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  • The Murmuring of Our Medical Multitude

    “The art world has changed out of all recognition in the last twenty years.”  These are the opening words of a book I stumbled upon at the makeshift bookstore in a low-budget art gallery in Amsterdam not long ago. The Murmuring of the Artistic Multitude: Global Art, Politics and Post-Fordism, by cultural sociologist Pascal Gielen, attracted my gaze because of the term Fordism, but also because we have all heard the same assertion about the transformation of medical care in the last 20 years. Might this tome address some relationship between art and production science? Indeed, post...
  • “I’ve Been to the Mountaintop” – Remember MLK on his 90th birthday

    Martin Luther King Jr. would have been 90 years old on the 15th of January and on the 21st, we remember his life and legacy. This year, I chose to read Dr. King’s speech, “I’ve Been to the Mountaintop.”  It’s an eerily prescient and inspiring speech delivered the night before he was assassinated on April 4, 1968 at the age of 39.  As you read the words you can almost feel that this great person knew his time was drawing near while at the same time throwing his whole being into the struggle for equality with a sense of gratitude for the fight. He writes, “And another reason...
  • Outside eyes

    A cardiovascular clinic recently held a second improvement event, a kaizen workshop. The clinic is part of a nonprofit regional health system with 34 unique medical specialties at several locations and more than 300 physicians. Planning for the event began eight weeks prior, including defining the target metrics and goals for the workshop. The plan was to reduce a number of wastes, including the time required to prepare charts for patients. As we were planning, the process owner and kaizen promotion office representative each had ideas about how this might be accomplished. The kaizen...
  • Constructive dissatisfaction

    As we walked down the hall together, the chief nurse executive at the hospital I was visiting commented that the nurses had been complaining. In fact, they had a long list of complaints, and they were right; a lot of processes weren’t working well and were creating problems for them. Understanding how she felt, I shared that I’d been thinking about “constructive dissatisfaction.” I believe it’s okay to be dissatisfied if we also commit to improvement. This is how we build a bridge from where we are to where we want to be. Isn’t this the heart of lean? We didn’t have time to discuss further...
  • The New Johari Window—a tool for understanding what we know and practice, and what we don’t!

    When I first saw the New Johari Window (shown above) I thought, “Oh, that’s busy. I wonder what it all means?” Learning what it meant made a big difference in my work. The source of the New Johari Window is CEDAC: A Tool for Continuous Improvement,[1] where Ryuji Fukuda shares it as a tool for identifying causes of process failures. His examples include missed communication, lack of skills, and lack of awareness of what each person knows. The original Johari Window is a visual model of interpersonal communication that can be used for improving communication, created by Joseph Luft and...
  • Celebrating the vital role of nurses in healthcare

    National Nurses Week is a time to celebrate the vital role of nurses in healthcare. The week-long recognition begins each year on May 6 and ends on May 12, Florence Nightingale’s birthday.  First celebrated in 1954, the 100th anniversary of Nightingale’s pioneering nursing approach during the Crimean War, official recognition began in 1982 when President Ronald Reagan signed the proclamation declaring May 6 as National Nurses Day. In 1994, the American Nursing Association (ANA) permanently designated National Nurses Week May 6-12. This year’s theme, “Nurses: Inspire, Innovate,...
  • Waste

    In the lean philosophy, any work that doesn’t add value is waste. Waste should be eliminated. That’s not a value judgment on the people doing the work. People shouldn’t have to endure wastes like awkward movements of bending and twisting, looking for supplies or information, clicking too many times when using software, or rushing to prepare a report with bad information that will have to be reworked later. People feel these wastes, and they are ready for better. In my opinion, waste contributes to burnout. People don’t mind working, but it bothers them when their effort is wasted. Value...
  • National Doctors’ Day

    It seems like most every day is a “National Day” of something. In fact, according to www.nationaldaycalendar.com, National Doctor’s Day is also National Pencil Day, National Take a Walk in a Park Day, and National Turkey Neck Soup Day. I do enjoy walks in the park and the simple pleasures of using a pencil (love that eraser!), though I am fairly sure I will never have turkey neck soup. Doctors, however, have my undying respect and fondness. Physicians have gone through so much just to be able to practice. One has to be hard-working and excel academically to make it into medical school (a...
  • Value

    In lean (Toyota Production System), value is defined by the customer. To be considered value adding, an activity must meet a high standard: Does it change the form, fit, or function toward customer needs or wants, and is it done correctly the first time (rework is never value adding)? In healthcare, we’ve also added “feeling,” as a patient moves from concerned to reassured. An equivalent question is: Would the customer pay for this activity? 1 Here’s a customer’s perspective on value: When my three-year old nephew comes to visit, he wants me to make my chocolate chip cookies – warm and...
  • Respect

    Working with an improvement team that displayed deep cultural commitment to respect got me curious about “respect.” What is a culture of respect? I saw the usual habits of respect: leave titles at the door, no interrupting, no blaming. This team had something more. Here are a few examples: When a colleague shared how she’d made a mistake, the team asked her to walk through the steps of what happened. When she blamed herself, they redirected the conversation to the process by asking questions about the process steps. When she finished, they thanked her and explained that because she had...

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