Lean Daily Management for Healthcare

A Strategic Guide to Implementing Lean for Hospital Leaders

Brad White

• Publisher: Productivity Press
• Year: 2016
• ISBN:
  9781315350738
• Edition: 1
• Topic: Negocios y empresa
• Subtopic: Operaciones

You likely don't need any more tools, programs, or workshops to improve your hospital. What you need is a simple and consistent approach to manage problem-solving. Filling this need, this book presents a Lean management system that can help break down barriers between staff, directors, and administration and empower front-line staff to resolve their own problems. Lean Daily Management for Healthcare: A Strategic Guide to Implementing Lean for Hospital Leaders provides practical, step-by-step guidance on how to roll out Lean daily management in a hospital setting. Ideal for leaders that may feel lost in the transition process, the book supplies a roadmap to help you identify where your hospital currently is in its Lean process, where it's headed, and how your role will change as you evolve into a Lean leader.Illustrating the entire process of implementing Lean daily management, the book breaks down the cultural progression of units into discreet, objectively measurable phases. It identifies what leaders at all levels of the organization must do to progress units into the next phase of development.Complete with case studies from different service areas in the hospital, the book explains how to link problem-solving boards together to achieve meaningful and measurable improvements in: the emergency department, the operating room, discharge times, clinics, quality, and patient satisfaction.After reading this book you will understand how consistent rounding, a few whiteboards, pen-and-paper data, and a focused effort on working the Plan-Do-Study-Act cycle can help you build a common problem-solving bench strength throughout your organization—establishing the framework upon which future improvement can be built.

IMPLEMENTATION

II

No great thing is created suddenly.

Epictetus

Pick up a pen and write your name. Now, switch hands and try again. Two things happen. First, the effort required to do the task goes up, and, second, the results diminish because you are writing the exact opposite way that you have your entire life.

Implementing this new management system will feel much the same way. You understand the need for it, and you can see the end goal, yet the mechanics of actually doing it will feel clunky. The reason is that success demands that you unlearn old habits and replace them with new. Your entire leadership team will feel this at different times, and frustration is an inevitable by-product. The good news is that by simply sticking with it, the awkwardness will fade. As new instincts for handling issues begin to take over, the process becomes increasingly easy.

As you read through this section on the mechanics of how to actually do this, be aware that learning them in theory is easy—they are deceptively simple. Putting them into practice though is much more difficult. To ease the process, implement the system in as small of steps as possible. Because the system is simple, the temptation is to do everything at once. Without expert guidance, this is ill advised. Instead, go from slow to fast and trust the process.

Lean Daily Management (LDM) runs on the plan–do–study–act cycle, known as the PDSA cycle (Figure SII.1). This cycle is used to prevent bias from seeping in by keeping the focus on data-driven problem-solving. Because so much problem-solving is currently done based on hunch and intuition, it will feel unnatural to waste time gathering data. Have the patience to do it right though because, so often, common sense turns out to be wrong.

The steps in the PDSA model are as follows:

Plan—Start with a question, or hypothesis, of what might be driving a problem. For instance, if the problem is the length of time that patients wait in the ED for a bed, the hypothesis might be that it varies by floor.

Do—Run the experiment by collecting data. For every fallout—in this case, a patient waiting over a certain amount of time—gather the floor that the patient is waiting for.

Study—Evaluate the data to see if there is a trend developing. Once one area stands out, you are ready to take action.

Figure SII.1 Plan–do–study–act cycle.

Act—Find out why that particular floor is driving the majority of delay. This will involve asking another question and repeating the PDSA cycle.

When a traditional Lean or Six Sigma organization first encounters LDM, there is an initial hesitation to implement LDM because they have made a significant investment into the current structure. There is an existing hierarchy of training, projects following a management format (usually define–measure–analyze–improve–control [DMAIC]), a method for reviewing and selecting projects, and an established way to track return on investment. With so much effort and work put into the system, there is a reluctance to abandon it or even to upset the status quo.

