Saskatchewan Health Care Data Not Showing Improvements from Lean?

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“[…]The government has stated that its kaizan promotion offices do not measure or evaluate lean, and that no reports have been written. At the same time, however, it has stated that lean has already demonstrated benefits. To test this, I reviewed the HQC website – Quality Insight – that has a significant amount of provincial data. For each indicator I will report the first and last month or year where data were collected.[…]”

Michel Baudin‘s comments:

The article’s author, Mark Lemstra, from The StarPhoenix, claims that Lean yielded no improvement in the financial or medical performance of Saskatchewan’s health care system,  based on data from the Health Quality Council (HQC).

The article’s title is only about “Savings,” but most of the body is about health outcomes and perceptions, and presented through numbers buried in text.

Before taking this article at face value, I recommend checking out the HQC website directly. As in the featured image above, some metrics have clearly improved. Other indicators are flat, like  the willingness of patients to recommend their hospital, or the rate of medical error reports. And some have moved in the wrong direction, such as those related to pain management.

It is perhaps not the rosy pictures that the Lean boosters would like, but neither is it the disaster Lemstra is painting.

See on www.thestarphoenix.com

Is it Lean’s Fault or the Old Management System’s? | Mark Graban

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Blog post at Lean Blog :

“[…]The problem is the culture doesn’t change overnight. Leaders have years or decades of old habits (bad habits) that run counter to Lean thinking. They might be (might!) be trying to change, but people will still fall back into old habits, especially when under pressure.

I hear complaints (in recent cases) coming from different provinces in Canada that say things like:

Lean is causing hospitals to be “de-skilled” by replacing nurses with aides. Lean drives a focus on cost and cost cutting, including layoffs or being understaffedLean is stressing out managers by asking them to do more and taking nothing off their plateNurses hate Lean because they aren’t being involved in changes[…]”

Michel Baudin‘s comments:

In this post, Mark Graban explains how the leadership in Canadian hospitals is slapping the “Lean” label on ancient and counterproductive “cost-cutting” methods, and how the victims of these practices unfairly blame Lean.

This is definitely L.A.M.E., Mark’s apt term for “Lean As Misguidedly Executed,” and is found in Manufacturing as well as Health Care. Much of the article — and of the discussion that follows — is about what I call yoyo staffing: you hire more than you should in boom times, and lay off in recessions.

Of course, it isn’t what Toyota did, and churning your work force in this fashion not only disrupts people’s lives but is bad business. Hiring, training and firing repeatedly prevents your organization from accumulating the knowledge and skills it needs.

Mark makes the case that Lean should not be blamed for mistakes that have nothing to do with it. Other than raising consciousness, however, the post does not propose solutions to keep this from happening.

While there have been studies published on Toyota’s approach to Human Resources (HR), I don’t recall seeing much in the American Lean literature on topics like career planning for production operators.

In his comments, Bob Emiliani paints the current generation of leaders as “a lost cause,” and places his hopes on the next. He seems to suggest that the solution is to wait out or fire the current, baby-boomer leadership and replace it with millenials. I don’t buy it and, deep down, neither does Bob, because he ends by saying “While one always hopes the “next generation will do better”, it could turn out to be a false hope.”

Like everything in HR, generational change has to be planned carefully. The people who rose to leadership positions presumably did so not just because of bad habits but because they also had something of value to offer. And the way the baton is passed is also a message to the incoming leaders: it tells them what to expect when their turn comes.

See on www.leanblog.org

The Virginia Mason Production System | Hospital Impact

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“Virginia Mason Medical Center in Seattle was the first in the nation to adapt the Toyota Production System as the framework for managing a medical center. We call our version the Virginia Mason Production System (VMPS). It is our management method to identify and eliminate waste and inefficiency in the numerous processes that are part of the healthcare experience.

By streamlining repetitive and low-touch aspects of care delivery, our physicians, nurses and other clinical staff members are freed to spend more time talking with, listening to and treating patients. We are discovering it is possible to provide high-quality care with lower resource utilization.”

