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  • 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...
  • 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. Our kaizen workshops start each day with team members sharing their hansei about the previous day...
  • Time or inventory; inventory or time?

    Between each process in a clinical value stream, we find patients waiting…and waiting…and waiting. At the Rona Consulting Group, we use hot-pink sticky notes to represent patient wait times on value stream maps. Stopwatch running, we sit down and wait with the patient and then record the number of minutes waited on a time observation form. We compare patient observations to identify the mode or most frequently occurring wait time and post that time on the hot-pink sticky note on our value stream map. Our standard practice is to post wait times on our maps, because that represents the...
  • Eiji Toyoda – A visionary leader

    Earlier in September, we learned of the death of one of Toyota’s visionary leaders, Eiji Toyoda. Today, we can use the term “lean leader” to describe this man, who was the Japanese equivalent of Henry Ford. In the 1950s, however, when Eiji Toyoda was creating new mass production methods and one of the pillars of the Toyota Way – Kaizen, or continuous improvement – the term “lean” had not yet been coined. Who is Eiji Toyoda? Most of us have read more about Sakichi Toyoda, who was famous for inventing the automatic loom and whose patents helped fund the company, or the men who pioneered the...
  • Why communication really does matter

    A patient’s family is asking logical questions, but an intern feels ill-equipped to answer. A resident and attending physician are presenting discharge plans, but they lack information from rehab and nutrition services. Every day, we’re reminded that the quality of the healthcare we provide begins with how well we communicate as a team. Inadequate communication is more than a daily challenge for the healthcare team. It can impact efficiency, the entire patient experience, and, most importantly, outcomes. The Joint Commission projects that approximately 80% of serious medical errors can be...
  • 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! Standard work was limited, and participation on the turnover team was variable with anywhere...

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