Tag Archives: gemba

Rounding in a virtual world

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If you are a regular reader of this blog, you know I am a fan of lean concepts and practices. In fact, my posts on lean have been some of the most popular ones over the years. So, it is no surprise that I have embraced a form of rounding or “gemba” now that I am serving as interim CIO at Boston Children’s Hospital.

As part of our commitment to being a High Reliability Organization (HRO), Boston Children’s Hospital has a program called “Rounding to Influence” (RTI). With this program, senior leaders meet with staff in their areas to discuss a specific topic and solicit input. The Rounding to Influence program is facilitated by David Davis, Vice President, Patient Safety, Quality and Regulatory Affairs. When I learned about the RTI program several weeks into my interim engagement, I was quick to start participating.

My first experience was tagging along virtually with Laura Wood, EVP Patient Care Operations / System CNO, on her rounds with clinical staff along with a few of my IT leaders. Given the topic for that session was about having the right information to perform your work, it was a great place to start and hear from our clinicians and support staff. Here were the questions:

Having the right information and data is important to everyone in order to perform their roles effectively.  Depending on your role, do you have trouble finding the information or data you need to do your job?  Do you know how and where to get the information/data you need?  Do you have concerns you are seeing incomplete or unreliable data?  How would you know?  How can we be more reliable in our information and data sharing?

The obvious next step was to start virtual rounds with our own IT staff. Here is how it works. Continue reading →

What organization can’t benefit from lean?

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As I start my interim management role at a new organization, I’m learning about pockets of best practices throughout the health network for daily huddles and other lean methods. I’m learning from my team that canstockphoto67324721 lean thinkingidentifying the right metrics to measure in IT is a challenge.

And of course, I’m getting a lot of standing meetings added to my calendar while trying to understand what each group’s unique purpose is and where specific type decisions are made. These are important questions given most organizations have too many meetings and people often say they spend too much time in meetings.

One of my first observations week one as I listened to colleagues is that there is potential for lean methods such as a daily management system, huddles, and visual boards.

I’ve learned a lot about lean and what it takes to introduce new concepts into organizations in recent years. One of the most important lessons I’ve learned is to listen and get to know an organization before making any assumptions.

I will be doing a lot of listening and learning in the coming weeks. When it comes to lean methods, I will share my experiences in previous organizations as it makes sense with my new colleagues and teams.

If you share my passion for lean thinking or are interested in learning more, check out my post “Lean classics worth a second look”. It’s a recap of previous posts covering huddles, visual boards, and gemba walks from my journey as a lean leader in different organizations. And if you have a story on how you have applied lean thinking in your organization, I would love to hear it.

Related Posts:

6 tips for successful huddle boards

Leadership huddles: not just another meeting

Making the invisible visible

Making the invisible visible – part 2

Importance of rounding or going to the “gemba”

Go to the gemba, seek to learn

Walking in a nurse’s shoes

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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 Sue in scrubs cropped (2)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 →

Lean classics worth a second look

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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 canstockphoto19155139“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.

Gemba Walks:

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 →

Go to the gemba, seek to learn

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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.” Gemba basicsWhile 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 →

Listen and learn — why I host staff breakfasts

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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 →

Importance of rounding or going to the “gemba”

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In lean speak, you have to go to the “gemba”, that place where the work is done. GembaTo 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 →