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  • Toyota recalls, leadership, and the long term

    Recently Toyota announced a recall of 3.37 million cars over airbag and emissions control issues. How and why would one of the finest quality global producers of automobiles need a recall, when they are a company committed to practicing mistake proofing and defect reduction? Toyota faces challenges as the largest global automotive manufacturer, selling into the most competitive marketplaces worldwide, where informed consumers demand the latest in full-line products and service innovations. In this marketplace, expectations of value, including the highest quality and product safety, are...
  • Improving access part 4: reducing backlog

    You’ve matched your capacity and demand, so you are able to do today’s work today. But all those appointments scheduled out into the future still need to be addressed. This is your appointment backlog, which is really the waste of inventory—an inventory of appointments. Just like supplies, an inventory of appointments has to be managed and can cause rework. For example, instead of getting care, patients who are scheduled into the future call to reschedule and/or miss their appointments, causing more work for the care team and wasted capacity. There are two types of backlog—good and bad. A...
  • Virginia Mason

    I have been asked in the last week what I made of the recent negative JCAHO accreditation news about Virginia Mason considering the management roots of many of our team and what many would consider the roots of lean in healthcare. My first reaction was how sad for patients and staff. They do not deserve this and are not responsible for this situation. My second was how tragic it is when leaders fail the people. My third was how poorly leadership can behave when the news is bad, yet so publicly visible when it is good. And, the fourth was what can we learn from this and share with our friends...
  • Practicing intentional kindness

    On a typical Sunday my 4-year-old son would have woken up early, seeking his daily dose of Peppa Pig and a trip to the playground. But this was not a normal Sunday. I awoke incensed, for in the past 36 hours Christina Grimmie, a talented 22-year old singer, was gunned down while signing autographs. Her brother instinctively tackling the gunman and risking his own life only to witness the gunman’s suicide. My brother called on Saturday morning and throughout the course of our discussion I came to a deeper appreciation of the current condition in my hometown of Chicago. He shared the harrowing...
  • New England Journal of Medicine Letter to the Editor

    Today, the New England Journal of Medicine published a letter to the editor written by RCG principals Samuel Carlson MD, Thomas L. Jackson MBA PhD, and Joanna Omi MPH. The letter was written in response to an article entitled “Medical Taylorism,” by Pamela Hartzband MD and Jerome Groopman MD, published in the January 14, 2016 issue. That piece drew commentary from many practitioners of lean healthcare, who expressed concerns that the article propagated serious misconceptions about the philosophy and values behind lean and the Toyota Management System. It is unfortunate that in the authors’...
  • Improving access part 3: managing your capacity

    Once you understand your true demand and have modified it by shaping, reducing, and substituting, it’s time to take a close look at your capacity. In ambulatory care, capacity is the number of available appointment slots in your schedule to meet your demand. There are several things you can do to optimize your capacity once you understand how much you have and where the gaps between capacity and demand are occurring. Ultimately, you will want to maximize available capacity. Start by measuring capacity. How many appointment slots do you have? What is your appointment interval length? Does it...
  • Improving access part 2: understanding your demand

    Now that you’ve leveled out the daily work and your care teams have the ability to focus on improvement work, it’s time to look at the current state of access in your facility. If you are not able to offer an appointment when the patient wants to be seen, you could be losing market share to others in the community who are better prepared to do so. To improve your access, you need to start by understanding your demand for appointments—how many patients want to be seen by you and/or your clinic on any given day. Demand is tricky. Most people think it is the same thing as “activity” or patients...
  • Improving access, part 1: smoothing the work of indirect care

    As more Americans have signed up for healthcare coverage, access to primary care has become a big challenge. After waiting weeks or months for an initial appointment, some patients can get what they need from that visit. But patients who need further care are back to playing the waiting game for an appointment with a specialty provider. Healthcare providers are as unhappy about this situation as patients are, maybe more so. But most don’t know how to fix it. With full schedules, the care team is so caught up in the day-to-day responsibilities of caring for more and more patients, completing...
  • An eye-opening trip to the gemba

    On a Friday night a few weeks ago, I went to the gemba. This time, however, it was not as a member of a lean team but as a patient in the emergency department (ED) of a hospital in which I have facilitated improvement work. Even with all my work on the gemba in hospitals, it was an eye-opening experience. I have been trained to observe processes “from the patient perspective.” But actually being a patient made me realize how important it is to try to walk in the patient’s shoes emotionally as well as physically. I saw and felt things that I would not have noticed as an observer. ...
  • Patient Safety Awareness Week

    March 8-14, 2015 is National Patient Safety Foundation (NPSF) Patient Safety Awareness Week. The theme for 2015, “United in Safety,” spotlights the shared role all stakeholders play in delivering safe care—from clinicians and other front line providers and staff, to managers, executives, and suppliers, to patients and their families. In support of your work to ensure healthcare safety, we offer here some ideas from previous blog posts, share a few reflections from members of our team, and provide a link to NPSF resources. Last October, in our blog posting Crisis leads to opportunities, we...

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