of the most common barriers to successful Lean Healthcare transformations is the lack of executive and middle management engagement in the improvement efforts including their ability to support and sustain those improvements.  These activities are competing with other things on their very full plates that take their time. Unless they deal with all of those tasks, the time it takes to do them, the inefficiencies in them, the prioritization of them, and so on, they will simply not have the time to engage adequately in organizational improvement efforts.

Therefore, we need to apply Lean principles to their individual schedules, their management systems and their leadership methods if we are to be successful in creating the time to engage.  We must take things off of their full plates if we are to put something else on.  The responsibilities of Lean management and leadership cannot be a bolt-on to, but rather must be a replacement of, other activities. This must occur through prioritizing or creating efficiencies in their current work that gives them the capacity to assume these new roles.

  • Don’t:  Just tell the managers they need to support the Lean activity then complain when it doesn’t happen.
  • Do:  Map the value stream of a manager’s work using the eight wastes and the four rules in use.  Identify the value added and non-value added activity.  Determine the target condition to help prioritize their tasks including the added work they will need to engage in continuous improvement.  Use Lean Healthcare principles to redesign and define their daily, weekly, monthly and annual standard work with measures and visual management.  Coach them for as long as it takes to achieve stability. Use A3 to course correct if you run into barriers.

In A Factory of One: Applying Lean Principles to Banish Waste and Improve Your Personal Performance, Daniel Markovitz takes a fascinating approach to using Lean principles that we normally apply externally and instead applying them internally to an individual’s work.  It guides the development of a person’s standard work using visual management at a personal level.  One of my favorite examples is the use of time as a metric for the effectiveness of meetings.  Most of the time an hour or two is blocked off for a meeting and the whole allotment of time is used whether it is needed or not.  Talk about putting the cart before the horse! Meeting attendees should be present to deal with the issues listed in the agenda, not to spend a specified amount of time together.  If one uses time as a measurement of the meeting’s effectiveness, then it becomes a priority to remain focused on the management of the agenda, staying on topic and dealing with the issues as quickly as possible so the meeting can end early and give back time.

Consider time as a valuable resource and worth measuring at many levels.  It will tell you where the waste is and where the opportunities are.

“Time is what we want most, but what we use worst.”
William Penn

This week’s blog was written by Dave Munch, M.D. and HPP Senior Vice President and Chief Clinical Officer.

Dave oversees all of HPP’s clinical and Lean Healthcare engagements. He plays a lead role in new services development and HPP’s continuous adaptation to the healthcare industry’s ever-changing needs.  Dave previously served at Exempla Lutheran Medical Center as their Chief Clinical and Quality Officer.   Dave has been a frequent speaker on the subject of leadership effectiveness and Lean transformation for a number of healthcare organizations including Institute for Healthcare Improvement (IHI), The University of Rochester Medical Center, Yale-New Haven Health System, Tulane University Medical Center, Pittsburgh Regional Health Initiative, Institute for Clinical Systems Improvement (ICSI), and the Voluntary Hospital Association (VHA).  Dave has served on the Agency for Healthcare Research and Quality’s High Reliability Advisory Group, has an extensive background in hospital operations, health plan governance, physician organization governance and clinical practice in Internal Medicine. 

Dave received his M.D. from the University of Colorado’s Health Sciences Center. He is also a faculty member for the Belmont University Lean Healthcare Certificate Program.
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