This episode is sponsored by StoreSMART.
My guest for episode #252 is Jordan Peck, a Senior Director in the Center for Performance Improvement at MaineHealth and Maine Medical Center. Jordan and I first met when he was a graduate student at MIT and was involved with the Lean Advancement Initiative (and I was working basically across the street at the Lean Enterprise Institute). At MIT, he earned a PhD in Engineering Systems and Health Care Systems.
Jordan and I have continued to cross paths every year at the Society for Health Systems annual conference. His career has taken him to the Veterans Health Administration and now into the private sector at Maine Health, as we discuss in the podcast.
Streaming Player (Run Time 48:20)
I'd also like to welcome a new sponsor for this episode and to LeanBlog.org… StoreSMART. They're an American manufacturer of products that can help support your Lean journey, whether you're in manufacturing, healthcare, or other settings. They have products to support visual management, 5S, kanban, strategy deployment and other Lean practices. Thanks for your support!
For a link to this episode, refer people to www.leanblog.org/252.
Topics covered and links related to the podcast:
- How Jordan got introduced to Lean
- Axiomatic design
- The “news vendor problem“
- Lean daily management practices, including huddles, gemba walks, etc.
- “Engaged work teams” and challenges in adopting methods from ThedaCare
- Working toward a culture of improvement
- When coaching is seen as criticism
- Creating a Lean Culture (David Mann)
- Books about ThedaCare
- Healthcare Kaizen (Graban & Swartz)
For earlier episodes of my podcast, visit the main Podcast page, which includes information on how to subscribe via RSS, through Android apps, or via Apple Podcasts. You can also subscribe and listen via Stitcher.
Thanks for listening!
Videos About Lean Daily Management at Maine Health
Also, check out this paper that was submitted by Jordan to the Society for Health Systems Conference (PDF)
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Check out my latest book, The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation:
Thank you for providing this podcast and thanks to Jordan for sharing. Very intriguing approach (MaineHealth). But every area every day gets a VP visit? Unless each area is making progress continuously, that would seem to be redundant. Maybe they are making progress every day. I wonder how much time each area gets for improvement and how they pull that off, especially clinical areas? Assuming significant time, I wonder how the original commitment came about?
Bart, thanks for the question. We find the following benefits to having leadership in the conversation every day:
1. We break the hospital into multiple routes; each route has 10-15 units. So, more often than not, at least one unit has a significant finding or improvement.
2. The VPs rotate, as do the staff presenters, and the Gemba walks are open to all staff which means that there are valuable new connections and conversations occurring every day.
3. The daily data review with leaders gives staff the chance to remember details around each issue. This increases understanding of the problem significantly and makes leaders more capable of partnering with the team.
4. Finally daily walks create momentum in the system. If we did it less than every day, and one walk was missed, people wouldn’t really notice. Then it can be missed again and before you know it the leadership commitment to supporting this program is undermined and staff members cease to work on their improvements.
We have organizations that have been doing this for 1, 2, and even 3 years without missing a day and the leaders insist that they can’t imagine anything they would rather be doing each morning.
And I hope the staff say the same thing about the leaders not missing a morning :-)
Hello Bart. My name is Erik Frederick and I am the Chief Operating Officer of Pen Bay Medical Center, a member of MaineHealth. We have been conducting walks at PBMC every day for 2.5 years. Your question is one I hear regularly.
The value of the walks goes far beyond the work being done around KPIs. The program raises the visibility of the executive team, breaks down communication barriers and strengthens the relationships of employees across the system. I often tell people that there is a social element to the program that cannot be described. You have to go on the walk to experience it. There are moments everyday that executives, managers and employees share laughs, frustrations and exchange ideas that resonate across the system.
I’ve been personally going on these walks for almost 5 years now. I agree with Jordan in saying that this is the most important thing I do each day.
Wow! Great commitment from leadership. I appreciate Jordan and Eric for your responses and look forward to learning more in the future.
Thanks Mark and Jordan for this update on continuous improvement at MaineHealth. The MIT background, where I met both of you, brings back memories. Sounds like you’re achieving very good results developing the culture with daily huddles. You provide another data point for the value of daily frequency which is hard for so many to even consider, never mind adopt. My question is where you see MaineHealth going next on the journey. With the culture to a point where staff are comfortable with basic PDSA, will you try to build on that, moving up the value curve to address more complex, system-wide process challenges across departments and full value streams? Or will you try the inch-wide, mile-deep “model cell” approach perhaps?
