This is a big day for Lean in healthcare, as here is a link to FoxNews.com with five longer videos about ThedaCare and their quality and cost improvement efforts (and results).
I thought last night's story (transcript) that aired on “On the Record” was certainly positive, even if not incredibly in depth. They allowed Dr. John Toussaint to emphasize that better quality and better care go hand in hand. Some Lean methods that were touched on:
- 5S (staging supplies so nurses don't have spend hours a day looking around to find or get items)
- Value Stream Mapping and waste elimination (identifying steps in the process that can be eliminated)
- Teamwork (a team working with a shared goal of serving the customer/patient)
- Hoshin Kanri (or strategy deployment) — metrics tracking boards focusing on safety, quality, time, productivity, and morale.
Fox New has five unedited videos online, you can view them all on this page of my blog in embedded players.
In the first video, Toussaint talks about (times approx):
- 0:50 – how their quality improvement efforts were inspired by manufacturing and the Toyota Production System — taking waste out of the system to improve quality and reducing the total cost of care
- 1:30 – the producer asks if what ThedaCare does could be copied by other hospitals — yes! Toussaint emphasizes measurement to detect problems and immediate problem solving
- 3:10 – Toussaint aludes to our Healthcare Value Leaders Network collaboration efforts (and mentions it directly at about 6:30)
- 4:45 – “The fundamental problem is that there's a ton of waste in the delivery of care.”
- 6:00 – 100 million medication errors in the U.S. this year — need to reduce!
- 6:45 – How does ThedaCare deliver better care? “Is that a value added step or not?” Involving patients in value stream mapping.
In this second video, a physician talks about the impact on the quality of primary patient care:
- Anticipating patient needs to get labs done and returned DURING the visit
- The doctor things this is the best office he could possibly be working in (based on 21 years of practice)
- He is getting to go home on time at the end of the day because things run more efficiently
- The doctor explains how ThedaCare isn't getting extra money for providing care this way, but there's the personal satisfaction (Mark's note: what Dr. Deming would call pride in work)
- Patient says care is more personal and less rushed.Doctor is less stressed and has more face time with the patient because of looking at better defined roles and responsibilities
In this video, entitled “What Works, What Doesn't”:
- Toussaint shows the “visual tracking centers” that are standardized across ThedaCare and tie into high level organizational goals (a process called “Hoshin Kanri“)
- “Just like on a Toyota production floor” – tracking results almost minute by minute
- Using charts combined with a common problem solving approach
- “We stole it from Toyota” Toussaint says with a smile
- Patient describes it as a streamlined process, far less waiting — “I think any time a process can be streamlined, people should learn from that… why reinvent the wheel?”
This video details the Collaborative Care modelin more detail than was on TV Friday night.
- Improvements in quality and service from the team-based approach (breaking silos)
- Visual display board in each room for the patient, family and care team
- Patient commenting on how care is much more organized, “not just laying here for hours before talking to a nurse or doctor, and then answering questions over and over.”
- Physician talking about finding the root cause of problems and preventing defects in the process (great “lean thinking!”)
- It's amazing that better service and this type of care costs less
- Toussaint emphasizes eliminate waste, delay and waiting – continuous information flow for the patients and providers — learned this from Toyota
- The RN shows how supplies are staged in the room, before Collaborative Care, they were spending up to 3 hours a shift looking for stuff. This is restocked twice per shift and there's evidence of “kaizen” as she says, “Well, we're changing it.”
The same video segment also covers primary care:
- Introduces a “patient flow facilitator”
- She describes the smooth flow of lab results and information to the physician for the patient's visit
- The patient leaves with a plan of care – their questions have been answered to help avoid follow up calls
In this video, Toussaint talks about how better quality can sometimes lead to lower payment to the hospital.
- Toussaint discusses how mortality rates for cardiac surgery patients are lower and the cost is lower (25% shorter length of stay) — better quality and getting paid LESS than a hospital with higher mortality and higher length of stay. 25% less payment for providing better service.
- “It doesn't make any sense.”
What did you think of the show last night? Of these online videos? Here is a link to the “GretaWire” discussion at FoxNews.com
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A central puzzle of lean is why doesn't this spread more, quicker. John expresses wonderfully his dismay at the fact that this is not even part of the national debate, regardless of the huge possible gains. He makes a great case for lean: it's not rocket science, it's a matter of believing in an ideal and solving every problem. So why don't we do this more?
Which is exactly the debate we've heard from every industry where a few pioneers do the work John has done and then wonder – why don't more people do it?
The deeper question for all of us in the lean community, I believe, is why don't we have more John Toussaints. Certainly, the key to have large organizations such as Thedacare succeed in this way, is the leadership of the senior executive. In healthcare, this means the willingness to measure, map and reveal problems in order to solve them. This does take courage – and persistence.
The interview is fascinating both for John's mastery of his topic, but also for the interests of the interviewer – who reacted like every other new person introduced to lean: huh? Can we get back to real life?
This is a great interview. It also reflects every interview of every lean leader i've come across: it's hard work but it's worth it, if we can do it every one can. The puzzle here, industry after industry, is why so few CEOs catch that bug? Is it in the way we teach it? Is it against top management nature? is it wrong for the incentive game? Indeed, one of the greatest moments of the interview was when the reporter kept trying to get john to commit "FOR" or "Against", and John stuck to his guns: we need to understand the real problem. Beautiful!
Michael – thanks for the questions. No easy answers tough.
Why has lean thinking not spread 100% even in the auto industry? You have GM "doing lean" in the factories, but the execs still haven't come close to transforming the way they lead. Their head sales & marketing uses the word "lean" to mean they don't have enough cars on the lot to meet demand. They are "too lean" he says.
But I digress.
I think it was Shook or Womack or said lean leadership isn't that hard to understand, it's just VERY different.
Mark:
Thanks for the video links. These five segments will make great teaching tools, in my opinion. While they may seem superficial to someone intimate with the challenges of a lean deployment, especially in healthcare, they present great material to inspire and provoke!
Toussaint's relaxed mastery of the basics (improvement in quality and delivery go hand-in-hand with cost reduction through elimination of waste) combined with his intimacy with how his system works right down to the front line should challenge every CEO.
And he even brought up my pet peeve – what we call healthcare is usually rework – when he said (paraphrasing) "We should be paid for improving a community's health, not for doing more procedures". Brilliant! The piecework pay for most medical practice REWARDS REWORK (fixing sick people) rather than fostering health. Not that we should not help the sick! Just that the model is upside down and the incentives are backwards.
Keep up the good blog!
-ALB
[…] by Mark Graban on August 22, 2009 · 1 comment Here are all of the videos, embedded from Fox News. Click here for a page with summaries of each. […]