But take a look anyway, if you have an interest in process improvement in hospitals. This is a collection of my best posts on this topic.

Sunday, February 23, 2014

This is not my main blog

Hi and welcome!

You can find my main blog here.

I have gradually copied posts related to transparency and Lean process improvement to this blog to serve as an archive and resource to people in hospitals who might want to review the experience at Beth Israel Deaconess Medical Center and other hospitals and apply lessons to their own institutions.  (You can also search "Lean" and "transparency" on my main blog and find most of these, but the search engine is not always complete, so you might find this a more useful place to review those posts.)

I've also included stories from training programs I've conducted around the world on this topic.  What a pleasure it has been to meet thoughtful and well-intentioned people in other countries who are interested in enabling their hospitals to become learning organizations.

Our early version of Lean in the Boston hospital was called BIDMC SPIRIT, so you will see a number of blog posts that refer to that.  We came up with the concept of SPIRIT in November of 2007.  All of the stories during the "SPIRIT" era had the logo atop, to provide a touchpoint for our staff.  I've left some, but not all, of those logos on these reprints to give you a sense.  Eventually, by July of 2009, we let SPIRIT die away as a program "brand," but the lessons we drew from that stage in our institutional development were extraordinarily helpful as we rolled out a philosophy more directly based on Lean principles.

People often ask me how many staff members read my blog during the period covered by many of these posts.  It is impossible to tell exactly, but the likely range is between 1500 and 2000 each day, out of the 6000+ FTEs and 900 doctors on staff.  Some people regularly went to the blog link daily, others subscribed through Feedburner or another aggregator service, some read it on Facebook or Twitter, and others were referred to it by the clipping service published electronically each day by our media services department.  I know, also, that when a specific staff member was mentioned in a blog post, s/he would circulate it widely to family, friends, and co-workers.  This, in turn, led many people to send me story ideas about programmatic successes and setbacks, whether in clinical care or logistical or administrative arenas.  It is hard to overstate the importance of this medium as a leadership, team-building, and institutional communications tool; but a very important aspect of that was that I wrote the posts myself, keeping them current and in my own voice.

But blogging is really not the main point here.  What you see documented is a consistent and decided institutional commitment to transformational change.  It takes a long time and with constant reinforcement from the top folks to fight inertia and entropy and build sustained momentum for this kind of change.  While the senior management has to work really hard to make this work, my personal involvement and interest as CEO and that of the Chiefs was essential.

Another lesson is that personalizing the stories of success and setbacks is extremely important.  You cannot overdo the recognition of individuals, whether formally or informally.

Finally, this approach really works on many dimensions of quality and efficiency, as Steve Spear, John Toussaint, Gary Kaplan, Jim Conway, Bruce Hamilton, Jim Womack, John Shook, Peter Pronovost, Brent James, Mark Graban, Jeff Thompson and the others say.  If there is any path for a general hospital or academic medical center through what is coming down the pike in terms of government and private payer revenue restrictions, and demands by the public for more personalized medical care, this is it.  The attached scatter diagram from The Leapfrog Group is one indication of the kind of results that are possible.

(I have not transferred all the many thoughtful comments from these blog posts.  You will need to go back to the originals to read those.)

I have also transferred a blogroll here of useful resources in this field.  You will find some of the world's experts listed therein, but also real-life people reporting on the work in their hospitals.

Best of luck to you as you make health care safer, higher quality, and more efficient!

Thursday, February 13, 2014

Lean-ing nicely in Den Bosch

I had a chance today to visit one of my favorite hospitals, Jeroen Bosch Ziekenhuis in the Netherlands, and spend time with a number of managers who have been exploring a wider application of the Lean process improvement philosophy.  Frans van de Laar, who runs the blood and urine laboratory, recently introduced one of the simplest and most effective examples of standard work, a morning huddle with the staff who collect the daily flow of samples from inside an doutside of the hospital.

You see Frans here with the white board, around which the staff huddles each day.  After talking about projected workload and staffing responsibilities, one component of the huddle (seen below) is to identify a problem of the week that the group will attempt to solve or a situation which they will attempt to improve.

Below that item, the group decides on an inspirational slogan for the week.  This week is was: Treat a patient like you would want yourself to be treated.

Frans was pleased to note that the huddle has changed a bit since he introduced it, with comments and suggestions from the staff being the impetus for modifications.  Beyond the more serious changes, there was the addition of this humorous priority item in the huddle summary:  Friday + [pictured] coffee and apple pie with ice cream!

Another item adopted by Frans and his team is this voluntary assignment board for minor tasks that need to be done around the lab.  Items are coded by whether they need to be done monthly, quarterly, half-yearly, or on an ad hoc basis and put in the left-hand slots. When a person has a lapse in regular lab work, s/he can volunteer to do the job.  Once finished, the tag is moved to the right-hand side, with notes documenting when it was completed.

One can imagine the alternative, spending time assigning people and monitoring their compliance with these items, possibly creating resentment at being assigned humdrum tasks.  Instead, people volunteer during their slow work periods and feel a sense of contribution to the team effort.

These two examples demonstrate that Lean is a state of mind and a philosophy:  Small improvements, engaged front-line staff, and a manager who views his/her job as one of empowerment and service to the team.

Wednesday, February 5, 2014

Lean hits the soaps

I now have total confidence that Lean process improvement has arrived for real and will soon be adopted in hospitals throughout the world.  The source of my confidence?

Watch this clip from this extremely popular, UK hospital-based soap opera, Holby City.  The new young protagonist, Raffaello “Raf” di Lucca, is a highly driven registrar who is also (tah dah!) a Lean process improvement adherent.

Hereford's Daniel Jones, founder and chairman of the Lean Enterprise Academy--which is "dedicated to pushing forward the frontiers of Lean and to spreading Lean to every kind of organization"--is finally getting his way!

Watch this clip for proof! (You just need to watch less than a minute.)