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  • 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. Travelling briskly between the office building and the hospital, I paused to smell a rose. I felt my mind slow, the pressure ease a little, and my self-awareness increase. I realized that I was pushing myself (and probably others) too hard — beyond what was...
  • Importance of continued measurement

    Have you ever held a kaizen workshop that resulted in significant improvement, only to find six months down the road that the process has reverted to the old ways and the improvement was no longer evident? Why does this happen? The main reason for this type of regression is lack of leader follow-up. With most kaizen events, we measure the improvement during the event and then at 30, 60, and 90 days afterward. If the improvement has been sustained during that period, we consider it a success and move on to something else. If we aren’t hearing anything negative, it must be okay, right? Wrong!...
  • Restoring joy to caregiving – reflections on National Nurses’ Week 2017

    Reflecting on the theme of National Nurses’ Week 2017 – “Nursing: the Balance of Mind, Body and Spirit” – I think about the importance of restoring joy to caregiving. When we use lean methodologies to take the waste and inefficiency out of work, we improve in the three dimensions of the Triple Aim: population health, patient experience, and cost. For the last few years, recognition has grown that a key dimension may be missing from that model:[1] a focus on staff engagement and the well-being of providers as a necessary element to achieving the Triple Aim. Fortunately, those of us who...
  • 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.” On the water, I got it for a little while, but then I drifted back to my old way. This pattern of catching myself...
  • 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. At the...
  • Detours

    The quick experiment failed. Now what? It’s time to find an alternate route forward—to find the detour, the Plan B (or Plan C or … Plan H). As I was walking to work, I discovered the sidewalk was closed for construction. I didn’t see a path forward. Crossing the street, I found a detour – the detour was the only way forward. The same applies for experiments: it’s not a straight path, there are detours. The unexpected is what needs our creativity, persistence, and fortitude. Finding or making detours is where the learning happens. It’s the forward part of “fail forward fast.” It’s the...
  • Fail fast

    During a weekend photography class, I had the opportunity to try a unique lens. We took pictures in the morning, critiqued at lunch, took pictures at sunset, self-reflected, and repeated. In the space of a weekend, we had four rounds of experiments using PDCA (plan–do–check–act). The short interval between doing and reflection enabled us to see the connection between what we had done and the impact on the photograph. We weren’t reckless – we established a goal and critiqued each photograph on its closeness to the goal, its technical accuracy, and artistic merit. If we had taken months to do...
  • Plan–do–check–act (PDCA)

    In the 1950s, Dr. W. Edwards Deming presented the plan–do–check–act cycle[1] for learning and improvement, based on the continuous improvement cycle of his mentor, Dr. Walter Shewhart. PDCA is four steps for applying the scientific method to any size challenge, problem, or opportunity and to learn from the experience. Plan: What’s my theory or hypothesis? What does better look like? Do: Conduct the experiment, implement the plan, or test the hypothesis. Check: How did it go? Did I get the results I expected? If not, why not? If so, do I know why? Act: What did I learn? What do I do with...
  • Go and see, again

    Same river as before, but a different day. And I went again the next day, to another part of the river with another dam. Each time, the view and experience were different. This time, there was heavy equipment on the dam doing maintenance. I like this as a reminder that workflows, like the infrastructure of roads, bridges, and dams, need maintenance. “Go and see” means seeing if the workplace is tidy, is standard work being followed, does the standard work fit? Are there new issues? Where is maintenance needed? In the Peri-Op Services area of a hospital, we had a solid workflow with daily...
  • Go and see

    A key concept in lean (which can be used in any part of life) is to go see what is happening and watch to understand. Yesterday, after seeing a video of the river overflowing the dam, I went to see for myself. Persevering over the long trek was worth it; seeing the falls in person was a different experience. The view was bigger in person—360 degrees of view. I could see where the water flowed, how the logs on top were held back to protect the dam, and the new safety fencing. The sound was thundering. There was a crowd of at least 10 people watching and taking photos. This is a very small...

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