I was invited to address a class at Alpert Medical School at Brown University this week. Entitled "Healthcare in America," this is a student-run preclinical elective on health policy and advocacy. I include pictures of some of the students who made particularly thoughtful observations or who asked really good questions.
Beyond the expected issues of comparing the United State health care system with those of European countries, we spent some time on issues of process improvement in hospitals. I had stressed the lessons of Lean, i.e., the idea of empowering and relying on front-line staff to call out problems and work-arounds and to work on solutions to reduce harm waste in the hospital setting. I pointed out that the people who work in hospitals, including and especially the transporters, food-service workers, and housekeepers, are extremely well-intentioned and driven by a desire to improve patient care.
I later received a note from Peter Kaminski, Class of 2015, who confirmed some of these thoughts:
I spent several years working in the kitchen and volunteering in the transport department at Emerson Hospital in Concord, MA. Just as you described, my coworkers, especially those in transport, were some of the kindest people I've ever met. Many are retired members of the community and are still the same dedicated humanitarians they were over 8 years ago when they first taught me what healthcare was truly about. While visiting some of them this past summer, I quickly realized that I wouldn't be going into medicine were it not for their influence.
With those thoughts in mind, it was fantastic to hear someone with your experience and influence affirming the vital importance of consulting support staff in crucial decisions to improve patient safety and satisfaction alongside organizational efficiency. I have no idea what the future will bring but it is greatly comforting to know that healthcare at its core is still people serving people, whether that means performing bypass surgery, wheeling a patient down to radiology, or bringing a patient their lunch.
Thanks for the invitation!
4 comments:
Is there a book or easy summary that could be used to introduce the Lean process to administrators who quite clearly have never heard of it -- or have such a vague idea of how to begin that they are unwilling to even consider it?
Through your many blogs you have surely convinced me that even beginning to employ the concept would be better than muddling along as "we've always done it". Change is hard, however, if the top doesn't know how to begin and the bottom no longer trusts the top to have a clue.
Pam, the folks at the Lean Enterprise Institute (www.lean.org) can help you with suggestions.
I strongly recommend the book "Making Hospitals Work" by Marc Baker and Ian Taylor, who are Senior Fellows with the Lean Academy UK. It is based on their improvement work with several NHS hospitals, and we are now using both the book and their experimental framework in our current improvement efforts at BIDMC. The book is available through LEI, as Paul suggests.
The greatest opportunity to eliminate waste is to enlist the patient to say "no" to care they don't need. Prescribe care instructions to patients so they are prepared before visits and stays. Give patients independent access to health education materials so they know the guidelines and can ask that their providers follow them. Front-line staff can direct patients to these materials and that can help establish a standard of care. Very Lean indeed.
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