This concern reflects a lack of understanding how a Lean management system works in harmony with a more traditional Lean or Six Sigma approach. LDM brings continuous improvement to the more disruptive process improvement (PI) approach that is currently being used. Done well, the strengths of both approaches can be leveraged to cover their respective weaknesses. There are three major benefits that a Lean management system can bring to an existing program that is traditionally lacking:

1. Staff engagement around small problems

2. Identification of potential projects

3. Sustainability of projects

Together, these three benefits help backfill the current program and close the gap that is created by overbuilding a PI program without having the management system in place to support it.

1. Staff engagement around small problems

Frontline staff are often absent in most PI programs. Because they are hourly employees, pulling them off the floor for training or project work triggers a charge that hits the budget. While the wisdom of this objection is dubious, it nevertheless poses a challenge for most organizations. As a result, solutions are developed not by the people who do the work but rather by those who are removed from it. The solution is then pushed down by fiat for the front line to execute. Not only does this disenfranchise the staff, but also it jeopardizes the project.

LDM helps bridge this gap by engaging staff around problems that are within their scope to fix. By focusing on what the staff perceive as problems, engagement naturally happens. Another benefit is that PI now becomes continuous improvement. Small improvements are made every day to fix the myriad small problems that create organizational friction, making it easier to run larger PI initiatives.

2. Identification of potential projects

Opportunity often lurks hidden in the daily activities of the hospital. Because they are the closest to the problem, staff are the best positioned to identify these opportunities. As they chase down problems that prevent them from delivering care, these little problems will unearth large problems through the consistent use of the 5 Whys. When this happens, these can be elevated to the PI team that is to be addressed with more rigor—usually the DMAIC process or an A3. Continuous improvement runs into a barrier and becomes PI.

3. Sustainability of projects

One of the greatest challenges traditional PI projects face is the sustainability of the solution. Because natural variation is so high in the hospital, it is difficult to develop an ideal solution that works all the time. By integrating the sustainability plan into the daily management boards, the key performance indicators (KPIs) from these large projects can be converted into metrics that can be tracked and, if necessary, improved, by the staff, weeks or even months after the project has officially ended. In this instance, PI morphs into continuous improvement.

While it is advisable to start with an LDM system and then build a traditional program later as more complex problems arise, starting with the traditional approach does not mean that the current progress must be sacrificed. Because a healthy PI program will include both process and continuous improvement, having one does not preclude the other. On the contrary, both should be built in tandem; otherwise, one starts to outstrip the other. In a heavily traditional approach, projects stall, and training yields little impact resulting in frustrated leadership. In a heavily LDM approach, problems are uncovered that daily PDSA cannot solve resulting in disenfranchised staff. When these two approaches are combined together though, problems are identified, solved, and sustained in one integrated system.

Chapter 5

Engaging the Front Line

Regard your soldiers as your children, and they will follow you into the deepest valleys; look on them as your own beloved sons, and they will stand by you even unto death.

Sun Tzu

Introduction

LDM begins and ends with the front line. Without their involvement, the entire system becomes an exercise in futility. Fortunately, gaining staff engagement is not difficult. While, typically, employee engagement has been treated as an arcane practice, LDM gives you a system to diagnose not only where engagement is flagging but also why. By treating poor engagement as any other problem that can be diagnosed, treated, and cured, staff engagement can move out of the murky world where it currently resides in and become another measured, systematically improved metric that can be managed.

Administrator Expectations

The core expectation of LDM is that every administrator devote approximately 2 hours every day to staff development and problem-solving—1–1.5 hours to work on the hospital instead of in the hospital. While, at first, this may seem like an unsustainable commitment, there are two factors that help to achieve this. First, LDM activities will replace several activities that currently consume the administrators’ time. Second, as the myriad small problems that constantly pull administrators away from more critical work diminish, the time available for doing what matters will increase. For instance, afternoon firefighting to get patients out of the ED and onto the floor can be replaced with daily preemptive discharge huddles (Figure 5.1).

Communication Structure

There are three major communication cycles that are part of the LDM process: (1) staff/administration, (2) administration/director, (3) and director/staff. Each has specific goals and guidelines that should be in constant consideration. All three communication cycles have one all-encompassing goal: to facilitate the development of these three groups of people (administration, directors, and staff) by identifying where in the process the learning h...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Preface
• Acknowledgments
• Author
• Introduction
• SECTION I PREPARATION
• SECTION II IMPLEMENTATION
• SECTION III PRODUCTION
• Glossary
• Index