1. Presented by Dalton Edge Mercer University
Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement Mark Graban Ch.11 Engaging and Leading Employees
Presented by Dalton Edge
Mercer University

2. Improving the Way We Manage
Lean isn’t just about tools
It’s also a distinct management method that guides what we do as managers & how we lead our employees
Lean goes beyond getting through initial project
Create an environment where people want to continually improve
“How are we supposed to change when you are managing the same way?”
IDM ISE ETM 2017
Dalton Edge

3. What Is a Manger’s Role?
Responsibility to set direction and lead the way
Intrinsic motivation
Strategy Deployment
Gary Kaplan, MD, CEO of Virginia Mason Medical Center
Kaizen methods
Recaptures passion
Make sure their employees understand customer needs, and how the pieces fit together
Lean cultures rely on intrinsic motivation and allowing people to thrive. Local goals should be aligned with larger organization’s goals through a “strategy deployment” (later discussed)
Kaizen cant be imposed from above. Leaders should introduce, teach, and encourage the adoption of kaizen methods, but its sustained only when employees are engaged. Employees become champions of kaizen when they see it reduces the burden of work and helps them recapture the passion that drove them to their original career decisions to work in healthcare
IDM ISE ETM 2017
Dalton Edge

4. How goals & ideas flow up and down in a Lean Organization (pg 242)
In a lean organization, goals, objectives, and strategy tend to flow top-down. Because Value-adding staff and clincians are closest to the process and to the customer, ideas should flow from the bottom-up. As upper managers set direction and vision, they ask employees to give input. As ideas flow up, managers may question and challenge those ideas.
IDM ISE ETM 2017
Dalton Edge

5. Engaging Employees in Change
Leaders try to force change
Engage people that are actually doing the work
Avera Health
CPOE
Involved physicians, nurses, pharmacists, and others before it “went live”
Then complaining that staff are being resistant
They are the experts and that must be respected
Computerized Physician Order Entry
Leaders were reminded that when majors changes occur, we need to go back to the frontline rather than having a few people off in a conference room deciding what needs to be done.
IDM ISE ETM 2017
Dalton Edge

6. Strategy Deployment
Virginia Mason Medical Center, ThedaCare, Baylor Scott & White Health, and St. Boniface General Hospital
AKA “policy deployment” or hoshin kanri
Aims to create alignment at all levels of organization
Aligned does not mean identical
Not just top-down!
Seattle, Washington; Appleton, Wisconsin; Texas; Winnipeg, Manitoba
Using a Lean management method called Strategy Deployment
Seniors at an organization help define 4 or 5 “true north” directions and objectives that cascade all the way down to front-line staff
Aligned does not mean identical.
At one hospital, the labor and delivery department proposed a metric for patient safety was the number of falls. But, because most of the patients are young and generally don’t fall, they stepped back and decided on a metric that was more relevant to their patients
Not just top down. The ‘catch ball’ process ensures that top-down goals are adjusted based on feedback and input from managers, and ideas from employees receive feedback from their managers.
IDM ISE ETM 2017
Dalton Edge

7. Common Management Problem
Various hospitals across nation seem to have the same problems
Most successful, or most personable nurses to supervisor overnight
Waste of talent
Supervisor overnight. Without training forcing them to learn on the fly, rather than be taught a management model that is consistently applied throughout the health system
This leads to employees struggling and removing themselves from management chain leading to a waste of talent
IDM ISE ETM 2017
Dalton Edge

8. Daily Lean Management System
Successful hospitals implement a daily management system to maintain improvements as well as kaizen
This management system consists of methods that include:
Process audits, or rounding
Performance measures
Daily stand-up meetings, or “huddles”
Kaizen and suggestion management
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9. Process audits, or rounding
Used to ensure standardized work is followed (and that it can be followed)
Observe process
Not to catch employees doing something wrong
Gemba walk
Post results
Observe process to see what opportunities for continuous improvement exist
Not like a policing function
Gemba walk; uncover problems and focus on improvement, not fault finding
Post results on wall. Helps communicate what problems were found. Creates accountability. Problems should be fixed right away!!
IDM ISE ETM 2017
Dalton Edge

10. Performance measures
Ability to measure performance effectively is necessary for CI
Honesty is key
Timely measures give more helpful info than infrequent averages
Posted in high visibility area
Control Charts
SPC
Some managers do not track performance and others do not share with employees. Respect for people means we are honest with people about how department is doing.
How useful would a speedometer be if it just gave average speed when you reach your destination?
Better to measure performance on a daily basis, once a shift, or more frequently
Posted in high visibility area where they can be seen as people are doing their work.
Statistical process control. Lets people know when highs and lows are common cause vs special cause
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11. Daily stand-up meetings, or “hudddles”
Daily update and communication meetings
Stand-up format, often where metrics are posted
Keep meetings short (5-10 mins)
Harvard Vanguard Medical Associates
Kenmore Clinic in Boston
As problems are brought up, they can be captured on a whiteboard or other methods
Huddles, Follow a standardized format, discussing recent problems
Open and honest discussion about patient flow and other possible issues in value stream
IDM ISE ETM 2017
Dalton Edge

12. Kaizen and suggestion management (pg 260)
Employees’ creativity and thinking are important roles in CI
Toyota Kata
Lean hospitals fully engage the creativity and efforts of their employees and physicians
Kata in Japanese means “way of doing” and “form”
This is the kata model
Setting a high goal (the challenge), and conducting experiments that are intended to close the gaps between the current condition and the next target condition that been set in the direction of the challenge.
Every experiment may not be a step forward but something is learned in each experiement
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13. Kaizen and suggestion management con’t
Proper balance between bureaucracy and uncontrolled changes
Kaizen card, or idea card
Follows PDSA cycle
After a suggestion is made, action should be taken ASAP
Rather than just listing what should be done, the card prompts employee to define the problem and what measurable impacts it may make for the department
Prompts employee to write a problem statement, proposed countermeasure in terms of outcomes, and obtain inout from coworkers and/or leaders
IDM ISE ETM 2017
Dalton Edge

14. Lean Lessons (pg 267)
Lean is not just about asking our employees to change; managers need to change their methods as well.
Managers must inspire their employees to take initiative to improve the system, while keeping them aligned with the big picture.
Standardized work applies to managers and how we manage; auditing the standardized work is a form of standardized work.
Employees should know how their processes are performing, but we should not pressure them to improve results by working harder.
Daily, visual metrics are more effective than monthly averages.
Employee ideas and suggestions should be managed in a way that avoids chaos, yet is not bureaucratic.
IDM ISE ETM 2017
Dalton Edge