Jim Bevier's Blog

  • Using takt time in healthcare

    Takt time is a simple calculation—available time divided by demand—but a fuzzy concept for many people in healthcare. Often we hear: “Well, we are open 24 hours a day and we never know how many people are going to show up at the door.” Let’s look at two concepts that help clarify the concept of takt time and how best to apply it.

  • Genchi Genbutsu

    Genchi genbutsu. Go and see. This is the action tied to a “gemba state of mind”—having a clear understanding of where and how value is created for your patients, where safety risks are for patients and staff, and where you must go to understand your processes. Some people have compared genchi genbutsu to Management by Walking Around (MBWA). It is not MBWA! To practice genchi genbutsu you must learn to observe, identify the seven wastes, and question everything you see. It means taking time to quietly observe work in order to understand it.

  • Everett Rogers changed my life

    The day I learned of Everett Rogers’ work on diffusion of innovation, I changed the way I approached managing change. The proverbial light bulb went off in my head when I first saw the normal distribution curve Rogers used to describe categories of innovation adopters, which is crudely reproduced here:

  • Lean enterprise = lean body

    A physician leader in a GI procedure area once said to me, “We really run lean here. Most other places have four or five more people to support our level of activity.” Of course the rate of staff turnover was high, the lead time was long, customer satisfaction was low, and they had replaced the nurse manager three times in the last five years. He clearly misunderstood lean.

  • Thanksgiving dinner and external set-up, or, “Is too much of a good thing too much?”

    It’s here again! That annual rite of eating too much high-calorie, high-fat, high-cholesterol, sugary food, and then collapsing in front of the television to watch the Detroit Lions and Dallas Cowboys take on their respective opponents. My mind, ever occupied with “lean” things, turns to external set-up at Thanksgiving. Last year, while reclining in my semi-comatose state, it occurred to me that too much external set-up for this event might be a bad thing. It took a serious cognitive shift for me even to entertain this dissonant thought. External set-up bad? No, no, this cannot be!

  • Hansei: A critical practice on the path to improvement

    Hansei (hahn-say) is a Japanese concept that roughly translates to a process of introspective, critical reflection—on both successes and failures—and commitment to improvement based on that reflection. When hansei is performed honestly it is emotional and leads to personal and professional growth.

    Here are two examples from my experience that help illustrate the depth and value of hansei. Both focus on shortcomings, but keep in mind that honest reflection on successes can be equally powerful.

  • There is no safety in numbers!

    In a small (30-bed) community hospital, operating room staff were struggling with the challenge of efficiently performing operating room turnover. The time to change over the room between operations was too long and too variable.  The average changeover time was 28 minutes, with a range of 15 to 39 minutes. Required tasks were completed inconsistently, with variability in the way they were performed. During one turnover the horizontal table surface was cleaned four times by four different people!

  • What do you do when opportunity doesn’t knock loudly?

    Experienced lean practitioners know that there are virtually no processes or work units that are devoid of opportunity for improvement. Indeed, improvement opportunities leap out at practiced observers. As an organization travels down the road of transformation, though, the opportunities become less evident.