GembaWalkabout

May 25, 2013

T-Minus 11 Days Until the Lean Healthcare Transformation Summit - To Be List, Item #1

“gemba walk” (lean thinking term) to go to the actual place where value is added + “walkabout” (Australian aborigine) a short period of wandering bush life engaged as an occasional interruption of regular work . Mike Stoecklein . mstoecklein@createvalue.org . my employer gave me that e-mail address, but the ideas and opinions below are mine.

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Most everyone has a “to do” list. I do, the current list has 174 item on it. Not everything is on today’s list, but these are reminders of things I need to do, commitments I’ve made.

What about a “to be” list? I was thinking that this is what the 10 guiding principles of the Shingo model are - a list of things to be. It doesn’t have to be the principles from the Shingo model. Other people have proposed their list of principles. Dr. Deming had 14 points (really principles, I think). Jeffrey Liker lists a different set of 14 principles in his book “The Toyota Way”. I could go on and on. You get the idea.

Here’s the 1st item on the “to be” list using the Shingo model for operational excellence:

Be a person who respects every individual. This goes beyond being nice. It means candor on what we see which could be uncomfortable for others to hear. It means respect for the environment because that impacts us all - now and in the future. It means attention to safety. Not just safety of the body (anyone can point out where the fire exits are), but safety to speak up - an environment without fear.

This is a tough item to apply consistently. It is not easy to be a person who respects every individual all the time every day. But it is worth trying.

If you want to learn more about this principle and the others, you’ll want to come to the 4th Annual Lean Healthcare Transformation Summit in Orlando, FL on June 5-6: http://www.lean.org/Events/2013_lean_hc_transformation_summit.cfm

If you are lucky there’s a seat left for you.

9:17am | URL: http://tmblr.co/ZtQJPylnhWO4

May 24, 2013

T-Minus 12 Days Until the Lean Healthcare Transformation Summit - Where To Start?

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We are learning about the Shingo Model For Operational Excellence as a framework to understand lean cultural transformation. We use this model for our Network member organizations who wish to have an understanding (assessment of) their progress along the journey.

I made a simple Prezi presentation about the model. Here is the link: http://bit.ly/YILfls

We wrote a White Paper on our work. Here is the link: http://www.createvalue.org/docs/Assessment_HVN_December2011(R5).pdf

The model has two components. One (the “house”) is shown below. It describes the “what” (the guiding principles).

In a recent course offering, the instructor asked, “where would you start and where would you focus your efforts?” Most people identify “cultural enablers” as the starting point. It has to do with the “people side”: systems for education, training, coaching, empowerment, involvement, safety, environmental.

Most organizations seem to actually start their work with “continuous process improvement”: systems for problem identification and problem solving, process improvement, value streams.

Few, if any, respond with “enterprise alignment”. But the instructor points out that by starting here the organization can make a lot of progress quickly and avoid a lot of improvement efforts that don’t contribute to the mission of the organization. To make the point, the instructor asks everyone to close their eyes, then point toward “north”. Then, open your eyes. The result - everyone is pointing in different directions. And that’s what can happen if your improvement efforts are not linked to the most important things (true north) for your organization.

If you come to the 4th Annual Lean Healthcare Transformation Summit, June 5-6 in Orlando, FL (http://www.lean.org/Events/2013_lean_hc_transformation_summit.cfm) you are going to hear a lot about the Shingo model. It’s starting to show up in the thinking from the leaders who have been exposed to it.

12 days, a few seats left … maybe.

9:16am | URL: http://tmblr.co/ZtQJPylj6Omc

May 23, 2013

T-Minus 13 Days Until the Lean Healthcare Transformation Summit - Two Minute Warning

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It’s coming down to the wire. The 4th Annual Lean Healthcare Transformation is going to happen in 13 days: http://www.lean.org/Events/2013_lean_hc_transformation_summit.cfm

We used the paddle signs (photo above) last year to keep the Experiments Around the Network Session (aka “15 Minutes of Fame) on time.

