tag:blogger.com,1999:blog-32053362.post5424110292737679314..comments2024-03-26T00:25:34.026-04:00Comments on Not Running a Hospital: Interns Learn Lean -- They get it in two days!Paul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger18125tag:blogger.com,1999:blog-32053362.post-90228500742856641502009-07-20T10:31:27.285-04:002009-07-20T10:31:27.285-04:00Contact Maureen B. at the Institute for Healthcare...Contact Maureen B. at the Institute for Healthcare Improvement. They have a fellowship program there that is excellent, along with other such things.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-39290800940782085562009-07-20T10:16:32.695-04:002009-07-20T10:16:32.695-04:00I applaud yours and ACGME’s work to integrate heal...I applaud yours and ACGME’s work to integrate healthcare improvement early in medical careers. <br />After more than 20 years in Critical Care I now would like to engage full time in the PI environment. What suggestions do you have for those of us in mid-career to identify opportunities (& progressive institutions) to learn beyond our first hand experiences and participate in healthcare continuous improvement?<br />Thanks!Unknownhttps://www.blogger.com/profile/15018131402267323333noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-19440461977945704242009-07-10T16:31:03.059-04:002009-07-10T16:31:03.059-04:00This project is a great idea! I am a first year I...This project is a great idea! I am a first year ID fellow, having just completed my pediatrics residency. I also have a specific interest in learning about hospital administration and QI. As residents, we learn almost nothing about these aspects of practicing medicine, and many doctors feel ill-prepared to function well in the "real world" after leaving their formal training programs. It is great to see residents being involved in the hospital improvement process, as it seems to me that QI represents the most seamless interface between medical practice and the "business of medicine." The goals of patient safety and better medical care are shared by both physicians and administrators - why not start learning this process when we begin our training as physicians? I look forward to hearing more about this project and maybe adapting some ideas to present to our residency program as well. Thanks!Jennoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-91936218070017223692009-06-30T15:16:34.596-04:002009-06-30T15:16:34.596-04:00Actually, ask "why?" five times to get t...Actually, ask "why?" five times to get to the root cause.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-7761434973221651992009-06-30T14:48:50.548-04:002009-06-30T14:48:50.548-04:00PookieMD,
The question to ask is "why"....PookieMD,<br /><br />The question to ask is "why". If you are stuggling through rounds and physician work, what is the disease in the process that makes it that way? Diagnose your work like you do your patients and get to the root cause.<br /><br />If you are stuggling through your work you don't have time not to do PI projects (since QI and PI are the same thing)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-80541256196188613042009-06-30T11:41:00.329-04:002009-06-30T11:41:00.329-04:00Agreeing... I think. I was merely challenging the...Agreeing... I think. I was merely challenging the PookieMD remark that I felt implied that an administrator's involvement in front-line activities is a negative thing. It's necessary to perpetuate involvement from administration!Andrewhttps://www.blogger.com/profile/16774855042572343164noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-35631829652152809692009-06-30T10:03:33.377-04:002009-06-30T10:03:33.377-04:00Are we all agreeing or disagreeing? I'm losing...Are we all agreeing or disagreeing? I'm losing track!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-22361328855988309882009-06-30T10:00:31.918-04:002009-06-30T10:00:31.918-04:00Anonymous, and Mr. Levy,
How do you know I DON'...Anonymous, and Mr. Levy,<br />How do you know I DON'T go to my administrator with QI ideas? Having an intern think about QI for a day or two is hardly ground up! My point was that medical schools and residencies don't have time to teach this, AND THEY SHOULD! However, I know that in my daily rounds as a community hospitalist, it is extremely hard to get through the work of being a physician, and that I have little time to even think about QI. I would like to see Mr. Levy outside of an academic setting and in the trenches--this is not to belittle his ideas, but to bring them into a stronger lens. I am a fan of Mr. Levy's blog, and have actually noted this in my own blog. I do believe in realitiy testing, however.PookieMDhttp://physicianpracticeseminars.comnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-39679758430995922032009-06-30T09:59:01.579-04:002009-06-30T09:59:01.579-04:00Paul, Pookie MD, et al,
Lean is driven from the f...Paul, Pookie MD, et al,<br /><br />Lean is driven from the front line, but does require buy-in from the top (which is clearly present at BIDMC). A favourite quote is "change done to us is debilitating, change done by us is exhilirating".<br /><br />Administrators have to be bought in on QI and Lean initiatives to make them sustainable. I've interviewed a great many lean healthcare experts in the past 6 months and have heard over and over that lean training without buy-in across the organization is sub-optimal. Teaching lean tools to people on the floor can yield great results, but the tools can also remain localized to the individual. To complete a transformation, change management needs to be applied.<br /><br />We were engaged to co-develop a simulation based on this requirement. See: www.experiencepoint.com/sims/Lakeview<br /><br />Lean training for professionals at Ontario hospitals includes this change leadership simulation as a part of the lean curriculum so lean efforts become sustainable. A big part is engaging people "at the top" and "in the trenches". You need leaders in both places.<br /><br />andrew.webster@experiencepoint.comAndrewhttps://www.blogger.com/profile/16774855042572343164noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-31180990833319455042009-06-30T09:01:16.466-04:002009-06-30T09:01:16.466-04:00To Pookie MD;
