tag:blogger.com,1999:blog-32053362.post4602633578650606658..comments2024-03-18T06:27:51.599-04:00Comments on Not Running a Hospital: La méthode Toyota pervertiePaul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-32053362.post-57446408941493469142012-12-18T16:04:35.396-05:002012-12-18T16:04:35.396-05:00Hi Mark- Thanks for the update on ThedaCare. I...Hi Mark- Thanks for the update on ThedaCare. I've read about their effort in the past, but not recently. It sounds like they are doing the right thing- disrupting themselves for the good of their customers (actually improving their chance for sustainability).<br />I've also appreciated reading and learning from your work with Lean.<br />Thanks again,<br />BruceBruce Ramshawnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-82048932564053200592012-12-13T22:58:27.880-05:002012-12-13T22:58:27.880-05:00This is exactly what happened in the 1980s in the ...This is exactly what happened in the 1980s in the department store industry. Nordstroms was making much more money than others due to its legendary customer focus. They also happened to have (still do, I think, though since I am guy and I don’t shop, I can’t say for sure) a piano player in the lobby.<br /><br />Several department stores tried to “copy” the Nordstroms model by simply putting a piano player in the lobby. What you are describing in this posting is exactly that, mangers trying to push a button rather than do the hard work of changing a process.Al Lewisnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-79731901580160553892012-12-11T17:16:57.821-05:002012-12-11T17:16:57.821-05:00Bruce - I agree that Lean is not Taylorism... Tayl...Bruce - I agree that Lean is not Taylorism... Taylorism is about the expert telling people what to do, where Lean is about people participating and figuring it out (maybe with a coach or facilitator, not an all-knowing expert).<br /><br />People with Taylorist habits tend to view Lean as a new way to tell people how to do things, sadly. They can't see what Lean really is through that old lens, sometimes.<br /><br />You're right that Lean needs to help create value across the care continuum -- value being health and quality of life, not efficient delivery of treatment.<br /><br />ThedaCare, a health system in Wisconsin, is using Lean to reduce admissions (which, in a fee-for-service environment, hurts them financially) and they are using Lean as part of ACO experiments.<br /><br />Hear their CEO, Dean Gruner, MD talk about this here in a podcast:<br /><br />http://leanblog.org/144<br />Mark Grabanhttps://www.blogger.com/profile/07953086531083611251noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-33434615871820908122012-12-11T12:04:43.265-05:002012-12-11T12:04:43.265-05:00I think this is so important for people to underst...I think this is so important for people to understand. It sounds like Taylorism to me (Scientific Management- published 1911, republished 2006). Boje and Winsor wrote an interesting article discussing this misapplication of Lean in the Journal of Organizational Change Management (1993). They suggest that the effort is intentional, although I believe, in most cases, it is just a lack of understanding.<br /><br />I also see a lack of understanding in healthcare when applying Lean, even when done well. It seems that Lean has been applied mainly in the fragmented sub-processes- the emergency department, the OR, etc. I've not yet seen Lean applied to the most important process to be defined, measured and improved- the patient's entire cycle of care. This cannot be done within a hospital only. I believe this would be truly accountable care.Bruce Ramshawnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-6343356940963461142012-12-11T07:27:39.576-05:002012-12-11T07:27:39.576-05:00Sadly, people can do any old stupid thing and they...Sadly, people can do any old stupid thing and they can call it Lean. Neither John Shook (from the Lean Enterprise Institute) nor anybody from Toyota can come with a cease and desist to force people to stop this behavior or to stop them from calling it "Lean."<br /><br />I call it "L.A.M.E." (Lean As Misguidedly Executed) when people force top-down changes on people without involving them in the process. You can't claim (well you can... but you shouldn't) to be "doing Lean" when you ignore basic TPS tenets like "respect for people."<br /><br />Going back in history, Toyota's Taiichi Ohno wrote that standardized work methods must be written by the people who are doing the work -- respect for people.<br /><br />Having standardized times (such as 15 minutes to clean an ear) can be helpful for planning purposes (to have enough staff to properly meet patient needs and to do work in the highest quality way), but a time like 15 minutes must NEVER be a hard quota (such as it cannot take more than 15 minutes). There is variation in patient care that must be allowed for...<br /><br />The top-down tyranny that's described in the Quebec piece shouldn't be called Lean. I'm glad you and the authors there can distinguish between (as Bob Emiliani calls it) "real Lean" and "fake Lean."Mark Grabanhttps://www.blogger.com/profile/07953086531083611251noreply@blogger.com