Something Lean is in the water in Wisconsin, as that state is one of the hotbeds of Lean healthcare. There's, of course, the ThedaCare story (from Appleton) and the upcoming book about their journey (“On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry” — on facebook and twitter).
But the topic of this blog post is a book from people working with the Children's Hospital of Wisconsin. The book is called Lean Doctors: A Bold and Practical Guide to Using Lean Principles to Transform Healthcare Systems, One Doctor at a Time, written by Aneesh Suneja with Carolyn Suneja.
I haven't read the book yet, but you can see the Table of Contents and some sample material through the ASQ website (the publisher of the book). I did listen to an archive of a webinar given by the author and a representative from the hospital, Terry Schwartz.
From the webinar, I like the sound of their approach. Suneja talked about some of the dysfunctions of some of the common approaches to Lean implementation. I agree that mass training isn't the way to go, as you'll train a lot of people and end up frustrating them by not being able to provide any support to get anything done. Nor is mass rollout of a single tool, like 5S ideal – you can't just cherry-pick a tool and expect meaningful results.
In their discussion of change management, I agree that people have to understand “why” (why you're doing Lean and why a new process is beneficial) so they WANT to follow the new process. I agree with their statements that you can't rely on punative hounding of employees to sustain a new process. And I agree with Suneja's assertion that Lean can't be just a bunch of projects – it has to lead to culture change and a new way of managing every day.
Suneja makes the case that you should start small – establishing a “model line” with a scope as small as one clinic or even one doctor. This is also a position I'd advocate – start small, get results, and then spread what was a more comprehensive approach to Lean in that model area. Suneja calls this a “deep dive” for that initial physician champion and their team/staff.
Suneja argues that if you have to pick a single metric to focus on, choose patient waiting time and orient improvement around that goal. This is consistent with the Lean/Toyota idea that the main goal is to compress time – with that, quality and other improvements will follow.
Suneja and Schwartz argued for doing “just in time training” in small doses, followed with immediate action and application of what was learned. I like that approach. By listening to staff and engaging them in that improvement, you start getting culture change (and people will own their improvements, making sustainment and continued improvement easier and more meaningful).
I also agree with their comments about 5-day Lean events (aka “Kaizen Events” or “Rapid Improvement Events”) not being a cure-all. I've never been an “event guy” and I agree with their stance that, especially in a healthcare setting, that five days might not be enough time to really get input and manage change. They called events “too forced” and “too regimented,” that true culture change might not happen that way.
So what were their results in initial model area (an ortho clinic)?
- 70% drop in wait times (door to doctor)
- patient sat scores increased “dramatically” (although their chart made this hard to confirm in a statistically meaningful way)
- less stress for the staff
- being able to go home on time
- seeing more patients
With these results, other doctors started pulling on Lean. That's the way to really help Lean spread. You have to demonstrate benefits and have people WANT Lean. You can't really force it on them.
Based on what I heard in the webinar, I'm looking forward to reading the book!
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Looks like great stuff, Mark. I’m anxious to see the book.
Thanks for the heads-up, Mark. This book sounds like a nice addition to the lean health care literature.
I’m about halfway through the book. Very illuminating. Highly recommended. Glad I bought it. We’re discussing the potential extent of its utility for our workflow assessment /re-design effort as part of our HIT Regional Extension Center work. There is some concern in the broader Quality community that the ARRA / HITECH “Meaningful Use” REC initiative will be driven to focus inordinately on getting at the incentive money, at the expense of inculcating durable internalized QI principles at the clinical level. That, IMO, would be short-sighted, resulting in only transient impact. I am arguing that properly executed lean tactics would likely provide the additional time for physicians and staff to tend to meeting the Meaningful Use criteria. But, I am getting some skeptical pushback there.
.-= BobbyG ´s last blog ..Irrespective of national health care policy reform legislation, the medical sector is going full-steam-ahead HITECH =-.
My guess is lean isn’t in the water but good management is in many people’s experience. Madison was a hotbed of Deming and quality improvement, including Brian Joiner, Peter Scholtes, George Box, my father Bill Hunter and many more. The Madison Area Quality Improvement Network did lots of great work and hospitals including Meritor and Mary Zimmerman were there adopting good management practices for nearly 30 years. It is no surprise those efforts set the stage for continued great work.
Some references including a post here just a few days ago
https://www.leanblog.org/2010/05/guest-post-deming-lean-and-healthcare-transformation/
http://management.curiouscatblog.net/2006/01/07/the-public-sector-and-deming/
http://williamghunter.net/articles/doing_more_with_less_in_the_public_sector.cfm
http://cqpi.engr.wisc.edu/system/files/r036.pdf
There was lots of great work done by lots of people at many different organization building a great pool of resources to apply lean management to hospitals.
.-= John Hunter ´s last blog ..Manufacturing in the USA, and Why Organizations Often Don’t =-.