Catalysis Healthcare Value Network member Torrance Memorial (TM) is a 610-bed hospital in California. Leadership, for years, has embraced respect for people as the principle underlying all their actions. It’s one thing to give lip service to “our people are our most important asset” it’s another thing to show it through action. When Covid hit Los Angeles, it was clear to leadership at TM adequate personal protective equipment (PPE) was going to be a big problem. At the same time there were staff who were idled by mandatory shut down of elective procedures. Leadership had to balance these two realities while maintaining the core of their belief system; respect for people. They came up with two core strategies. No layoffs and meet all PPE needs. A series of spectacular events transpired in which both strategies were realized. All PPE needs for the hospital were met and all employed staff kept their jobs if they chose to.
Jeremiah Hargrave is the PI leader at TM. His job radically changed in February. During the first few weeks of the crisis he, along with the Patient Safety Director Bret Barrett, was called upon to create a flexible labor pool. He became the manager. The goal: no layoffs, find meaningful work for everyone. Jeremiah immediately understood one of the top priorities; PPE. How could he leverage this pool of some 500 workers he had inherited who usually worked in outpatient surgery, GI, lab, and other departments? One of the flex pool nurse managers had an idea. She and her husband spent an evening at home building a face shield. The ICU was running low and there were none on boats from Asia coming any time soon. Using plastic laminate sheets in the garage they built a shield prototype. She brought it into the team the next day. They immediately recognized the importance of the discovery. After running it by infection control for approval the race was on to create a production process.
Jeremiah knows how to organize a team to build things, he worked at Toyota for 12 years prior to coming to TM to lead the improvement team. So, he worked with front line flex pool members to create an assembly line. The first team built 20 shields/hr. Then the PI team got involved. After multiple Kaizen they were at 130/hr. In three days, they built 5000 face shields meeting all the ICU needs. Every day they had different people. About 50 staff per day were working out of the flex labor pool. So, it was imperative to create standard work. Each day a training session took place for the new workers. Then a PI “supervisor” oversaw the worker until they understood the standard work and could complete it flawlessly. Without standard work there is no way they could have trained so many staff in such a short time to produce that many masks. Think of Rosie the Riveter. During world war 2 untrained workers used standard operating procedure manuals to quickly learn standard work which allowed for ramped up production of the materials required to win the war. Covid is a different kind of war but the core of lean thinking still applies.
Another problem arose. The organization was running out of sanitary wipes. Again, with supply chains in shambles the PI team and flex pool staff were called on to quickly figure something out. Someone from environmental services said, “we have oxycide disinfectant can we use that”? Quick study showed the disinfectant could be used to saturate microfiber cloth. The individual cloth squares once saturated could be bagged up and sent to units. Within a day or so a mothballed medicine unit was opened, supplies were gathered, and the process was started. The flex pool employees were assembled again following standard work and within two days they were producing 100 bags with 12 wipes each a day. A bonus, the cloths could be reused!
Other meaningful and important work was created for these employees. They screened employees and patients as they entered the hospital for symptoms, including taking temperatures. Who knows what’s next, but this team of people led by great leaders feel they can tackle just about anything at this point?
There are many lessons we can learn from this amazing example of leadership and creativity. Let’s summarize into 5 questions all healthcare leaders should be asking themselves now.
Where is the principle of respect for people on your priority list?
What goal have you set for number of staff infections?
Have you created any alternative other than laying idle staff off? If so, what?
Have you supported and re-deployed staff to do work that gives their life meaning? How do you know?
What process is in place to unleash the creativity of staff to solve problems?
What will you learn from the TM example? Someone once famously said “don’t let a good crisis go to waste”. Maybe it’s time to rethink the underlying principles of your work. Or establish a management system for improvement or re-examine what metrics you are tracking. Whatever it is, do something to improve yourself and your organization. A good start is to begin to answer the five questions. You can build a better future for your people, now is the moment to make lasting change happen.
Hear more from Jeremiah Hargrave on our Podcast, The Lens
Diane Johnsey, RN says:
Lucy Xenophon MD says:
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