Monday, July 02, 2012

Learning Lean in Ipswich

Today was the first of a series of workshops on the Lean process improvement philosophy at Ipswich Hospital, and I was pleased to meet two dozen people from various jobs around the hospital.  We started with an introduction based on the Toast Kaizen video produced by and featuring GBMP president Bruce Hamilton.  Then it was off to gemba, the "factory shop" floor, where the class members shadowed a member of the staff. The idea was to practice observation skills and try to identify the various types of waste found in all organizations.  (You see one example above, with a student watching the work done by the unit coordinator of one of the wards, and another below, observing a staff member keeping up with the status of his patients.)

The class members gained a new appreciation for the degree of difficulty faced by their colleagues in doing their everyday jobs.  They noticed impediments, inefficiencies, and work-arounds.  We listed these and posted them to compare the experiences from different areas of the hospital.  Later, I gave everyone a homework assignment, which was to answer the following question: 

Waste exists in Ipswich Hospital because the people who work here are uncaring and lazy. True or False? Provide evidence in support of your answer.

I suspected (and hoped!) that the answer would be "false," and it always was.  People understood that the well-intentioned and hard working people in the hospital face the common problems of complex organizations.  I promised to include the "best" answer here, but they were all excellent, so I have chosen a few a random.

Gary Picken wrote: 

False. I believe the large majority of staff at Ipswich Hospital are caring people who want to make a difference to patient's lives. Waste exists there because we are working in systems and with processes that are inefficient. These have often come about more by accident and the legacy of history, than by design and gathered evidence. The waste continues because we either do not see it or we feel impotent to effect change. Certainly, as clinicians in this organisation, we have not received the investment of the training for such leadership in the past. 

An example of waste:  An elderly man with lower limb arterial insufficiency referred to me for a femoral arteriogram, a procedure involving puncture of a large artery in the groin and an overnight stay in hospital.

Imagine, he has the worry of waiting for the 'test', the myriad of social arrangements to enable him to be there on the allotted day, his hospital bed and slot on the list are ring fenced so unavailable to anyone else.

He arrives in the angio suite after being admitted to the ward (time of ward clerk, nurse, junior doctor, porter) only to have his procedure cancelled because nobody has told him to stop taking his clopidegrel (strong blood thinning medication).

None of the staff wanted that outcome for him, just the opposite. The system had failed him. An ancient system that relied totally on the experienced medical secretary and faltered when she was absent, ill or made redundant.

That's where LEAN, I hope, can improve our hospital.

Jenna Ackerly noted:

The statement that waste exists at Ipswich Hospital because the people who work here are uncaring and lazy is false.  My experience in EAU today and from working in the hospital generally, proves this by constantly demonstrating dedicated, hard working and caring staff, going about their work in good humour.  Waste in fact exists because people are so busy going about their day jobs, in the same way they have always done (or been shown to do), that they fail to spot duplication, waste and inefficiency – or if they do, they feel that they do not have the responsibility to change it. 

Often new processes are introduced without explicit instruction that the old process can be dropped – thus creating confusion and duplication.  In my experience the only problem with our dedicated and caring workforce is that they work hard but not always smart, thus refuting that they are lazy or uncaring.

Jonathan Douse opined: 

Waste does exist at Ipswich Hospital but I dont think it is because people are uncaring or lazy:
1)      I chose to work at Ipswich Hospital because it is a friendly place to work and because people generally say yes when I ask for their help.  If they say no it is because they have a good reason.
2)      When I walk down the corridor I see people directing the lost visitors and patients.
3)      My clinic receptionist is frustrated by her inability to get inefficient processes changed. 
4)      Many  of my colleagues work far more than their scheduled hours.

And Sam Bower offered this thought:

Waste exists because we do not dedicate the time to think about how to eliminate waste and improve process. For example the ward clerk redirecting all the mail today. She knew it was a problem as it "annoyed" her but when does she have an opportunity to tell someone it's a problem? She did today when I dedicated an hour of my time to observe her work. We need to do this more often. An hour a week with a colleague to identify waste and to embed the philosophy of lean thinking into our organisational culture. Not linked to finance, not linked to targets, but linked to improving the working lives of staff and improving morale.

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