Michel Baudin‘s insight:

This blog post by the CEO of Virginia Mason sheds some light on the specifics of the “Virginia Mason Production System.” He confirms that the focus has been on administrative tasks to allow doctors and nurses to spend more time with patients, rather than on what happens while the doctor or the nurse is with the patient.

What he describes involves breaking down communications and administrative transactions in “small lots,” organizing groups of contiguous rooms into “cells,” and reassigning tasks to better leverage available skills.

See on www.hospitalimpact.org

Visitors see ‘lean’ during RUH tour | Star Phoenix

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 Technology is often touted as the cure for many of our modern afflictions.Funny, then, that a whiteboard in the staff room could make such a difference in how the city’s busiest emergency department runs.”It’s very low-tech,” says Jon Schmid, the registered nurse manager for Royal UniversityHospital’s emergency department. “But the impact it has on our organization is huge.”…

Michel Baudin‘s insight:

The text of the article is informative, particularly about the use of a white board, but the picture does not show this white board. In fact, it seems unrelated to the article, as if the newspaper just slapped on a stock photo from a hospital.

As it is, however, this photo is a good reason for the quotes around the word “Lean.” It is an encyclopedia of work space design mistakes, with work surfaces at uneven and ergonomically inappropriate heights, causing people to stoop, or even squat to access the refrigerator. Not to mention empty space in the center and chairs.

Workspace design mistakes

See on www.thestarphoenix.com

Lean in administration at St. Luke’s Internal Medicine | David C. Pate

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TEAMwork is St. Luke’s application of lean principles. It’s our management operating system. TEAMwork stands for timely, effective, accountable, measureable work. And it’s making its way through St. Luke’s Health System as we gain on our Triple Aim of better health, better care, and lower costs.

Starting last summer, SLIM embarked on a top-to-bottom examination of how it conducted its work. They wanted to eliminate waste by tapping into the potential and knowledge of every member of the clinic team and build a culture of continuous improvement.

 

 

Michel Baudin‘s insight:

The improvements described are all about supplies and the handling of patients by nurses and administrative staff.

There is not a word about any changes to the work of doctors themselves or involvement by doctors in the improvement process. What form might that take? I don’t know, but, the last industrial engineers to work on health care before Lean were Frank and Lillian Gilbreth 100 years ago, and their focus was the work of surgeons inside operating rooms, not patient handling before and after they see a doctor.

The result of their work was the now standard mode of operation in which the surgeon calls for tools that are handed to him by nurses. It seems hard to believe today but, earlier, surgeons would actually leave patients to fetch tools.

Following in the Gilbreths’ footsteps today would mean for Lean Health Care to get involved with the core of the activity: what doctors do with patients.

In manufacturing, successful Lean implementations start with the work of production on the shop floor, not with the logistics upstream and downstream from production. First you worry about line layout, work station design, and the jobs of production operators. Then you move on to keeping them supplied and shipping their output.

See on drpate.stlukesblogs.org

The trouble with Lean | Canadian unionist blogger bashes Lean healthcare

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Are you Lean, becoming Lean, doing Lean or thinking Lean? Almost the entire province of Saskatchewan has gone Lean. On the surface Lean offers everything front line workers should want. …

See on diablogue.org

Hospital in Frankfort, MI, implements Lean | Grand Traverse Insider

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From this article, it appears that the focus is on clerical support functions and loading docks, not on patient care. This is how it is described:

“Recently, the hospital used Lean thinking concepts to create more efficiency between its clinical and clerical staff by ensuring that the proper documentation forms are available for particular procedures.

‘We created a card that informs the clerical staff what form is needed and how many forms to print,” said Rommell. “We also did some reorganization in our loading dock area to create more efficiency in handling our supplies.’”

As is common in the press, the background on Lean is not entirely accurate. For example, the article says:

“… the Toyota Production System[…] spread to American manufacturers with publication of the book, ‘Lean Thinking'”

Actually, it started in the early 1980s, about 15 years before.

