Lean lessons at Jeroen Bosch Ziekenhuis

I was so pleased to be invited back to Jeroen Bosch hospital in the Netherlands to conduct some three-day workshops on the Lean philosophy for a number of the senior managers.  Now, you can't learn everything about Lean in three days, but this set of seminars is designed to cover some of the basic principles--and especially to get participants out on the floors to see what life is like for the front-line staff.

After being greeted by hospital CEO Willy Spaan with a pertinent quote from William Glasser's Choice Theory, we started with the marvelous video Toast, produced by the GBMP.  Here, you see participants chuckling as Bruce Hamilton displays the simple inefficiencies of the toast "production" process in his home kitchen.  By viewing waste in this kind of neutral setting, people avoid getting defensive and applying preconceptions and then are better able to apply the lessons to their own workplaces.

Then it was off to gemba, to shadow various people throughout the hospital.  The point here was to identify the obstacles that people face in doing their day-to-day work and to learn better how to see waste in the organization.  Not by interviewing the staff people, but by just watching them do their work.  For example, here you see Paul van Hall, unit manager of Perinatology, as he has a chance to watch Evelyn in the central sterilization area as she organizes surgical instruments for cleaning. 

(This kind of exercise has to be done very respectfully and carefully, lest those being shadowed fear that they are being judged.  Instead, they are told, truthfully, that the point is for senior leaders to learn about how things are done in the hospital.  Most people being shadowed soon forget they are being watched, and many later express appreciation for the interest shown in their work.)

Upon their return, we asked all the participants to tell some stories of waste they had seen and to enter the examples into the categories symbolized by the acronym UWITDMOP, standing for Unused Human Talent, Waiting, Inventory, Transportation, Defects, Motion, Overproduction and Processing. (Check Mark Wroblewski's blog for a variant, WORMPIT!)  The examples seen at Jeroen Bosch were quite similar to what I have seen in other hospitals and are common to all kinds of large, complex organizations.  Also, the experience of going to gemba opened the eyes of many of these managers, as they gained appreciation for the obstacles encountered by staff every day and for the tendency to invent work-arounds to carry out their tasks.