This year you can hear from 10 of our Network member organizations:
Palo Alto Medical Foundation “Lean Transformation in a Large Multi-Specialty Practice: How to Spread a Model Line”

Nemours Children’s Hospital “How Continuous Improvement Helped Nemours Pre-op Department Reduce Patient Wait Times from Registration on Day of Surgery to the Pre-op Holding Bay”

Sutter Gould Medical Group “Laboratory Value Stream Improvement”

UCLA Health System “5S in 150 Clinics in 5 Months”

Scottsdale Healthcare “Creating a Lean Transformational Journey: The Scottsdale Healthcare Model”

St. Rita’s Health Partners “Waste Walks in the Hospital and in Physician Offices”

Beth Israel Deaconess Medical Center & HGA Architecture & Engineering “Relocation of a Pre-Admission Testing Clinic”

Christie Clinic “Daily Team Based Process Improvement”

Martin Health System “Department Level Shingo Assessments”

BloodCenter of Wisconsin “Opening the Door to Staff Engagement and Empowerment”

You can only see and hear about this if you come, and there are only a few seats left.

10:19am | URL: http://tmblr.co/ZtQJPyleiPuF

May 22, 2013

T-Minus 14 Days Until the Lean Healthcare Transformation Summit - Blues Clues #2

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On May 5th I wrote about the painting I made and donated to our company: http://gembawalkabout.tumblr.com/post/49683530759/t-minus-31-days-until-the-lean-healthcare

Today I offer some clues about a part of it. Here’s a close-up view of the upper left-hand corner.

You’ll see the theme of “pigs” all around this painting. Looks like in this part of the painting there are a couple pig-related things going on. In the background, it looks like we can see 3 pigs (actually the snout of a 4th if you look closely). Looks like those pigs are behind bars. Looks like the back (or side) of a truck carrying pigs from one place to another (maybe the market?}

I used to work at a pig farm, years and years ago. Occasionally, we (my brother and I) needed to get them on and off of trucks like this. As I recall, it seemed to take all day and it was a lot of work. What does “getting the hogs off of the truck” have to do with lean healthcare and leadership? That’s enough of the clue. Talk amongst yourselves.

The other clue in this image is the spider web. I was influenced by the book “Charlotte’s Web”. Remember reading that book? What message has Charlotte left on this painting? It says “Is there more to life than standard work?” Well, I ask you - is there? Think about it. Talk amongst yourselves.

If you want to talk more about the messages in this painting and talk about the answers to these questions, you’ll want to come to the 4th Annual Lean Healthcare Transformation Summit, June 5-6 in Orlando, FL: http://www.lean.org/Events/2013_lean_hc_transformation_summit.cfm

When I see you at the Summit and you mention this blob post (Blues Clues #2), I will give you a small gift - a token of appreciation for reading the blog and for coming to the Summit.

8:22am | URL: http://tmblr.co/ZtQJPylZl0H_

May 21, 2013

T-Minus 15 Days Until the Lean Healthcare Transformation Summit - OMG! OKC!

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Like most people, I spend most of last evening watching the aftermath of the tornado that hit Moore, Oklahoma. I grew up in Kansas. I know about tornados. I’ve been through some. Not like the EF-4 (or 5?) yesterday.

Our Network has 2 organizations in the Oklahoma City area: INTEGRIS and Mercy. Our hearts and prayers go out to them and the people in the Oklahoma City area.

It puts things in perspective. Still 15 days until the Summit, sure. Hope you will be there and hope to see my friends from Oklahoma City.

http://www.lean.org/Events/2013_lean_hc_transformation_summit.cfm

7:18am | URL: http://tmblr.co/ZtQJPylUpZ8Z

May 20, 2013

T-Minus 16 Days Until the Lean Healthcare Transformation Summit - It Is What It Is

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I follow God on Twitter. You can follow him too. He’s @TheTweetOfGod. He tweeted this the other day: ”It is what it is” is what people say when it’s not what it should be. I think he’s right.

At my previous job, there was a guy who liked to say that - a lot. ”It is what it is”, he would say. Meaning, “look, this is the way it is and it’s not going to change, so drop the topic”.

