Wednesday, June 17, 2009

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.

5 comments:

Frank Calberg said...

You write: "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."

Do you have the opportunity to communicate a couple of concrete examples regarding opportunities? Thanks very much in advance.

Paul Levy said...

A bit premature to say much, as we would have to understand things better -- but some have to do with the sequencing of these education-based work rounds with the actual clincial processes, like getting orders entered earlier in the day..

nana said...

I kept backtracking, following all your "gemba" links and never found an explanation for that actual term???

Paul Levy said...

Gemba = The place where work happens, where value is created for the customer. First described here: http://runningahospital.blogspot.com/2009/04/going-to-gemba.html

Farmer Bob said...

The best way to achieve massive shifts is incrementally, with constant improvement, as with small steps and long journeys.

I applaud your efforts to immerse executives in the realities of the workplace. Too many managers have little idea of how their companies work is performed.