Lean games in Den Bosch

We played a couple of my favorite games in the last two days at our Lean training workshops at Jeroen Bosch Ziekenhuis.  The value in using simple and amusing games is to remove the participants from their day-to-day frameworks and allow them to focus on exercises that reinforce Lean principles.

Yesterday's game was designed to illustrate the concepts of 5-S, fixing the workplace so it is conducive to easy acquisition or use of needed supplies by removing extraneous materials, organizing according to how often they are used, keeping the workplace neat, reducing variation across the institution, and ensuring that these practices are persistent.  The terms used to describe these steps are: sorting, setting in order, shining, standardizing, and sustaining.

The game is a simple number sorting game.  Teams of two are asked to look at a sheet of paper and tick off the numbers between 1 and 49, in order.  The first sheet starts with a jumble of numbers going up to 100 (top picture).  The next sheet, having been sorted, appears with no numbers after 49 (see above).  The next sheet places the numbers on a grid (see below), so it is easier to find the next one in sequence.  

The next sheet offers the numbers in sequence. The final two sheets require the players to perform a quality audit, as two numbers are missing.  First, they are all presented in a jumble.  Next, they are presented in sequence.  Our students quickly saw the value of the 5-S principles, and we later went up to areas of the hospital to see how it might be applied in settings like supply rooms.

Today's game, an all-time favorite, was Pig.  It is meant to demonstrate the value and power of standardized work.  In round one, participants are asked to draw a pig on a grid, following oral instructions.  The results, to say the least, are mixed!  Compare the drawings above and below this paragraph.

In round two, written instructions are provided, and things improve a bit.  In round three, a picture is provided along with the written instructions and there are high quality, consistent results (as seen below).

Beyond fun and games, the issue of standardization is a deadly serious concept when we turn to the problem of clinical variation.  We always want to leave doctors and nurses with the discretion to vary from protocols when necessary; but, for the most part, we want to remove creativity from the workplace with many clinical procedures.  Our class viewed this problem as we watched a video of two nurses carrying out a straight-forward, but important, procedure, cleaning a central line.  Even though a written protocol exists, it contains some ambiguity.  It might be that the ambiguity resulted in the nurses carrying out the procedure in slightly different manners; or it might be that they had committed the protocol to memory rather than reviewing the documentation each time; or it might be that they simply had habitual variations in how they conducted the procedure.  But the lesson was clear to our participants:  Achieving standardized work in the clinical setting is important but difficult.