Tag Archives: lean healthcare

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

Finding your passion

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One piece of advice I give young people is that they don’t have to decide what they want to do for the rest of their life at age 22. Just think of all the jobs that didn’t exist 10 years ago and what might exist 10 yearscanstockphoto19577734 (1) finding passion from now.

As we acknowledge the nurses among us for National Nurses Week, think how much the nursing field has changed over the years and how many opportunities and different paths nurses can take these days. There is a growing need for nurses with informatics training but that is just one possible path among many.

My oldest daughter is a nurse practitioner. But she didn’t start there when she went to college. She got her undergraduate degree in hotel and restaurant management with a minor in business. She wanted to do travel and tourism – and see the world. On graduation day she looked at me and said, “Mom, I don’t know what I’m going to do with my life that’s meaningful, but I don’t think it’s travel and tourism”. I looked at her and said, “Just get a job and then figure it out”. That was the response of a parent having just put their oldest of two children through college and anxious for her to get started in the full-time work world. Can all you parents of young adults relate? Or did I sound like a callous and unsupportive parent?

She floundered for a year or two after college with a couple different jobs including work in the travel industry for a short time. But she started thinking early on after graduation about becoming a nurse. Whenever she talked to me about it, I told her she’d be a great nurse – super organized, able to multi-task better than anyone I knew, with fabulous people skills. But I also told her that she’d have to buckle down and study the sciences if she wanted to be a nurse.

She considered her options and decided to pursue a combined nursing / nurse practitioner program getting her second bachelor’s degree then her masters. She had found her passion! 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 →

6 tips for successful huddle boards

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I recently had an opportunity to advise an IT department on their overall lean initiative. While no two organizations have the same lean journey, there are common challenges. Visual management and huddlecanstockphoto19155139 boards are components of a lean management system. Here are some of the common challenges you can expect to encounter and tips for success:

“Perfect is the enemy of good” – You must be willing to experiment and get messy. Visual boards take many shapes and forms. Do they help you focus on the right work and metrics as a team?  It’s less important that they look pretty to the outside observer.

Standard framework with room for variation – Even if there is a standard for what all huddle boards in your organization should look like and include, there must still be room for variation by unit or team. What’s important to one team may not be important to another. If you’re ready to get started and wonder if there will be an organization standard at some point, don’t wait for it. Just get going and adapt later if a standard appears. Continue reading →

Making the invisible visible

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The whiteboard in my office has become a working draft for our IT leadership visual management board. And it’s become a focal point of discussion as I socialize the idea with our IT VPs, directors and canstockphoto26356044managers. I’m encouraged that everyone who gets the walkthrough supports the idea and sees the value in it. They see the potential it has to address some fundamental problems in how we work as a department.

Ownership of the board is shifting to the team. I’m using color coded sticky notes to add ideas and pose questions. I’ve encouraged IT leaders to stop by and put their own sticky notes up as we develop it together.

Some have asked if they should do something similar with their own team. The answer is yes! We need to commit at the leadership level and model behaviors. But to truly be effective, each team should have some kind of visual management and huddle that rolls up to the leadership huddle. Continue reading →

Lessons from an aspiring lean leader

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This week I will be sharing lessons I’ve learned as a lean leader and champion – in particular around visual management. The Lean Enterprise Institute (LEI) holds an annual Lean Transformation Summit canstockphoto16267629where experts and practitioners come together from all industries to learn from one another.

My talk will cover a multi-year journey that has involved learning from others both in and out of healthcare, site visits, training classes, lots of reading, and experiments with my leadership team. Most of my talk is based on my experience and lessons learned at the University of Michigan Health System.

I was delighted to see that University Hospitals where I’m currently the interim CIO has been on their own lean journey since 2011. At our hospitals you will see huddles and visual boards throughout. Thousands of staff have been trained in lean concepts and methods. In contrast, there have been limited experiments with lean at the corporate office. I have a few allies in my IT leadership team who have experience with lean in other organizations. A good start!

I would have been making a mistake to arrive at UH as the interim CIO and start introducing lean methods week one. I needed to see and hear the problems that need to be addressed. Continue reading →

October is Quality Month!

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Each year UMHS celebrates Quality Month and this year is no exception. Last week as part of our Lean Thinker’s Series, Dr. Richard Shannon, EVP Health Affairs, University of Virginia Health System, gave an excellent talk titled “Patient Safety and Quality: The New Currency in Academic Health Centers”.

It was good to hear how another academic medical center is approaching similar challenges and applying lean. Some of my takeaways from his talk and the lunch discussion that followed:

  • Dr. Shannon described their Be Safe initiative – “Our Be Safe initiative is advancing our status as a high performing organization by systematically applying the scientific method (Lean Principles) to improve the safety of our patients and workforce through real time problem solving.” He shared examples of how they have reduced the incidence of hospital acquired infections, a problem for all hospitals.
  • Senior executives hold a “situation room” and digital report out each morning. They spend 15 minutes reviewing critical problems that have been reported and then spend the next 45 minutes actually going to the units to understand the specific problems more deeply. And they do it on Saturdays as well.
  • Their IT team plays a central role in providing data and reporting in support of their daily management system. They have developed the “Be Safe” reporting system. It is a common platform that supports daily manual entry from any employee and takes automated updates from other feeder systems. He emphasized the importance of having actionable data. All of their A3s are done online and uploaded to a library that can be queried. Patient safety events are documented with an online form as part of the system. I plan to reach out to their CIO, Rick Skinner, who has shared some of their lean stories with me in the past. Having heard Dr. Shannon’s talk, it’s time to get a much better understanding of their 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 →

So what’s the problem – A3 thinking

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If you don’t know what an “A3” is, don’t worry. When I started at University of Michigan Health System, I didn’t either.  When I first saw an A3 meeting on my calendar, I asked “What group is that?”

Plan, do, check, act. PDCA on white isolated background. 3d

There were so many groups with different acronyms!  Turned out it was a meeting with a few colleagues to update our status report on major UMHS IT initiatives. We were using an A3 format for our report.

So what is an A3? It is a tool used as part of Plan-Do-Check-Act (PDCA).  The A3 name actually comes from the paper size (11 x 17 sheet) that tells a story laid out from the upper left-hand side to the lower right.

Telling the story of a problem on an A3 includes looking at the background (why and what), describing its current condition (where things stand), and doing a root cause analysis. And then, establishing goals and targets, proposing countermeasures, making an action plan and determining success metrics.   Continue reading →