Tuesday, September 28, 2010

Wow, they work hard!

The roll-out of Lean at BIDMC continues throughout the hospital. A current project is to redesign the work flow on "CC6," one of our busiest medical/surgical floors. Although the staff has been working on this for several months, it can be difficult to find time during the workday to make improvements when nurses, patient care technicians, and others have full patient assignments. So, this week, we have taken two days aside for an improvement event, during which the staff will have dedicated time to look at their processes and experiment with improvements.

I dropped by for a short time today to watch people outline the "current state" of their work flow. A person in each job category prepared a step-by-step itemization of their daily routine. I offer a videotape of sections of this below. In order, you will see Stacey Adamson, physical therapist; Dawn Castro, resource nurse; Mike Crowley, unit assistant; and Laurie Phillips, case manager. You will also briefly see Jenine Davignon, a management engineer from our Business Transformation office, and Allison Wang, a college co-op student in that office. And finally Oscar Juarez and Sandra Espinosa, being reminded to post lunch breaks as part of a busy day in the work flow of a patient care technician.

I was impressed by the complexity of each person's job. I also began to see, as they presented their daily work, opportunities for reducing waste and improving the work environment and patient care. The team will undoubtedly find many more of those opportunities during this two-day session. If I can drop by tomorrow, I will report back to you.

If you cannot see the video, click here.


Alison Small said...


Just thought I would give you a recap of how our Lean Event went today for CC6A.

Before I give you some of the highlights of what we learned and accomplished I would like to say that we had great representation from many different roles such as Staff Nurses, Resource Nurses, PCTs, Case Management, Rehab Services, a Unit Assistant and a Physician`s Assistant all of whom I am greatful for attending because they all have an effect on the workflow and the patient experience.

What we learned and did:

We learned about the Lean Process and way of thinking. We learned that 90% of a process involves waste and that this is what we will work on improving.

We learned the Core Values of Lean: Respect for people, all those we work with and care for. Continuous improvement: nothing is perfect and we should always strive to do better, faster, cheaper and easier.

We learned about the 8 wastes and went to "Gemba" by going to CC6A and doing direct observations of staff doing the work. This was very enlightening to many of us who do the work everyday but don`t see the waste till you actually observe it! We had a lot of discussion around this and found that Motion, Unused Talent and Process were the three wastes most observed.

We also played the "Money Game" and learned about the benefits of Teamwork.

We watched the "Airline Video" and laughed but appreciated it`s relevency to Healthcare and the difficulty patients have navigating the system along with trying to understand the many roles of those who care for them while they are in the hospital.

We learned about A3 and began to learn how to identify problems and break them down using the funnel method.

Last we mapped our Current State and were in awe about the many tasks and responsibilities we each have within our own jobs, and I know we gained respect and came together as a team while doing this.

Our Accomplishments were many:
We realized that we do a lot!
We gained respect for each other`s roles.
We all work together towards the same goal like a Team!
From the patient`s perpective a lot of people are caring for them.
There is a lot of waste: walking, redundancy, lack of organization with roles and supplies.
Leaned a new language!
Last we learned that we have a lot of opportunities for improvement and we are ready to tackle them!

We were also visited by the Joint Commission who observed what we were doing and hopefully were impressed by the teamwork and professionalism that went into our day.

Tomorrow we will continue with our A3 and come up with a couple of problems that we can work on and solve with a team effort!


Alison Small

Mark Graban said...

Paul, thanks for sharing, as always!

It seems that Alison really learned a lot and did a nice job of summarizing the key mindsets and approaches of lean.

I hope you'll be able to share more updates on this work.

Erica Mazza said...


I am so happy to have stumbled upon these posts. I am quite familiar with CC6; last fall I was employed as a patient care technician (PCT) here for my first co-op experience through Northeastern University. Additionally, I returned through school (with great surprise) for my second medical/surgical clinical placement this past summer.

From these experiences I have been able to take on both the role of a PCT and a nurse in training, and this has given me great insight into the importance of communication. I am proud to have worked with each and every one of these men and women on CC6 and can attest to all of the hard work they put in for the patients they care for.

It is clear that NONE of the roles played here are easy - and that teamwork is imperative toward keeping the operation flowing smoothly. CC6 is certainly a bustling place. I hope that seeking to better understand the roles and day-to-day tasks of each person will foster greater respect and provide energy toward continual improvement. Thank you, CC6, for taking such concrete steps toward working together, for leading this front, and for setting such a great example for the rest of the hospital. Also, thank you to Paul Levy for sharing these videos and updates with the larger BIDMC community. I only hope that patients are aware and appreciative of all this teamwork taking part on their behalf behind the scenes!!