Thanks, Tom. Yeah, daily huddles are pretty well proven to work. I’d even dare call it a “best practice.” Folks in healthcare get so wound up about wanting to copy “best practices” unless they find one they don’t like…
I’ve heard people ask, “How often are we doing to do our daily huddles?” Sometimes they end up doing them weekly. Fine, try that and see if it works… but then don’t complain that “Lean doesn’t work here.”
This rant was not, of course, directed at you, Tom :-)
Thanks for commenting.
Hey Tom!
Great question. Inevitably after a hospital has been doing the Gemba walks for a few months, leaders start to go back to their old way of wanting to tackle the fire of the month with a big project. We push back on that and recommend that the leadership do value stream mapping of at least three major streams (ex. ED Flow, Inpatient Flow, Revenue Cycle). Through that process we have them identify all of the issues that they are facing and triage them by the correct approach to fix them (front line work, individual’s project, RPIW, etc.). Then we have them prioritize the list and we spread the work out over the year.
Naturally some big emergencies still take precedence but we really do try to plan it out as much as possible.
Jordan
I’d suggest that there’s always a need for basic PDSA or staff-driven small Kaizen activity. Yes, there’s the need to prioritize, focus, and align bigger projects or events… but I’ve seen staff-driven continuous improvement be 1) aligned to goals and 2) “fix what bugs you” at the same time… I’d argue not every small improvement needs to be aligned. That’s the beauty of Kaizen is that you spread out the burden and everybody helps fix something. Bigger projects do require more thoughtful consideration though.
Great discussion – very helpful to hear contrasting approaches to the spread of Lean approaches in health care (or any) organisation.
The engagement from clinical staff sounds excellent, and coaching specific tools and methods as the context arises sounds like best practice.
Supporting projects to link up across a value stream to improve important KPIs is a familiar challenge. It feels as if clinical areas could undertake a lot of excellent work that improved issues for that area and its patients, without necessarily affecting organisational targets.
I noticed a mention of project work in the linked paper. Is there also a strand of targeted work undertaken at MaineHealth?
Summary of the episode by Cameron Stark:
https://leanhealthservices.org/2016/08/01/harnessing-improvement-efforts-in-an-acute-hospital/
Cameron,
Yes, we also have people on our team that do project work, however it feels like chasing fires in many cases. At many of our hospitals we are able to get the leaders to do some value stream mapping and prioritize the projects based on strategic priorities. On the other hand, if they are adamant about an issue prior to them doing that ground work, it is hard to say no. At the same time we are working with managers to lead their staff in choosing high impact front line improvements that also align with the organizational strategy.
One issue is that, in many cases, the true organizational needs (which lead to project requests and front line work) are not necessarily what shows up in the organizational strategic plans. The next big frontier for our developing management system is to ensure that strategic planning learn from front line efforts as well as drive them in a “catch ball” style. Given the length of a strategic planning cycle, this has been slower work.
Thanks for the question!
Jordan
Great podcast and subsequent conversation concerning aspects of the lean daily management system at Maine Health. Thanks for that!
I also really appreciate the lesson in axiomatic design. You inspired some research and reading here. I just listened a second time to be sure I’m following along!
Looking back, I see a number of things that we got right (despite being completely ignorant of axiomatic design) in my last job (in a very different industry) because we decoupled requirements and reduced the communication of information between processes. But, oh my goodness, what a lot of opportunities for deliberate application of these ideas in healthcare!
Some of our success in this area came through application of the second rule implied in work observed by Steve Spear (DNA of the Toyota Production System): customer-supplier connections must be direct, with unambiguous yes/no requests and responses. To some extent this forces decoupling and it certainly reduces the information content. If information content is strictly binary (yes/no or +/-) it is, obviously, a whole lot simpler. And if you can’t tell the faucet to “run hot with more flow”, for example, but just one of these at a time in binary request (temperature +/-; flow +/-), it invites decoupling.
Comments? What is your understanding of the relationship between the “rule of connections” and axiomatic design?
Andrew, thanks for the comment. My friends and I used to joke that Axiomatic Design was just Nam Suh writing down how he thinks logically. It is so simple and yet so powerful. In that way, I have found that it aligns with many different innovations that pop up which use the principles (whether they do it on purpose or not). In that way, if you find a design or idea that seems smart, it is likely that if you were to reverse engineer it with Axiomatic Design you would find that it seems to meet the basic requirements of a good design!