Further, it says:

“…hospitals across the nation have moved to incorporate the Japanese principles of ‘Six Sigma’ and ‘Lean’…”

Six Sigma came from Motorola, and there is nothing Japanese about it.

And next:

“Toyota […] has been using these principles for a long time…”

Toyota never used Six Sigma.

See on www.morningstarpublishing.com

A perversion of the Toyota method | Pierre Deschamps | La Presse

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The article is in French, from Quebec. Following is a full translation:

“A recent story in La Presse reports on the implementation of the famous Toyota method in home care by the Montreal firm Proaction. The article argues that the implementation is driving nurses, social workers and occupational therapists to nervous breakdowns.

In fact, what is described has nothing to do with the Toyota method, but is a practice labeled “Lean,” disconnected from one of the fundamental values of the Toyota approach.

Toyota’s business philosophy is based on two fundamental principles: respect and continuous improvement. At Toyota, the continuous improvement process is based on the respect that the company provides to its customers, suppliers and employees. Continuous improvement, yes, but never at the expense of respect for people.

In recent years, several consulting firms who see the Toyota approach as a business opportunity have appropriated some of its processes, and argued that organizations adopting them would rapidly increase their performance and efficiency.

What these companies have forgotten is that the Toyota method is successful when it is part of a strong corporate culture and in businesses with a healthy work environment. It is not successful in organizations where there is a significant psychological distress and is mental suffering high among employees, as appears to be the case with several employees of the health system.

In addition, for the Toyota approach to be successful within an organization, those who want to use it have an excellent knowledge of the culture and be able to develop a profile of the organization in terms of governance, leadership, ethics, practices, traditions, etc..

In a book called The Toyota Way to Lean Leadership, the authors issue a serious warning about external consultants who claim to be experts in the Toyota or Lean approach.

The traditional role of external consultants is to manage a project and produce a plan of action. Actually, the consultants do the thinking for their clients. They claim to have expertise in Lean methods and guarantee that they say will make the client’s organization more efficient by eliminating all unnecessary tasks and standardizing work.

However, in reality, knowledge of the new methods remains with the consultants and they leave at the end of their engagement is very fragile.

The authors insist that the changes we want to make within an organization to improve performance must be under the direction of a person called sensei or master, who will act as a guide to employees .

In this case, obviously, the Lean consultants — who manage to bring social workers and occupational therapists on the verge of a nervous breakdown, exhaust them, and create a climate of fear — operate outside the philosophy of the Toyota approach.

In fact, they are the opposite of all that is at the heart of this philosophy. The Minister of Health and Social Services is quite right to say that what is at the heart of Lean and, more precisely, the Toyota Way is involving and listening to the service staff in a climate of respect for the values of the organization and all the people, staff and patients.
Want to locate in an area like health care techniques without the underlying philosophy is not only doomed to failure, but can be detrimental to the quality of care.”

See on www.lapresse.ca

‘Lean’ approach to health care

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This article suggests that the implementation effort is both intense — with 50% to 60% of US hospitals and health care systems having launched some form of initiative — and confused.

The featured image shows what looks like a barcode scanner pointed at a prescription bag with no barcode. Is that what Lean is about?
While the title only refers to “Lean,” the content gives equal billing to Six Sigma, implying that both have had a comparable impact in Manufacturing.
The second picture shows nurses and administrative staff around a reception desk, suggesting that Lean is not about doctors and patients, but just about efficiency in support activities.

Patient experience is barely mentioned. A manager reports that UMass Memorial has reduced waiting times, which sounds great, but a nurse reports spending less time with each patient, which does not sound so great.
There is no mention of improvement in the quality of care, for example, by prevention of treatment errors, that one would expect out of Lean.

See on www.telegram.com

Should Hospitals Eliminate Waiting Rooms?

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A PBS news story about how a visit to Toyota in Japan 10 years ago shamed Virginia Mason Medical Center in Seattle into eliminating waiting room. It does not give details on how they actually did it. We can only hope that they actually eliminated waiting itself…

See on www.pbs.org