National Nurse Week begins tomorrow. I’m fresh off a 4-hour shift shadowing a nurse on a busy inpatient unit with cardiac surgery patients. I was taking part in the “Walk in My Shoes” program at Stony Brook Medicine where I currently serve as interim CIO.
All the executives were asked to block out 4 hours this week to shadow a nurse. I looked forward to my shift despite the other work on my desk. And as I told the nurse I shadowed, spending time on their unit was more fun than some of the problems I deal with as a CIO.
But I wasn’t there to have fun. I was there to understand what a nurse’s day is like and find ways that administration can help. And as the CIO, I wanted to understand how they use the systems we support and to find opportunities to improve them.
I donned a pair of scrubs, the universal hospital uniform and a fashion neutralizer. It’s amazing how different it feels to be on a nursing unit in scrubs compared to being a “suit” who periodically does rounds with a bunch of other “suits”. The staff seemed more willing to just tell it like it is when I encouraged them to be candid with me.
As soon as got to the unit a nurse realized I was from IT. His first thought was that I was there about a system problem that had been reported in the patient safety system. I introduced myself and my role as interim CIO. I told him that while I was there to shadow another nurse, I wanted to hear about their IT issues. This was my “gemba” walk with a group of nurses. Continue reading
I am a lean leader and always willing to share my learnings. I’ve written several blog posts chronicling my lean experience at different organizations. Some of them have been quite popular with readers. I’ll call them my “lean classics”. Here’s a recap for your reference:
Huddles and Visual Management:
Leadership huddles: not just another meeting – describes my first IT leadership huddle launch back at University of Michigan Health System. As my lean coach said at the time, be willing to experiment, it doesn’t have to be perfect. We learned and tweaked it as we went through the PDCA cycle.
Making the invisible visible – describes the beginning stages of the visual board our IT leadership team created at University Hospitals in Cleveland.
Making the invisible visible – part 2 – describes that same effort several months after we launched it and how we used it as a team.
6 tips for successful huddle boards – based on experience, my advice to those considering their own huddle boards. Remember, you need to be willing to experiment.
Importance of rounding or going to the “gemba” – describes early experience with clinical and operational rounding both at Brigham and Women’s Hospital and University of Michigan Health System. Continue reading
I’ve written about gemba walks. Gemba is the Japanese word for “the real place” or that place where the work is done.
I am fond of a quote from President Dwight D. Eisenhower: “Farming looks mighty easy when your plow is a pencil and you are 1,000 miles from the corn field.” While I don’t know the specific context for the quote, it applies to business today. As leaders, unless we see the way work happens on the front line, we cannot understand the problems we need to solve and the barriers we need to remove. That doesn’t happen by just meeting in a conference room.
All hospital leaders were assigned to do at least three gemba walks this summer. The walks are supposed to be an example of each of the following:
- patient and family experience such as observing check-in
- front line staff experience such as shadowing someone or attending a unit’s daily huddle
- “break out of your silo” experience such as observing one of your downstream customers or walking a “value stream” (a high level view of how work gets accomplished across multiple departments and physical locations)
We are expected to Continue reading
Last November, I started the practice of hosting monthly breakfasts for up to 20 of my department staff at a time. We skipped two months around the time of our major inpatient go live in June. That means I’ve spent time with at least 160 staff getting to know them, listening to their concerns and answering questions in a small, informal setting. There’s a small group of “frequent flyers” who have come to more than one so far. I tease them that it must be the food but I know it’s them wanting to have a voice which I’m happy to listen to. “Make your voice heard” is a theme I’ve been encouraging all year.
At the most recent breakfast, there was a lull in the conversation. I called upon one of my frequent flyers whom I have come to know is willing to tell it like it is. Continue reading
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. Continue reading