Gemba meets GME

Our senior executive Lean training program always has a visit to gemba as part of the day's session. This time, we went to one of the clinical floors to watch the process of work rounds. The purpose was mainly for us to practice using Lean tools to gather baseline data and identify variation in the work process.

Here's a picture of intern Elena Resnick reporting to resident Lauren Fishbein. Our doctors in training do an excellent job, but we noticed many opportunities for better integration of their activities with those of other departments in the hospital (e.g., radiology, pathology, and case management). However, that would require a massive shift in the mode and purpose of work rounds, attributes which have been in place for decades as part of the design of the medical education process.

We'll come back to this problem some day in the future. For now it was an illustration of the degree of complexity of an academic medical center, where the delivery of clinical care is intimately -- and often inefficiently -- connected to the delivery of undergraduate educational services to medical students and graduate medical education to residents.