“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
———————————————————————————————————-
I was on a visit to one of our member organizations with JT (Dr. T) and JB. After some touring of the facility and seeing various (impressive) applications of lean thinking, we convened with senior leadership in a conference room. Even though our goal is not “assessment”, people always want to know what we think. So, we told them.
One question came from a physician - how do recommend that organizations handle the dynamic between physician autonomy and standard work? I’ve heard that question (or something like it) before. A big part of applying lean thinking is getting agreement from everyone who works in a process on the current best way of doing things, and then everyone does it that way, using this is the basis for continuous improvement. The way physicians have been trained (and the way they have been allowed to practice) grants a lot of autonomy to individual physicians.
Dr. T’s response to the question was interesting. He asked, “when you go to see a doctor, where is the value added?” Silence. Finally, someone offered up some measures of success - clinical outcomes, evidence-based practice, yada, yada, yada. Dr. T asked the question again. More silence. Finally, he described the typical office visit to see a physician. The waiting, and more waiting, collecting information, doing some testing, actually talking with the physician, then some follow-up steps. Dr. T. explained that of all of the steps in the process, the part that adds value to the patient (from the patient’s perspective) are those few minutes with the doctor. There may be other steps that are necessary or needed (under current process) - so they could be “necessary waste”. But, from the patients perspective, only one part adds value. ”And we’re not going to mess with that part of the process”, he added.
So, we have lots of work to do to eliminate many of the non value-added steps, and to make the “necessary waste” as efficient and effective as possible, but we’re not going to mess with that doctor-patient time (some have called this “middle ware”).
Same thinking applies in the inpatient setting, although the roles are more intertwined and it is imperative that all participants adhere to standard work - including the physicians as it relates to the overall process. But when it comes with the doctor-patient part, we’re not going to mess with that.
