One of my favorite of the 14 “Toyota Way” principles to discuss with hospitals, in particular, is principle #8, which says:
“Use only reliable, thoroughly tested technology that serves your people and processes.”
Too many organizations, across multiple industries, think that software, robotics, or other forms of technology will be a “silver bullet” or what some call a “siren song.” I'm not anti-technology – I love gadgets and new technology in my personal life. But I think organizations and leaders are wise to follow the Toyota Way example of not using technology for technology's sake. For example, too many hospitals invest millions in automation (including in pharmacies and labs, only to see things not improve) and Lean provides an alternative.
In this post, I'll cover topics including GM and tweeting cars, technology approaches to preventing texting-and-driving, and a hospital that is using video cameras as a high-tech workaround to the problem of nurses not having enough time at the bedside.
I heard a story on the radio (NPR, I think) recently about a GM concept vehicle that will send you a text message when your gas tank is running low. I believe this was something being shown at the Detroit Auto Show, but I can't find a web reference. A text message when your tank is low? What's wrong with the fuel gage right in front of you behind the steering wheel? What am I missing here? I'd rather trust an analog gauge than my iPhone, especially since prompt delivery of text messages isn't always assured (regardless of what AT&T ads claim). Is this a real need for some customers or a gimmick that sounds cool?
Texting while driving (or emailing) while driving is certainly dangerous, even while sitting at a red light (as I was reminded in a recent community email from the Keller, Texas police department). A number of companies are working on apps or built-in cell phone features that would disable your phone while the GPS sensor senses you are moving. Many GPS navigation devices have this safety feature built in.
But what if you are a passenger? Then the phone, like some GPS nav units, would need an override of some sorts. So a well-intended technology solution might be circumvented by some drivers (much as some nurses find clever ways to bypass the patient wristband barcodes that are supposed to ensure that the right patient gets the right medication).
The email from the City of Keller recommended that drivers put their phones in their trunk to help avoid the temptation to look at the phone. That's a process-driven approach, but what if you get into an accident (not from texting) and you need to make a call?
I also heard one commentator say recently that every phone has an OFF switch and that could be used by drivers. So what's the need for apps or potential nanny-state mandates to prevent texting while driving? Now, some want to ban texting and WALKING in New York, if you can believe it.
Another story I heard on WBAP, the local Dallas-Fort Worth news station, was about a Baylor Health System hospital putting cameras in EVERY patient room, sending a feed to the nurse's station, so the nurses could better monitor patients. I can't find an online reference to this story either, even on the WBAP website. While this might sound like a laudable goal, keeping a better eye on patients, I asked this question on twitter:
If the problem statement is defined as “nurses can't see patients because they are at the nurses' station too much,” then putting in a video camera feed in to provide visibility might seem like a reasonable countermeasure. But observing patients from afar, via video, might not be preferable compared to the nurse actually being in the room. If you see a fall-risk patient trying to get out of bed via video, the nurse might not be able to get there in time to prevent a fall.
What if we framed the problem as “nurses are at the station too often” and we found ways to get them out of the station? What if we ask “why are the nurses at the station so much?” Maybe their Computers on Wheels don't get a good wireless signal, so they come back to chart at a PC at the station? Or maybe the carts aren't holding a charge, so they come back and plug them in at the station? Can we develop a process where nurses do shift handover at the patient bedside instead of at the nurses' station?
Maybe there are less expensive solutions than putting in video feeds? Just because we CAN put video in each room, that doesn't mean we necessarily should. Are we getting to the real root cause of the problem? Are there manual approaches, like looking at your dashboard, that could work just as well as the texting solution?
What do you think about any or all of these points?
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Mark,
One of the things I like about stuff from you and others with a lot of experience, is the ability to see the flaw in problem statements. You have restated the key question beautifully: “Why are the nurses at the station so much?”
All of us trying to implement Lean need to constantly remind ourselves to spend more time understanding the problem than developing the solution. Thanks.
Rule #8 is also one of my favorites as well. It can be easy to get lost in understanding problems, and I don’t want to sound too simplistic, but what seems to keep me aligned is getting back to the fundamentals of value and flow. What is value to the patient, and what actions are enhancing or impeding flow? Of course the other principles of lean apply, but those two seem to “right the ship” for me in many instances.
I was going to tweet about this post, but it’s illegal to use your phone while driving where I am. I like this post because everyone is always looking for some miraculous technological advantage to beat the competition while ignoring the obvious waste in their current process. Thanks!
