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  • What do you do when opportunity doesn’t knock loudly?

    Experienced lean practitioners know that there are virtually no processes or work units that are devoid of opportunity for improvement. Indeed, improvement opportunities leap out at practiced observers. As an organization travels down the road of transformation, though, the opportunities become less evident. What happens when those opportunities do not bubble quickly to the surface? Where do we search for them? How do we tease them out from work processes that don’t produce a lot of defects? What if all the “low-hanging fruit” has been harvested? What if there are no customer complaints?...
  • Building connections with IT

    When it comes to planning, creating, and implementing the best improvements, assembling the right team is vital. We’ve probably all been part of a team that could have been strengthened by someone who was left off the invitation list. Who are the folks you most often find missing or disconnected from your improvement teams? At the Lean Enterprise Institute’s recent Lean Summit for Healthcare Transformation, the information technology (IT) department was highlighted as one group that is often left out of lean activities. In his breakout session, “Leveraging Information to Improve Patient Care...
  • Inputs, outputs, and human beings

    Within Rona Consulting Group, we debate how to refer to patients in the context of clinical value streams. Always with respect, of course. My partner, Patti Crome, a former nurse executive, speaks of having “a patient on her shoulder.” But there is a real dilemma when transposing the industrial method of value stream mapping to healthcare. In manufacturing, value stream maps chart the flow of an inventory of parts or materials through a production system. Consultants will spray-paint parts red to measure their travel time from the first through the last process in a value stream. In...
  • Leadership lessons for healthcare leaders

    A healthcare leader recently asked me to recap lessons from my time at Virginia Mason, so that he could share them with his team. Reflecting on my experiences there, I find myself still embarrassed that for the longest time I could not see another way to lead in healthcare nor truly grasp that a dramatically better product was possible. It was my growing discomfort with what we were doing for patients and with the daily duress of healthcare professionals trying to do their jobs that finally forced me, and us, to attempt a different approach. Dr. Don Berwick, co-founder and former president...
  • What does it mean to “meet takt time”?

    Clinical value streams are consciously designed to match patient demand with the supply of clinical services, in a management exercise known as “meeting takt time.” The word “takt” is German for “tempo” or “time.” (Insiders refer to takt time simply as “takt” to avoid redundancy.) Mathematically, takt is defined as:  T = t/d, where: T = takt. t = time scheduled for service production. d = average patient demand for clinical services. For example, let’s say that you run an emergency room. It is open 24 hours per day (that’s t, the time scheduled for service production) and you...
  • Flow, push or pull?

    The language of value stream mapping describes a collection of processes in one of three physical states: “flow,” “push,” or “pull.” These three little words can cause much confusion. With the help of a little economics, I will attempt to clarify these terms for healthcare. Flow. Let’s begin with a process in a state of “flow.” This is the ideal waste-free state of a lean process. In a state of perfect flow, patients never wait to be seen and clinicians are always busy—but never rushed. Medicines, tools, and supplies are always available in the right amount at the right time. What patients...
  • What is a process?

    One of the fundamental building blocks of value stream mapping is the simple concept of a “process”: “a series of actions or operations conducing [i.e., leading] to an end” (per Merriam-Webster http://www.merriam-webster.com/dictionary/process.) To succeed in building clinical value streams, let’s get a little more detailed.  In the language of value stream mapping, a process is a sequence of  “operations,” where an “operation” is defined as a sequence of “tasks” performed by an “operator.” We initially build clinical value streams by following a patient with a stopwatch. Tracking...
  • Developing lean leaders: lessons from the 2013 Lean Healthcare Transformation Summit

    Last week I attended a conference that has been on my professional bucket list since it first appeared four years ago: the Lean Enterprise Institute’s Lean Healthcare Transformation Summit. With its roots in the Toyota Production System, lean has truly taken hold and begun to show impressive possibilities in healthcare organizations of all shapes, sizes, and settings across the globe. Stories on lean successes in healthcare were among the highlights of the summit, as was the crowd of networkers eager to share and learn from one another. What really has my brain going, however, are the...
  • Mapping clinical value streams

    In this blog we’ll explore the method of value stream mapping as applied to the clinical operations of the healthcare industry. Originating within the automotive industry—at the Toyota Motor Company—value stream mapping naturally raises questions in the minds of doctors, nurses, and healthcare executives: “How can a method that started in the automotive industry possibly apply to healthcare?” “What are the benefits of looking at healthcare processes in such an industrialized way?” “Assuming that the method is worthwhile, how do I map healthcare processes using this method?” These...
  • Announcing Rona Consulting Group's blog

    As part of our commitment to help healthcare leaders become lean executives and transform their organizations, we are launching a new user-friendly blog series. In these blogs you’ll be hearing the perspectives of RCGs expert consultants on the social and technical sides of lean transformation in healthcare.  We’ll be reaching out to support you—the clinicians, healthcare executives, and staff at the front lines of exploring lean applications in healthcare—bringing you commentary, ideas, experience, and advice to facilitate your journey. You can search the by author or topic, or just...

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