National Hospital Week Billboard

Lean Leap to Health Care #8 (click for Part #7)
by Scott McDuffee

“When a baby is born, a pleasant chime can be heard throughout the hospital and smiles come across the faces of all who hear.”

Now dated, I drove past a National Hospital Week billboard yesterday. The 88th event occurred May 10-16. Often, we lean thinkers can be critical thinkers. Just hang out with a group of us at a coffee shop like we did last week and hear dozens of ways to make processes work more in tune with the customer by removing waste and addressing issues. We aren't always the best at acknowledging success and progress because we seek problems and challenges as a means to continuous improvement.

As I research Health Care, some of the challenges are illustrated by large shocking numbers. Somewhere in the neighborhood of 100,000 lives are lost each year based on things which go wrong in hospitals which didn't exist before arrival. Besides the related negative patient experiences, nosocomial infections also result in huge cost implications to the tune of over $5 billion.

Some challenges are illustrated not by numbers but by personal stories. We already know the patient's experience would be improved if patient information was more available. When I talk to people about health care experiences, one of the first things they say is, “I had to give the same information to different people in different areas through the whole system.” I also hear about many experiencing the “pain” of delays and wait times on top of the pain they arrived with.

The billboard got me thinking. What about all the things going right?

First, let me acknowledge a couple of things. One is that hospitals and many organizations in Health Care are different from other organizations. At the factory, getting things done right and on-time – seems like life-and-death. But in Health Care, it literally can be.

As Coach Mike told me, “In the future, hospitals will become more focused on wellness but now they typically deal with acute symptoms and illness. When someone comes to the hospital, there is usually the potential of something very wrong.” This makes it different.

Health Care is not different because the lean principles don't work in this environment; it is different because the situations are different. Mistakes and successes are both life altering and administered under stressful situations.

The principles of lean apply. Specify value from the customer's perspective. Identify all the steps and hand-offs in the process to remove those which does not enhance value. Flow value to the customer at the pace required. Pull resources into the process to ensure value is available, capable, and competent. Create visual ways to know if the process is healthy as well as the patient. Pursue a perfect patient experience through continuous improvement by listening and engaging with the customer and those closest to the customer – the nurses, staff, and physicians.

When someone comes in with pain and related anxiety, how we handle it is paramount to the patient. If I made a mistake in the office furniture factory, there were costs involved as well as trust won or lost based on reliability or quality but the people in health care literally have put the lives and welfare of others in their hands.

Hospitals have many winning examples. The names I hear most frequently are Virginia Mason Medical Center in Seattle, Washington and ThedaCare in Appleton, Wisconsin. These hospitals are going a long way along the journey – improving outcomes and processes, reducing costs, and increasing satisfaction of physicians and staff as well as the patient. Also, improving quality and turnaround for important lab work, increased capacity to help patients, as well as millions of dollars savings projects are described as I talk to people around the county who are applying lean principles.

My second acknowledgment is that hospitals exist to serve doctors who serve patients. This can create some complexities based on many “owners” and the potential focus on “point velocity” and specialization where it is not desirable. The best way to think about the patient experience is as a care delivery system; not as optimizing a department or function from a silo perspective. We need to find the simplicity on the other side of complexity.

Besides these many opportunities, like the baby chime, there are simply heart-felt moments related to caring human interactions. Fred Lee, in his book called If Disney Ran Your Hospital: 9 1/2 Things You Would Do Differently says, “Nobody has moved the cheese.” This is in reference to the popular Spencer Johnson, MD book Who Moved My Cheese?.

Lee suggests patient values and needs are long established. In fact, Florence Nightingale said it well in 1846, “Apprehension, uncertainty, waiting and fear of surprise, do a patient more harm than any exertion… Always tell a patient, and tell him beforehand, when you are going out and when you will be back, whether is if for a day, an hour or ten minutes.” Patients need assurance.

Lee uses this SHARE formula for success – Sense people's needs before they ask (initiative). Help each other out (teamwork). Acknowledge people's feelings (empathy). Respect the dignity and privacy of everyone (courtesy). Explain what's happening (communication). I see similar philosophies in the various systems I study.

I was reading excerpts from Quint Studer's What's Right in Health Care which touches me deeply with people going the extra mile because they care. As stated ther,e, these stories will make you “think, laugh, and shed a tear or two” about the Health Care calling.

One story reminded me of working with Pat, a fellow volunteer, last week. Pat and I were scheduled to work on the same day, the same time, in the same role. This could have been prevented by a better scheduling system and communication for our time at the hospital. This is a problem which should be embraced.

Pat and I took potential frustration and turned it into a positive. We spent time walking the processes together, meeting the people, engaging in dialogue, discussing the barriers, and describing the challenges. Although there isn't a formal process, Pat showed me the ropes and shared with me how he managed the communications and connections hitting on every point in the SHARE formula above. Pat is unconsciously competent. For more than just the people in the waiting room, he relays the facts as well as relates to feelings. Pat is caring.

He understands patients won't always remember the specific treatment or procedure but they will always remember their experience. Pat's face lit up when he shared updates with patient's families. His face lit up even more when he heard the baby chime and made the opening comment.

Think of how good Health Care will be with both the noble cause of caring and the continuous improvement of lean.

How do you see the combination working together?

Click for Part 9

“Scott McDuffee is an experienced Lean professional who is currently searching for a new career opportunity. He is based in Mansfield, TX.

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