Grace Bourke's Blog

  • 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.

  • 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

  • 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:

  • Beyond workplace heroics

     The world appreciates heroes--they achieve the extraordinary! Workplace examples include the programmer who comes in at 8:00 am after working until 4:00 am installing the latest software version; the nurse who pulls a double shift; the lab scientist who repairs machinery on the weekend, and the administrator who makes the eighth round of revisions to the board report. 

  • Wait…don’t tell me

    This crossing sign visualizes the concept of pausing before moving forward together, just like the request to “wait…don’t tell me.” I experienced this pausing before moving forward when helping a 9-year old with her third grade reading homework. She was struggling and asked me to tell her the words she didn’t know.

  • Kitting reduces setup time

  • Low-hanging fruit

    While I was taking an early morning walk, a patch of ripe blackberries caught my eye – a tasty treat of low-hanging fruit. As I sampled the ripe berries, my thoughts went to a time at work where our team didn’t see the low-hanging fruit.

  • Self-care

    Take a breath…pause for just a moment and take a deep breath. My family is in the final hours of preparing for a wedding, and the days have been long, intense, and emotional. Everyone is giving 100 percent. As we were jumping from one important activity to another, I remembered an experience I had last week of pausing to smell the roses.

  • Perfect takes practice

    Feeling adventurous, I went ocean kayaking. Having paddled before, I thought I was capable. As the professional instructor demonstrated the correct way to hold the paddle, I learned that my grip and arm position were wrong. Adjusting, I was ready to learn to paddle. I struggled with the correct movements, especially a flip back of the left wrist which I kept doing as a forward twist. The instructor coached me a few times before saying, “You’ll get it when you’re on the water.”

  • Step in, step up

    Recently, a team was doing a 5S workshop. A 5S workshop (sort, set in order, shine, standardize, sustain) is an intensive week-long event that is a fundamental step to implementing lean process improvements. It involves letting go of treasure/junk that has accumulated as a safety net. Then, everything is put in place, cleaned, inspected, made predictable, andmaintained through auditing and 5-minute daily touch-ups. The process has been described as “bone crunching” or “gut wrenching” for the teams as they build consensus and make many, many tough decisions. It’s always a challenge.

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