Friday, November 22, 2013

IWantGreatCare advances the Lean agenda

I don't think Neil Bacon (of IWantGreatCare* fame) meant to reinforce one of the main tenets of Lean process improvement in a recent blog post, but he did do so. I also don't think Neil meant to enhance the Lean philosophy by adding a new key dimension, but he did that, too.  Let's start with his story from University Hospitals Morecambe Bay Trust:

The senior nurse from the surgical unit recounted to her colleagues how last week an elderly patient had used his iPad, from his hospital bed, to provide feedback on his care, highlighting a problem and concern he had using the iWantGreatCare pages for the hospital.

The nurses on the wards are able to receive instant alerts if there are concerns that need addressing for their ward – and thus the nurses were instantly made aware of a problem. Interestingly, in his comment the patient said something along the lines of “this needs sorting at some point, but I don’t want to interrupt anyone now”. Whilst the comments on iWantGreatCare are anonymous there were not many elderly patients sitting in bed with iPads! Thus the nurse was able to go directly to the patient and say “Let’s solve that problem now”.

I am told that the patient (who is still in the hospital) was completely amazed, not really expecting anybody to do anything ever, let alone seconds after he had given his feedback – this was not what he had come to expect from the NHS! Not only was the problem fixed, but the patient has been telling all his visitors and family about the incredible hospital and how the staff really listen, really care and get things fixed. His confidence is high, as is the morale of the staff who see people talking about the great care they deliver.

Lean is about front-line driven process improvement.  We encourage staff to call out problems they see in their work environment, and then managers "swarm" on those call-outs--in real time--and invent experiments that might improve the situation.

Here, though, we've gone a step further.  Here, the patient has been added to the front-line team by being given a simple technological approach that permits him/her to be empowered to make the call-out.

Whether Neil knows it or not, he just advanced the science of process improvement in the health care environment by one great leap forward. Well done!

* Think TripAdvisor for health care to get the concept.


William Bonnaud Dowell said...

I am told that the patient (who is still in the hospital) was completely amazed, not really expecting anybody to do anything ever, let alone seconds after he had given his feedback – this was not what he had come to expect from the NHS!

Great to see something is being done but dont you find it immensely depressing that we've been let down so many times in the past that we generally don't now expect feedback to have an impact?

This is just a great example of how It really does take consumer-ended tools to shake things up - up until now the monolithic powers of the NHS have meant all the powers of innovation have been invested into the other end of the equation. I'm a huge believer - as somebody with a life-long chronic issue - that this sort of thing will revolutionise healthcare more than anything else, but it needs, at ever step, to be plugged in to the thinking of staff, clinicians and management, otherwise it will be futile.

Mark Graban said...

Thanks, Paul -- this is really interesting.

The key, when problems are called out (by staff or patients) is that somebody needs to respond. If it's staff calling out a problem, managers need to help the employee solve the problem (engaging and involving the employee as much as possible, or getting help in the mode of a "servant leader").

I talked to an organization the other day that had taken some of the tools from our "Healthcare Kaizen" book -- they had put up a board on the wall and they collected problems and ideas from staff members on cards that went onto that board.

The problem was that NOBODY helped respond to what became known as the "bitch board."

That's certainly not the intent of Kaizen (and not what we wrote about in our book!).

Copying a tool (putting up a board, getting an iPad app and web system installed) is the easy part. Actually USING it is the important part.


Anonymous said...

Mark, your comment made me smile with recognition (and cynicism). Doing what you describe is actually worse than doing nothing because it tells staff and patients that administration really does not have its heart in improvement efforts and is just giving them lip service. Like the white board I saw in the ICU of the hospital (part of the dominant system in Northern VA) where my mother was a patient, listing the # of falls, infections, etc. Only this was December and it hadn't been updated since August. What do you think that made me think of that hospital?

nonlocal MD

Mark Graban said...


Yeah, I've (unfortunately) seen hospitals that have apparently gotten bored with updating metrics, updating patient information white boards in rooms, etc. It doesn't make me think very highly of the hospital and its leadership.

I think part of the root of the problem is somebody pushes a new approach ("hey, let's post metrics!!") but it's never really incorporated into any semblance of standardized work for leaders. It's just one more thing to do instead of being part of a holistic management approach.

Same thing can happen with "kaizen" and continuous improvement. Is it just one more thing to do or is it a core part of how we manage?