DailyKaizen

I will admit it here: I have a really good boss, actually a great one, actually two great ones (in reality, 580,000 great ones, but these are the two that support me directly). Every Division here is led by a business leader and a clinician leader, and the ones that lead mine never think twice about having our teams as close to patients as possible. This has been true even before we began doing work with LEAN.

So it was with just a little calendar wrangling, but without any lack of desire, that I brought my boss from the business side to one of our medical centers. With one of our members’ consent, he began in the waiting room, shadowed the rooming process, the physician visit, and the physician managing her practice using our electronic systems.

On the way out I asked what were the 10 things that he observed in every 10 minutes and sure enough the things he observed were unique to what I observed, but no less relevant. It was a reminder to me that despite the mind clearing that I do when I go to observe, I still bring a perspective, around use of the electronic system, team approach to care, patient-centered care, which heightens my senses toward these areas.

One of the attributes that makes this boss great is his ability to discover the most important things about a situation in a brief amount of time. Participation in the Gemba is a great activity in this case and the great thing is, it’s always there and the staff enjoy the opportunity to teach. It just takes 20 minutes, no to-do’s when you get back to the office, no speeches required, just watching and listening. I’ll also say that the conversation changes ever so slightly when it’s happening where the patients are getting care. This is a great environment to recommit to what’s most important.

I think everyone should bring their boss to the Gemba. If everyone does that, then everyone will be there eventually. The patients are already there. It’s very possible that you’ll be reminded that you did the most important thing in your work environment : arrange to have a great boss.

Over the past couple of years we have invested a lot of time and effort in Lean education.  We have trained more then thirty project managers, consultants, and analysts.  In addition, we have had hundreds of staff and line-managers from all parts of the organization, clinical and non-clinical participate.  This last week I had the opportunity to co-lead a week long training of a group of new consultants and line-managers.  It was the first time in a long time that I had the opportunity to participate in an intensive training program and it was about time I polished up my skills.

What was exciting for me and reflected in the training was how much our knowledge base and competency in Lean has advanced over the last two years.  As an organization we have learned a lot!  Two years ago our training was almost entirely focused on the “tools and methods” of Lean.  We had very little experience in implementing Lean based management system.  We had not yet tangled with the challenges of traditional human resource, accounting, financial or supply chain systems.

Wow, how things changed.  During the entire week last week our discussions were rich with the reality of our current state as an organization grappling with change.  We spent many hours going to the actual place work takes place, talking to the actual people doing the work and observing the actual work being done.  We would the return to the classroom and talk not only about where the technical modules of Lean could be applied, but also about why the processes were broken in the first place.  While learning the technical aspects of Lean are required by every leader that wants to be an effective change agent it is only part of what needs to be learned.  Equally important is understanding the root cause of why 95% of the problems exist in the first place: the current management system   At the end of the fourth day one of the new consultants commented they were excited, yet overwhelmed by just how much there was to know.  Walking out of the room that night this comment stuck in my mind and it reminded me of the following quote from Art Byrne:

“Everything has to change.  Are you willing to do that?”

Over tim

Patient and Family Centered Care - what better a concept to go hand in hand with LEAN!

I was invited as a guest of The Commonwealth Fund to attend (and ultimately present) at the 3rd International Conference on Patient and Family Centered Care. Luckily, this conference was in Seattle, and in a hotel just across the street from one of our shining medical centers in the downtown corridor.

Participating in this conference for me was like seeing long lost cousins - it was agreed from the beginning who we are all working for in health care. And there are a lot of impressive organizations working to bring patients and families into every aspect of the care process, even in our own community. Sometimes the best way to learn about what a colleague actually does is travel somewhere with them….

What I showed was our approach to health information technology, which is designed with patients at the center. Much of H.I.T. today might not be described as such. The “customer” of these systems is often the care provider. The ultimate decision maker in the patient-physician relationship, though, is the patient, and therefore, the technology and systems we create should help the patients make the best decisions.

With that in mind, this survey title from Harris Interactive is concerning to me, and not in the spirit of what we are trying to accomplish. It appears to characterize health information seeking by patients as pathological. Could it be that health information seeking is a response to health information deficit?