James Hanson's Blog

  • Beware the Quick Fix

    As both a physician and an administrator/manager, I am used to people bringing problems to my attention. Indeed, it takes years of training and experience to become an attending physician or a leader in a hospital, and one wants to share that knowledge. In my eagerness to help, I have been quick to offer advice about what others might do. My suggestions have certainly been meant to be helpful, but upon reflection I have likely helped create workarounds and patches.

  • How lean leadership helps avoid the “drama triangle”

    In 1968, Stephen B. Karpman, M.D. wrote about the drama triangle as illustrated through fairy tales.[1] He described the three necessary roles in any drama—Persecutor, Victim, and Rescuer—and how different characters take on these roles at different times throughout a story. The Victim appears to be, and certainly feels, mistreated and powerless. The Persecutor can be a person, but can also be a condition or circumstance (a new electronic health record system, for example). The Victim blames the Persecutor for causing his or her sad state.

  • Interruptions as Defects

    As an intensive care physician, I have always expected frequent interruptions. After all, patients are critically ill and often unstable, and prescriptions, orders, and communication must be clear and timely. Nurses, respiratory therapists, residents, pharmacists, nutritionists, consultants, and family members often call or have me paged to ask a question or to be sure that I am aware of something. Doctor availability seems like a good idea—one that enhances communication for the entire team.

  • “Patients are not cars!”

    When first introduced to lean, many clinicians immediately dismiss the idea that the Toyota Management System (TMS) could help improve healthcare. Doctors have been admonished not to practice “cookie-cutter” medicine. How could lean production allow physicians to provide individualized care, as we have been taught? After all, as the common objection goes, “Patients are not cars!”

  • We Can’t!

    During a recent kaizen workshop, the team noticed a lot of motion waste when they analyzed the standard worksheets of medical assistants (MAs) in a diabetes clinic. The MAs would walk between the room in which they took vitals and weighed patients and another room down the hall where they performed fingerstick blood tests for glucose and hemoglobin A1C. One team member (let’s call him John) asked why they did not co-locate the glucometers in the vitals room. The response was, “We can’t.”

    “Why not?”

    “Regulations from the state.”