I see a lot of that in healthcare. The story I wrote about yesterday (my wife’s Uncle Mike dealing with the non-system of healthcare). By the way, we learned that Mike passed away early yesterday, so that’s one way of not having to deal with the dysfunctionality of healthcare.

If “it is what it is” is just a copy out for “it’s not what it should be”, then we need to change it to what it should be. This means hard work, changing systems, disrupting the status quo. Hard work. But if we don’t do it, it’s not going to get done.

If you want to participate in this effort, you’ll need to come to the 4th Annual Lean Healthcare Transformation Summit, June 5-6 in Orlando, FL: http://www.lean.org/Events/2013_lean_hc_transformation_summit.cfm

It is what it is, but it doesn’t have to stay that way.

7:13am | URL: http://tmblr.co/ZtQJPylPuKth

May 19, 2013

T-Minus 17 Days Until the Lean Healthcare Transformation Summit - Lean End Of Life Care

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I visited my wife’s uncle this past week. His name is “Mike” too. He’s a nice guy. I remember he and his wife went out of their way to make our wedding day really special years and years ago.

He’s nearing the end of his days. His body is wearing out. It happens. One of his sons was describing how his care was going, and it was not a pretty picture. Not very lean.

Mike’s been living in the nursing home section of a hospital in a small town. The care in that room and facility seems fine. It’s the care between facilities that doesn’t work well for the patient, at all.

Mike’s been receiving kidney dialysis on an outpatient basis for years. This has worked well at the nursing home. The equipment is right on the same campus. The problem occurs if Mike’s condition changes (which has happened) and he needs more intense care. Once that happens, he is “switched over” to inpatient status and then he no longer has access to that handy dialysis equipment just down the hall. Nope. That won’t work at all. They need to put him in an ambulance, send him to a bigger city (home of the famous clinic founded by two physician brothers in the midwest) and he gets his dialysis there.

Why? I asked why and why again, and why some more and it comes down to money. It’s the way the different parts of the healthcare system works (or in this case, doesn’t work). People call it a system but it’s not. A system is a set of interdependent components that work together toward a common aim. What Mike experiences is more like a series of unfortunate events. Mike deserves better than that. There are thousands of Mikes out there experiencing this series of unfortunate events every day.

If you want to help get rid of the series of unfortunate events and help create a system, then you’ll want to be at the 4th Annual Lean Healthcare Transformation Summit, June 5-6 in Orlando, FL: http://www.lean.org/Events/2013_lean_hc_transformation_summit.cfm

Some day that’s going to be you that needs a system of care.

8:44am | URL: http://tmblr.co/ZtQJPylKs1Dc

May 18, 2013

T-Minus 18 Days Until the Lean Healthcare Transformation Summit - Behave!

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“I want you to behave!” How many of us have heard that? (anyone with a parent). How many of us have said that (anyone with a child).

Why do people behave the way they do? It’s complex, but (I think) there are some simple guides.

If we understand the system of profound knowledge that Dr. Deming described in his 1993 book “The New Economics”, we would understand there are 4 bodies of knowledge that are interconnected and work as a system.

Psychology is one component. So that should give us the answer about why people behave the way they do, right? Yes, and no. Psychology tells us that there is intrinsic motivation and extrinsic motivation and the phenomenon of over-justification. It tell us about the hazards of over-reliance on extrinsic motivation (do this and you’ll get that).

But Psychology is connected to “appreciation for a system” and we know that systems drive behaviors. If we want different behaviors, we need to think about the systems that affect people. There is overlap between systems and the individual. Sometimes the amount of overlap is huge, and sometimes it is small.

If we want better behaviors, then we need to think about systems and try to redesign them. It’s that simple, and that complex. It doesn’t explain everything about why people behave the way they do, but it’s a good start. It’s better than focusing on the person.

If you want to work with others to improve the systems that drive the behaviors of healthcare, you’ll want to be at the 4th Annual Lean Healthcare Transformation Summit: http://www.lean.org/Events/2013_lean_hc_transformation_summit.cfm

Act now (that’s a behavior) while we have some seats left. When the seats are gone, they’re gone (we have a system for that).

