Did you know that back in the early underground mining days, miners were dying because of deadly gases that would seep into the mines? They learned that canaries, hanging in cages within the mines, would die long before the levels of gas were deadly to humans. This was their early warning system for action. This is the purpose of a process measure.
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.
What I see at gemba visits, and what I experienced as the Decision Resource leader at ThedaCare for 12 years, is that as an organization’s lean maturity develops, it attempts to create focused outcome measures that narrow down to the most critical things to measure. While it is good that outcome measures are developed, organizations have not gone through the effort to develop a complete picture of the process they are trying to improve. What is missing are the measures that show the reliability of the processes that create the outcome measure. A mature measurement system contains both the process and outcome measures for all measures they are attempting to improve. They also ensure the process measures are measured real-time or near real-time so that immediate action can be taken for prevention or Jidoka. It is a visible sign of both lean and analytical maturity. If you want to read more about what makes a good process measure, read Linda’s blog post from a few months back.
I’ll describe an example for another industry to show the irony. Suppose an airline was having issues with planes needing to make emergency landings because they were constantly running low on fuel. The airline executives were running monthly reports and sending the reports to let everyone know when these events were occurring, and which flights were impacted. They also said that all managers were to post these reports on their visual management walls to let everyone know what was going on. They had a monthly executive review of these events as part of their leadership standard work. Think about it. This example would not be a measurement or action-based process that would get quick improvements. Does this sound familiar? Similar processes are occurring frequently within healthcare.
The next time you go to the gemba, look for the canary indicators for each outcome measure. Are they there? Are they timely enough to take action? Their absence is an opportunity for improvement.
Please share in the comment section about some of the canary indicators you see.
Brian Veara, Program Director
Catalysis Healthcare Value Network