Tag: Lean Healthcare

Turn Our Waiting Room Into Just… A Room. How’s That For A Hoshin?

Ikitt‘ve enjoyed many of the commercials GE has put out over the last few years.  They seem to have struck a nice balance between informing about technology and entertaining the audience.  I mean, how many times do you find a new way to use KITT in today’s advertising world?  One of the first I remember was “Healthcare Re-Imagined – Love Story” which showed how improved technology can help patient care.  And who can forget the little kid capturing the power of wind?


The most recent agent smithbrings in Agent Smith from the Matrix to explain to us how GE technology in hospitals is improving patient care and reducing waiting time.  And at the end, I think I heard a pretty good hoshin!  Here’s some of the dialogue from the video, Agent of Good:

GE has wired their medical hardware with innovative software to be in many places at the same time…  Using data to connect patients, to software, to nurses, to the right people, and machines.  Helping hospitals treat people even better while dramatically reducing waiting time.  Now a waiting room… is just a room.

There are some additional videos from the GE website connected with this video, including aventura-hospitala visit to Aventura hospital in Florida where we hear snippets from the hospital staff on how they believe the technology is helping them improve the quality of care.  In an earlier video one statistic they throw out is that the system has helped reduce the waiting time for patients by 68%.  Not bad!

If you spend a little extra time, you can find little coded spots (I’m not sure why they made it so hard and repetitive) using the time bar in the first extra video that give additional facts, such as:

  • A typical hospital can expect nurses to get an hour per shift back to spend on patient care, up to 250 hours annually
  • Can help increase equipment disinfection compliance up to 90% at a typical hospital so equipment is there and ready to go faster.

Now, I’m not always an advocate of a complex, capital-intensive electronic system being a countermeasure.  In the first year, or even months, you usually find so many things you wish you had known about when you designed the system, but to change now would mean costly rewrites to software or changes to hardware that you’ve already sunk a lot of money into.  Before developing such a system, first I’d ask, is there a simpler, more manual way to get the same job done?  In fact, many times someone develops a new shiny system just hoping to find a problem to attach it to.  But, if you develop a system to solve a problem, if you take time to define the problem and study your potential countermeasures,  and then design an electronic system to implement the solution and sustain it… well, then there’s not much to argue about!

From the additional videos, I heard several comments from the hospital workers that were really focused on how they use the system to improve patient care:

  • Everything is tagged and is specific to that equipment, and I can go into the system and see exactly where it is in the hospital and see that.  And since my area is critical, it’s a matter of life or death.
  • The GE software helps me provide better care because I’m able to get to the equipment sooner that is often vital to that patient
  • When a patient comes in to a hospital, they expect to be treated efficiently, effectively, and returned to their home.  The GE software is the catalyst that has helped us improve the bed management system.
  • It wasn’t until the GE software was implemented, that we were able to significantly reduce the amount of time a patient waits.
  • For that nurse to have that extra 5 or 10 minutes to spend with a patient, it makes a world of difference.
  • What if, we were able to see that a nurse only got to spend 2.7 minutes with a patient?

Hoshin kanri is usually associated with setting strategy.  I’ve always associated it with the image of a compass pointing you in the direction you want to go, towards your ideal state, or what I’ve heard called an organizacompassnorthtion’s “True North”.  Many times a slogan, or a short set of phrases, are associated to help bring imagery and meaning to the purpose of your organization.  A simple (and Toyota) example would be Lexus with “The relentless pursuit of perfection”.

A hoshin helps focus your organization’s improvement efforts by outlining a vision of where you want to be someday, even if you may never get there.  As you implement lean, you may create a great kaizen process, hold many improvement events, reduce changeover times, 5S the heck out of your maintenance area, create wonderful management systems with visual controls…  but at some point you may sit back and reflect from a distant vantage point and ask yourself, do we know why we did all of this improvement work?  If you are operating with a hoshin in mind, you should be able to connect most of your work towards the achievement of that ideal.

“Turning waiting rooms into rooms” may be a smaller hoshin, for one area of patient care, so it isn’t likely a rallying cry for the entire healthcare industry.  But it is connected to improving the patient experience, and is something just about anyone can relate to.

Does your company’s lean transformation have focus and purpose?  What’s your hoshin?

How NOT to Implement Lean – Thanks for the Lesson, Grey’s Anatomy

There are right ways and wrong ways to implement lean at a company.  True lean improvements have a benefit for the business, the customer, and the employees.  If you only focus on a single area to create benefit in, there’s a good chance that you will alienate the other two.  If you make it a perfect world for employees, you may not make any money.  If the customer is put on too high of a pedestal, you also might not make any money.  But if you only work to maximize how much money you bring in, there’s a good chance customers and employees alike will seek to go elsewhere.

Grey's 2A recent episode (aired 1/31 – “Bad Blood”) of Grey’s Anatomy features an “efficiency expert” who is essentially in charge of making the hospital run much, much more efficiently and cheaper because they are out of money because several of their doctors sued the hospital for negligence for flying them on a cheap airline where several of them were severely injured and several more died.  Following me so far?  Great.

The opening scenes caused my lean implementation radar to scream “No!  Wrong thinking!  Why would you do it this way!”  At least they weren’t calling it “lean”.  But in the first few minutes, the efficiency expert told them all they would be following new equipment storage standards to reduce their surgery changeover time, and an “eye in the sky” security system with a doctor behind it would be monitoring everyone and making improvement suggestions in real time.

Grey's 1Later on in the show, a guest is in the hospital teaching everyone his standard method of closing an incision, and that it would be the new standard that everyone throughout the Seattle Grace hospital system would be required to perform in order to help cut their surgery time in half.

I’ll give you just a few seconds to guess what the reaction of the employees in both scenes was from being dictated how they were going to operate from this point forward.  Rebellious, frustrated, not on board, rolling their eyes, combative… the list goes on!  So, what could they have done differently to implement their “efficiency programs” with more buy-in from their employees?

A really simple answer is, involve them in the problem solving and the solution.  There is great power when employees have ownership of both the problems and the solutions.  If employees and management are both aligned at the outset to the question of “what problem are we trying to solve”, and then both work together to develop solutions, implement them, and study the results, then adoption of the countermeasures across the company / hospital would happen much faster.  (it’s never that easy, of course – but better than not doing it together!)  So really, it is all about involving everyone in PDCA (or PDSA), and not just specialists.

Now, if you watch the show, you’ll counter with “Well, they are under a serious budget crunch, the hospital is going to run out of money and close down in a matter of weeks, and they have to make these drastic changes quickly in order to help everyone keep their jobs, so they don’t have time to involve the employees and do a proper job.”  And I might agree, say that’s true, but then I’ll counter with, “If they had only been using lean thinking all these years, their standards for approving private airlines may have caught a potential risk situation early on and prevented all the chaos, or they might have already made a lot of efficiency improvements that would have made them a profitable hospital in the first place.”

Are you going to wait until a crisis happens to implement or adopt lean thinking at your company?  Or are you going to implement it so that you avoid ever getting into a crisis in the first place?