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  • 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. There is danger in describing lean with words like efficiency, throughput, increased productivity, increased value, accountability, and yes, even lean, without making sure others understand what we are saying. Given the...
  • Thinking errors in coaching and healthcare – part 2

    In part 1 of this blog series, I introduced the problem of thinking errors or “cognitive errors” in both coaching and clinical decision making. The shortcuts or “heuristics” we all use to reach conclusions are hard to overcome, perhaps because they do serve a useful purpose. For example, when we hear footsteps coming up behind us at night we’re immediately on alert without even thinking about it. The smell of coffee in the morning tells us there’s a pot brewing in the kitchen. If we hear a noise in the front hall and happen to own a cat or dog, we’re much more likely to attribute that to our...
  • We Can’t!

    During a recent kaizen workshop, the team noticed a lot of motion waste when they analyzed the standard worksheets of medical assistants (MAs) in a diabetes clinic. The MAs would walk between the room in which they took vitals and weighed patients and another room down the hall where they performed fingerstick blood tests for glucose and hemoglobin A1C. One team member (let’s call him John) asked why they did not co-locate the glucometers in the vitals room. The response was, “We can’t.” “Why not?” “Regulations from the state.” The team went about working on other ideas and tests of change...
  • The lean science of waiting room design Part I: flow, push and pull

    As we learned from Womack and Jones in their book Lean Thinking: Value the patient. Map the process. Flow the process, so patients never wait for clinicians—and clinicians never wait for patients. But, if you can’t flow, pull.  What does “pull” have to do with waiting rooms? The concept of pull is one of the most difficult to understand in all of lean production. In this series of blog posts, I will endeavor to explain. Lean healthcare offers us a scientific, evidence-based way to design waiting rooms with remarkable precision. Flow Let’s start with the state known as flow. In...
  • Thinking errors in coaching and healthcare

    A while back, I was coaching a kaizen workshop on a clinical process in which information technology (IT) had been a big constraint and source of frustration. As part of our standard work after kaizen training, the team goes out on a “waste walk,” returns with their observations, and then posts them on a “waste wheel.” As his contribution, one of the clinical leaders wrote on a yellow sticky note “IT is a barrier to this process” and handed it to the team leader to put on the waste wheel. In what seemed to be a pretty typical, good-humored, guy-to-guy maneuver, the team leader vented his...
  • 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! Picture...
  • Standard work—BBQ Thanksgiving turkey

    As the Thanksgiving holiday approaches, I thought it would be fun to demonstrate one of our key lean tools at home—BBQ’ing the Thanksgiving turkey. Yes, whether we’re in the gemba at work or at home, Standard Work is a prescribed, repeatable sequence of steps or actions that balances people’s work or dinner preparations to takt time.Title: Standard work for BBQ’ing Thanksgiving turkeyDate: November 14, 2013  Operators: Cook/BBQ chef  Task # Task description Task time 1 Purchase: Buy fresh turkey (select size that will fit your kettle grill), 8 lb. bag of...
  • 5S and patient satisfaction

    What could be worse than searching for something while others wait? We have all spent time looking for something at one time or another, but have you ever watched while someone else searched for something? As painful as it is for the one searching, it’s even worse for those watching—especially if they are not in a position to help. In healthcare, who is it that watches and waits while we search? Our patients and their families. Several years ago I was the family member anxiously watching while an ED trauma team worked on my husband, who had just taken a serious fall from our roof. The team...
  • Quality controls cost

    Quality controls cost. Period. Quality and cost are two sides of the same coin, and many players within the patient care value stream influence both. When we work to understand their roles and the leverage points available to them, we increase the chance for successful collaboration and improved value for patients and families: Healthcare delivery relies on thousands of interlinked processes—both clinical and administrative—that extend from a patient’s call for an appointment to the final settlement of their bill.  And we know that waste exists within every step of the healthcare...
  • Using Pareto analysis to attack problems

    The Dodgers' Brian Wilson, A's Josh Reddick, and Red Sox's David Ross and Mike Napoli have heightened the popularity of beards and baseball this fall. Baseball’s postseason, with all its drama and tension, can be a hairy situation any year. But this October turned into the Follicle Classic. Teams like the Red Sox and A’s have brought their cities not only playoff buzz, but also playoff and World Series fuzz in the form of flowing beards. So how do these popular flowing beards in baseball today connect with our Toyota Management System philosophy and lean tools...

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