Anyone that knows me knows I am a gadget freak. And will try about anything. But I have to agree on your post and my experiences from a patient standpoint is quite frustrating.
I am quite frustrated in several dealings with medical industry when there seems to be an effort to utilize their latest technology over what is really needed. It is very difficult to argue many times but it seems to happen at the Dentist, Audiologist, GP, Dermatologist, and the Hospital. I believe it is rampant and out of control. The other side note is that before recommendations, they always seem to ask about insurance and co-pays.
I may have become to cynical but as a result, I question the quality of medical care I am receiving. Should I be worried that technology has taken over practicality and common sense?
I have been evaluating Root Cause Analysis software the past month. Sound like something I could sell the medical profession? ;)
One interesting thing to research is the use of surgical robots and whether outcomes are truly better or not for different types of procedures.
High-tech flashy gadget… but is it better?
To be clear, the robots are really directed by surgeons, don’t get visions of autonomous robots working independently based on programming.
Link from CNBC story:
http://bit.ly/aCbkOZ
Unfortunately Joseph, healthcare is stubborn enough to stick with making the mistake that were made decades ago in other industries. That was – and still is… – very common in NA. I wrote a blog about one of the worst experiences I had with “mindless” automation how I called it: http://elseinc.com/elseincblog/2010/10/.
However, it also widely spread in Europe where I remember a “Lean” facility getting quotes to get rid of an automated train system that had been implemented as part of their “Lean” transformation two years before. What was even more amazing was the fact that, in the same time with the search for a contractor to remove the railing system they were looking for a provider of ceiling mounted automated carriers. They had had one before deciding to install the fully automated train as I could see the rails above. Now they wanted to put it back in place again as it was “better” than the automated train…
How can you beat that mindset? I am getting nervous even thinking about the silliness – as I don’t want to use the proper word for it – of the management thinking that way… Millions of dollars just put in the garbage due to the shortness of sight in not seeing the value of people and what true Lean is.
So, apparently, healthcare has hard time learning from others.
Another danger not noted is that technology oftent stifles improvement. We’ve implemented I.T. solutions to “hardwire” best practices and what we’ve really done is “hardwire” reliable poor performance while limiting opportunity for process improvement.
There was a famous documentary put out in the early 80’s showing industrial leaders from the US going over to see what was driving process improvement over in Japan. Deming was actually in the documentary also. Many of these industrial leaders interviewed talked about the technological advances in Japan that they had to catch up on missing the point of all the lean stuff that was really driving quality. As an outcome of that visit GM invested heavily in much troubled robotics and automation lines, GE bought Fanuc Robots (not sure of their current status), and Westinghouse bought Unimation (Westinghouse is not even around anymore unless you count CBS).
Anyway you words of advice to beware of technology should be well taken.
Yes, GM invested billions in automation and robotics and the hope for a “lights out factory” with few workers.
Imagine if they had invested that in developing people and their problem-solving skills?
Toyota plants tend to be LESS automated today than GM plants…
I really have a problem with video feeds without a reason. When a nurse is in your room, you know it and adjust your behaviors accordingly. When a video is running full time, it becomes part of the background noise that you soon forget about, and may do something you don’t want blasted all over YouTube. Remember, we were told that body scans taken by the PornoTubes at airports would be destroyed after being taken, only to find them later on the Internet. Too great an invasion of privacy for me. That being said (I have vented) and out of the way, I agree with you Mark. The social interaction part of healing-the kindness, touch, compassion, help, assistance and information-is lacking with the video approach. Good old face time may be of far greater benefit. And isn’t added customer value what we are seeking. If technology can add that value, then let the consumer make that decision with the providers as a part of the value stream of care.
Good points, Patrick. Do patients have a button that allows them to turn off the video?
Simple solutions seldom are. It takes a very unusual mind to undertake analysis of the obvious. – Alfred North Whitehead
The importance of identifying root cause can not be overstated. If one diligently drives to the root cause(s) of problems and then selects a solution that is cost effective, quick and requires limited human resources to implement, the lure of a quick technology “fix” will be avoided. I think we all, at times, fall into the trance of technology. We just need a fairy godmother to remind us to KISS, keep it simple stupid! That’s where a good Lean Master is worth their weight in gold.
Great post Mark. I hear all the time in my organization that our new EMR will fix that problem. Bad process that are computerized become bad electronic processes.
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