In lean speak, you have to go to the “gemba”, that place where the work is done. To go to the “gemba,” I rounded with some of my colleagues in the early days of our inpatient Epic go live. They included our Chief Medical Informatics Officer (CMIO), the executive director of our children and women’s hospital, and our Chief Nursing Officer (CNO). We visited many different inpatient units – to listen to staff tell us how it was going and describe issues. It reminded me that I need to once again make time to regularly round with our users.
In every industry, IT leaders should do rounding – either on their own or as part of structured rounds led by others. How else will we hear from front line users of the systems we implement and support? How else will we hear what really works and what doesn’t? How else can we stay grounded in our users’ experience with the systems and tools they need to do their jobs? How else can we understand what they need from us?
When I was CIO at Brigham and Women’s Hospital in Boston, I participated monthly in the Safety Matters: Executive Walkrounds. These walkrounds occurred every week, led by the CEO, COO, CMO or CNO. I joined the ones I could fit in my schedule, at least monthly. I knew that I’d hear the good and the bad – what our users loved about our systems and what they didn’t like. What they were waiting for us to change and improve.
At UMHS, we have formal Patient Safety Rounds facilitated by our Chief Medical Officer (CMO), Dr. Skip Campbell. He and Maureen Thompson, Operations Director, Chief of Clinical Affairs, have conducted the Patient Safety Rounds since 2002. They happen every two weeks and are one hour long. They include participation by the CEO, COO, CNO, Dr. Jack Billi, as well as reps from Pharmacy, Material Services, Risk Management, Infectious Disease, and others.
Their purpose is simple: engage the staff in describing barriers to patient safety. Dr. Campbell conducts these informal rounds with staff at the “gemba”, where people work. He asks open ended questions, such as “What is the next error likely to happen?”. The staff speaks openly about patient safety and system issues. The Patient Safety Committee, chaired by Dr. Campbell, reviews the feedback from these rounds regularly within committee meetings.
I joined the Patient Safety Rounds at UMHS last week for the first time. I heard firsthand about a range of issues. When senior leadership shows up and takes the time to listen to the staff, issues besides patient safety come up, including IT issues. New issues and ones we are aware of and working on already. Needs that could be better supported with innovative technology solutions.
I have the opportunity twice a month to join these Patient Safety Rounds and hear from our customers, so there are no excuses. If I am not there, one of my senior leaders will be.
One of my next challenges is planning “gemba” walks with my IT leadership team within our own department. As I said in a recent blog on lean, going to the “gemba” in an IT department is difficult; the majority of staff work in cubicles on computers. The “gemba” is clear in manufacturing – the assembly line. It’s clear in a hospital setting – the patient care and support service areas. Where is the “gemba” in IT? You don’t take “gemba” walks in the hospital by attending staff meetings, you go watch people work. That’s the challenge of knowledge workers, there isn’t much to watch. What exactly is the team’s process to observe and understand on a “gemba” walk? Time to figure that out!