9:01am | URL: http://tmblr.co/ZtQJPylFSg1x

May 17, 2013

T-Minus 19 Days Until the Lean Healthcare Transformation Summit - Connection Economy

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I’ve been re-reading some books by Seth Godin. I always learn something. Here are some thoughts on some important ideas that I gleaned from “The Icarus Deception”:

* The industrial age had little use for art because it decreased productivity for the organized factory. That age is ending, and we need to clean out the cruft it leaves behind and build something more valuable in its place. The connection economy demands that we create art. (“Cruft” is the engineering term for the leftover detritus, useless computer code, broken devices, empty boxes, and junk that we have to maneuver around as technology advances.)

* As the industrial age has faded away and been replaced by the connection economy— the wide-open reality of our new economic revolution— the fence has been dismantled. It’s gone.

* The value we create is directly related to how much valuable information we can produce, how much trust we can earn, and how often we innovate. In the industrial economy, the stuff we made (literally stuff— widgets, devices, and O-rings) comprised the best assets we could build. Fortunes belonged to men who built railroads, lightbulbs, and buildings. Today we’re seeking something a revolution apart from that sort of productivity. The connection economy rewards the leader, the initiator, and the rebel.

* The connection economy has made competence not particularly valuable and has replaced it with an insatiable desire for things that are new, real, and important.

* The connection economy functions on a steady diet of new, real, and important. The connection economy builds a new asset, one that we can measure and value now for the first time. Suddenly, it’s not the building or the rules or the packaging that matters; it’s the bridges between people that generate value, and those bridges are built by art.

* When you hear the word “artist,” do you picture the slightly crazed Dalí or the self-destructive Jackson Pollock? Perhaps you’ve been trained to imagine that you need to be someone like Johnny Depp or Amanda F. Palmer in order to make art. This notion is both dangerous and wrong. Oscar Wilde wrote that art is “new, complex, and vital.” Art isn’t something that’s made by artists. Artists are people who make art. Art is not a gene or a specific talent. Art is an attitude, culturally driven and available to anyone who chooses to adopt it. Art isn’t something sold in a gallery or performed on a stage. Art is the unique work of a human being, work that touches another. Most painters, it turns out, aren’t artists at all— they are safety-seeking copycats.

You can meet other artists and participate in the connection economy by attending the 4th Annual Lean Healthcare Transformation Summit, June 5-6: http://www.lean.org/Events/2013_lean_hc_transformation_summit.cfm

19 days left. Seats are going fast. You will want to have one.

8:25am | URL: http://tmblr.co/ZtQJPylAsqzT

May 16, 2013

T-Minus 20 Days Until the Lean Healthcare Transformation Summit - Just say “no”

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We help our Network member organizations host visits so they can share the good work that they are doing. We call them “gemba visits”. We just completed our 28th visit since we started in 2009. They are very popular. People like to go see how others are applying lean thinking in healthcare.

We track the number of attendees, and we are noticing what might be a trend - a “new normal”.

We used to have just under 40 people in attendance, now we are seeing something different - perhaps. We ask our key contacts about this, and we understand there are new restrictions on travel and education and other things.

We seem to be experiencing another course correction in healthcare. I’ve been through many before. A lot of it is centered around our traditional model of care - the inpatient hospital. We are seeing less readmissions - that’s a good thing. But it requires adjustments on the part of management. And most do not seem to be equipped to handle this. They seem to be falling back on the old standby - say “no” to everything. Then, “cut-backs in staffing” is the next phase.

These are temporary adjustments that don’t get to the root causes of the problem. I heard something from someone during our Shingo model education and training the last few days, “you can’t solve a problem that you can’t see”. This is truth. The percent of people who see the problem and the root causes are very low, perhaps only one percent. Most will try to resolve this in the typical manner - saying “no” and layoffs. Temporary actions that don’t get to the causes and only make matters worse.

If you want to connect with those who understand the true root causes and wish to redesign the system, you’ll want to be at the 4th Annual Lean Healthcare Transformation Summit, June 5-6 in Orlando, FL: http://www.lean.org/Events/2013_lean_hc_transformation_summit.cfm

That is, unless someone has told you “no”.

7:44am | URL: http://tmblr.co/ZtQJPyl6HzB9

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