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  • 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...
  • Using takt time in healthcare

    Takt time is a simple calculation—available time divided by demand—but a fuzzy concept for many people in healthcare. Often we hear: “Well, we are open 24 hours a day and we never know how many people are going to show up at the door.” Let’s look at two concepts that help clarify the concept of takt time and how best to apply it. 1. Takt time for the whole operation is not very helpful in the day-to-day operation of a complex organization like a hospital. It becomes more understandable, applicable, and useful when we start drilling deeper into the operations of discrete departments and...
  • 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. These quick fixes do not accomplish true improvement most of the time, and fail to develop the problem-solving skills of the...
  • 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. The Rescuer, the person who helps the Victim, plays...
  • Crisis leads to opportunities

    The current media attention has a created a sense of urgency for healthcare leaders and their teams to be ready for Ebola screening and treatment for patients, and it has highlighted the need for healthcare teams to adhere to the best practices for infection control and prevention. We understand this is an unprecedented situation and wanted to take a moment to express our thoughts and encourage you during this challenging time. Texas Presbyterian Hospital has long been considered an excellent 
hospital...until September 28th. On this day, the delayed diagnosis of a patient with Ebola,...
  • Genchi Genbutsu

    Genchi genbutsu. Go and see. This is the action tied to a “gemba state of mind”—having a clear understanding of where and how value is created for your patients, where safety risks are for patients and staff, and where you must go to understand your processes. Some people have compared genchi genbutsu to Management by Walking Around (MBWA). It is not MBWA! To practice genchi genbutsu you must learn to observe, identify the seven wastes, and question everything you see. It means taking time to quietly observe work in order to understand it. It means going to gemba instead of calling an “expert...
  • Paradigms

    One of the biggest challenges in lean transformations is getting our teams and our leaders to understand and accept change—continual change—as the new normal in their work environment. There are those among us who claim to embrace or even enjoy change, but I don’t believe that many of us actually find it easy. We all use familiar paradigms to help us function effectively. New ideas create uncertainty, and we simply are not comfortable giving up control. The word paradigm can be defined as “a model or pattern for something that may be copied” or “a theory or group of ideas about how something...

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