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Bold Leadership for Culture Change

3/31/2017

 
Fundamentally, Lean is about changing the paradigm of how organizations work. In traditional organizations, decisions are handed top-down, and lower-level staff have no say. In our hospitals, that means that deadly mistakes go unreported for the sake of following orders. Nurses and doctors are frustrated. Patients feel lost in the process. Lean gives us the tools to end this mismanagement.
 
Lean makes every employee, patient, and family member a valued part of the care process. Every person participates in quality control. The results? Better care, zero defects, and a richer bottom line.
 
But culture change is difficult. Any type of change, even if it’s good, meets resistance. People’s lives are on the line—no one wants to take chances. That’s why culture change requires bold leadership, a bold vision. Leaders must believe in their organization’s ability to deliver the highest quality of care. Leaders must work day and night to get everyone on board, to build new bridges between patients, care teams, and staff.
William Edwards Deming said it best: 
“To successfully respond to the myriad of changes that shake the world, transformation into a new style of management is required. Then to take is what I call profound knowledge – knowledge for leadership of transformation.”
“Our staff and physicians already felt they were focused on patients, but the structures and processes we used were largely provider-centric. We were often only giving lip service to listening and responding to what patients and families really wanted. In my organization, we had prepared the ground through our work on patient- and family-centred care, but even so, a Lean management system required far more courage.”
      
– Maura Davies, CEO of Saskatoon Health Region
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Me with Maura Davies

​When healthcare CEOs and presidents take these courageous steps, transformation happens. 
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​Fewer falls. More successful surgeries. Chemotherapy patients in and out faster, and back home to recover.
 
Changing the culture to be open to criticism at all levels is a huge shift. Yes, it’s difficult. But it saves lives.

Using the Fishbone in Healthcare

3/17/2017

 
​At JBA, we’ve spent hundreds of hours working with fishbones. Healthcare is complex. Fishbone diagrams help us map all the components that go into a patient’s care.
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​For example: the procedures that lead to a successful surgery often cross many departments. A patient checks in at the registration desk. He’s passed on to the surgery floor nurses. The nurse preps him while the anesthesiologist puts the patient under. The surgeon meets the patient in the OR. In the moment, no one has the full picture. The fishbone shows us the whole picture.
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​With our clients at JBA, we start with our target. Maybe it’s improving patient consent for blood transfusions. We then create a fishbone to diagram all the roots causes of misinformation, confusion, or missed steps in the consent process. We end with a streamlined roadmap to improvement, seen below.
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​Here’s a video from the manufacturing world, where the fishbone concept originated: 
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    About the author
    ​

    John Black, President and CEO of JBA, has implemented Lean improvements for four decades, first with the Boeing Company and later as a leading consultant in the healthcare industry.


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