Unfortunately, your attitude is sha...To Pookie MD;<br /><br />Unfortunately, your attitude is shared by many MD's (e.g. QI is way down on the priority list compared to other things), which is precisely why MD's are NOT leading the charge and having the administrators come to them instead. Why don't you go to your administrator with some QI ideas?<br />As for WHEN, it should be incorporated into the medical school curriculum in the second year with didactic instruction, reinforced by day to day exposure during clerkships, internship, residency, etc. Paul is starting this at the lowest level he can, which is the intern right now. Frankly, I think Harvard is missing a huge opportunity to model a new medical school curriculum which would incorporate these precepts. They wouldn't have to lift a finger to find people to teach it in Boston, with the IHI, Gawande, Paul, and numerous other knowledgable people. But no one likes change, least of all medical bureaucrats.....<br /><br />nonlocal MDAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-88830321839094245772009-06-29T14:44:58.114-04:002009-06-29T14:44:58.114-04:00You get it. And, you have a cohort of high achiev...You get it. And, you have a cohort of high achievers. Onward, upward!76 Degrees in San Diegohttps://www.blogger.com/profile/14358630186174729315noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-52944204080849221042009-06-29T09:53:15.162-04:002009-06-29T09:53:15.162-04:00I think you completely misrepresent my approach, w...I think you completely misrepresent my approach, which is anything but top down. The whole idea of Lean and BIDMC SPIRIT is that change is driven from the people on the factory floor (i.e., gemba). It was the MDs who asked for this training, and the interns love it.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-30972220871991680392009-06-29T09:42:07.458-04:002009-06-29T09:42:07.458-04:00I have sometimes been critical of your blog as you...I have sometimes been critical of your blog as you don't appear to be in the trenches, and have a top down approach. Medical students, residents and attending physicians are trained to do medicine. I advocate that we physicians learn about QI, through-put, LEAN, kaizen etc., but ask, "WHEN?" Medical school is already 4 years, and the shortest residency is 3. I think it is important that we lead this charge, but sometimes resent it when administrators come at me with the latest improvement strategy, with out ever asking for input from those who will actually implement these strategies. I think those IN the health care trenches are best fit to implement change, but sadly, the least likely to do so.PookieMDhttp://physicianpracticeseminars.comnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-36486577924876351372009-06-26T17:43:23.586-04:002009-06-26T17:43:23.586-04:00Great idea. Many hospitals now have a residency p...Great idea. Many hospitals now have a residency program for RNs. Have you thought about doing something similar for them?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-69009872485839710892009-06-26T13:33:53.604-04:002009-06-26T13:33:53.604-04:00This was a great idea and should be piloted by oth...This was a great idea and should be piloted by other institutions. I am the practice manager for a pediatric hospitalist program in Florida and we are currently in the process of updating our resident orientation manual to include a section on "How The Residents Can Impact Hospital Throughput".Ray Brown Scholarnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-92102658770024362162009-06-25T14:41:48.506-04:002009-06-25T14:41:48.506-04:00Ozarks Community Hospital Vision for Change: Visi...Ozarks Community Hospital Vision for Change: Visit the OCH Health care blog to read our health reform plan. http://ochhealthcarereform.blogspot.comPaul Taylorhttps://www.blogger.com/profile/01099937949357653556noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-71522931748888127712009-06-25T14:01:37.667-04:002009-06-25T14:01:37.667-04:00This is a great idea and, of course, discharges ar...This is a great idea and, of course, discharges are known to be problematic in all hospitals.<br />However, just reading this and thinking that all those observations were made so quickly by 3 relatively untrained people makes me wonder - exactly why is it that our government doesn't feel that reforming the processes and systems of health care would save big bucks???!!!! It seems like requiring hospitals/practices to start process/system reform immediately, rather than wating weeks arguing over a public vs. private insurance plan would begin producing immediate results, rather than the gridlock we always see in Washington. Grrr!!<br /><br />nonlocal MDAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-75499455571957651022009-06-25T09:12:25.441-04:002009-06-25T09:12:25.441-04:00What a great idea to involve interns in QI as soon...What a great idea to involve interns in QI as soon as they start! Who better than untrained, intelligent eyes to critique inefficient actions? I wish I were involved in something like this my first couple of days of orientation, rather than sitting for hours on end listening to corporate propaganda.New Internal Medicine Intern, MDnoreply@blogger.com