What do making cars and delivering healthcare have in common? More than you think! Manufacturing and lean principles apply, although the details differ. For instance, making cars and caring for patients both include producing on demand, immediately, defect free, one at a time, without waste or error in an environment that is physically, emotionally and professionally safe.
A 2010 episode from NPR’s This American Life (approximately 1 hour in length) discusses what makes GM and Toyota different, using their 1984-2010 joint venture—New United Motors Manufacturing Incorporated. “Stopping the line” is one of the organizational differences highlighted and this has parallels in the healthcare world. Continue reading →
In the past two years I have had the privilege of facilitating sessions with senior leadership teams at more than ten healthcare organizations, with the objective of helping them develop their roadmap to operational excellence, or lean. A number of these teams identified cultural issues as a barrier to transforming their organizations. More importantly, they put these items at the top of their list of barriers to address.
Some examples of cultural issues that have surfaced include: silo mentality, lack of commitment to team decisions, punitive consequences for surfacing problems, no transparency of results, top-down management styles, and fear in the workplace. In organizations in which any or all of these behaviors are present, it is impossible for operational excellence to take hold or sustain over time. Continue reading →
When we observe leadership behavior long enough, we often witness someone in a high ranking position that could use a slice of humble pie. Because of their position, a leader’s behavior is observed by everyone in the organization. If the leader communicates the wrong way or jumps to the wrong conclusion, everyone knows. And the consequences of a high ranking leader acting like they know it all, can be demoralizing to employees.
It’s hard for some leaders to show confidence and exhibit pride in their work, but not cross the line to arrogance. Continue reading →
One of the advantages I have in my role is to participate in gemba at many organizations. I can see their lean journey maturing. I can see their business management systems developing as their leaders iteratively go through cycles of PDSA. I also see the large amount of process waste that emerges as each unit in an organization builds their visual management system. This waste is preventable. I will save additional comments on that for my next blog. Continue reading →
March is my “anniversary month” at the ThedaCare Center For Healthcare Value. I officially started (as a volunteer) this month in 2010 – five years ago. As we prepare for our 6th Annual Lean Healthcare Transformation Summit in June , I would like to share some observations and personal reflections from the past five years.
Nothing like a serious illness to a love one that requires daily visits to a hospital to provide a front seat view of the current state of our healthcare system. My 85-year old mother was going through CRT (combined chemotherapy and radiation treatment) for cancer.
At the cancer treatment center, Monday was “infusion day.” Infusion wait times of four or more hours were the norm. Department associates explained that, “Mondays are very busy.” Scheduling practices such as starting all new patients on Mondays is a contributor to the un-level demand. My mother’s treatment plan, one that many patients also followed, involved accessing her port and giving her a weekly ‘bottle’ each Monday which was removed each Friday. This too contributed to the un-level demand. Continue reading →
Is there a better way to pay for healthcare than the prevalent “fee-for-service” model?
The answer to this question has been pursued for years. Recently, it has become even more urgent due to the changes in Medicare reimbursements (Hospital Readmission Reduction Act), the Affordable Care Act, and recent targets set by the Obama Administration to increase alternative payment methods in Medicare. The goal of payment reform is to find a better way of paying for healthcare that results in better value (i.e. higher quality, lower cost, resulting in better health). In other words, the right care, at the right time, in the right setting, at the right price. Continue reading →
The current way healthcare services are delivered in this country is, at its core, the opposite of lean. Those of us working in the industry need to do much more to become truly patient-centered, or lean, as stated in so many of our mission statements.
To elaborate this point, I will focus on “flow and pull value,” a fundamental principle of lean. When this principle has been applied to the care process, the patient dictates where, when, and how often a service is provided. In addition, waste has been eliminated, so that service can be provided at the lowest cost possible. Examples of this principle in action may include: Continue reading →
It sounds like a simple idea to change from push to pull.
In the months of December and January, many hospitals are in the middle of putting the finishing touches on their annual budget. Thousands of line items, each requiring thought, planning, and measurement are rolled up into a larger set of numbers. Hospital leaders will use this one document to make future financial decisions basing their assumptions on data from the previous six months when the budget process began. This is known as the push style of budgeting. Conversely, some hospitals are changing their annual budget process from push to pull, and have reduced the time spent on budgets by 60% or more. Continue reading →
In 2008, as the U.S. economy tanked, Congress passed a $700 billion stimulus package to fund ‘shovel ready projects’ to put Americans back to work and America back on its feet. They specifically designated $30 billion to wire the American healthcare system. The Office of the National Coordinator was created to manage the digital transition and Meaningful Use came to life. The idea, of course, was that the investor (the U.S. Government as a proxy for the U.S. Taxpayer) must see a return on investment in the form of demonstrated use of the technology it had just funded, thus ever increasing strings were attached to Meaningful Use incentive payments. The $30 billion fund will be exhausted by year end 2014. The compliance carrot of increased revenue is progressively being replaced by the threat of penalties for noncompliance. Now what? Continue reading →