Blog Posts

Patient Voices Prevent Tragedy

4/14/2017

Last time on the blog, I talked about culture change. Culture change takes bold leadership—leaders who solve problems by putting quality first. Easy to say and not always easy to do.

Sometimes those leaders are patients and patients’ family members. When patients are bold enough to speak out, hospital caregivers better listen. Why? Because including patient voices can prevent future tragedy. I like this definition for tragedy from Merriam-Webster: “a very bad event that causes great sadness and often results in someone’s death.”

Watch this video of a young mother's experience of tragedy:

Here’s how this mother’s story ended: An air ambulance was finally arranged for the baby. The mother had been trying to get her baby help for more than a week. She was frantic – her new baby died seven minutes after the helicopter landed.

The reason this mother could be as positive as she seemed in the video was that time had passed. When I spoke with her she wanted to tell her story, she asked that she be videotaped. She’d been invited to participate in a Lean 3P Clinic design event JBA conducted in Saskatchewan. Even though her concerns were discounted in more than two dozen interactions with the healthcare system, she was enthusiastic about trying to make sure such tragedies don’t happen again. She showed tremendous courage, and decided to become part of the solution for others.

Don’t misunderstand me, I’m not calling out Saskatchewan, there are many wonderful positive stories in that great Province. What about Seattle you might ask? Here in Seattle we saw another tragic example of a patient’s voice being silenced. Talia Goldenberg went in for elective surgery to fuse her neck, due to a rare joint-tissue disorder. After the surgery, her father, an MD, could tell something was seriously wrong with his daughter’s airway. Nurses moved her to the ICU. But then, in a critical mistake, the surgeon who performed the surgery ignored the father’s pleas and removed Talia from the ICU. Later, Talia suffocated to death in front of her father. If the surgeon had listened to Talia’s father instead of his ego, Talia would have survived. Tragedy.

Left to right: Me, patient advocate Heather Thiessen, and JBA consultant Tina Hallberg.

At JBA, we make patients part of the transformation process. Here’s Heather Thiessen’s experience collaborating with hospital staff:

“I was part of a design group for the adult ED. It was my second Lean event and so exciting. In my many years as a patient, I had never been asked what I think. But who better to help when making changes? We see waste and safety issues daily, but who do you tell? More often than not, our voices in the past would be hushed or we’d be told we don’t know what we are talking about.

Studies have shown that families are often the first to see when a patient is failing health-wise. When that’s not heard, that patient is in danger. My husband is a prime example. When I was hospitalized for my myasthenia, he could recognize when I was not doing well, especially when he had been away at work. He had that fresh perspective and knew if something was not right. He would ask the nurses, “What is wrong with Heather?” He knew right away if something was out of my normal. Often, if his observations were dismissed, I would have a trip to the ICU that evening.

This is why the patient and family voice is so critical. We were able to bring our perspective to the table, and what was so amazing in the ED design event is that everyone’s “professional hat” was not brought to the table. Instead it was, “How can we all come together to make sure we build a patient- and family-centered, safe hospital?” I am still part of the group that meets regularly on updates and decisions, with the patient and family voice first and center.

As a patient and family advisor I was so respected, and my thoughts and ideas were acted upon — and that was a distinct change from the past. Patients, for the first time in my 20 years of being a patient in the region, were seen as a valuable part of the team.”

Patient voices help hospital staff see problems before they become tragedies. Patient voices come up with solutions that hospital staff can’t.

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

Me with Maura Davies

When healthcare CEOs and presidents take these courageous steps, transformation happens.

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.

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.

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.

Here’s a video from the manufacturing world, where the fishbone concept originated:

My Mentors

2/27/2017

Today on the blog I want to pay tribute to three people whose vision and guidance made my Lean education possible. Of course, there are many others who deserve mention, but here are three leaders who had a lasting impact on my work. Read on below the graphic for more information and stories.

Yoshiki Iwata

Iwata was founder of Shingijustsu Company, Ltd. He was an original member of the Toyota Autonomous Study Group (a project team assembled from Toyota’s subsidiary companies), which first developed Toyota’s Lean production practices (the kaizen system). He and Nakao reported to Taiichi Ohno, father of the Toyota Production System.

When we began our Lean Journey at Boeing, we reached out to Iwata. We wanted to learn Lean techniques from the original source.

Iwata had a deep sense of the power of continuous improvement. He once said, “We need both revolution and evolution. People will never get used to the idea of it. If we take small steps, it takes some time before people understand. Kaizen shows them real results.”

Yoshiki Iwata with Carolyn Corvi, Boeing executive who transformed how Boeing built airplanes with the 737 moving production line.

Chihiro Nakao

Nakao, like Iwata, trained with Taiichi Ohno at Toyota. Nakao consulted us during our Lean transformation at Boeing, and later mentored me through my transition to consulting.

It was Nakao who first suggested the name “Wash Your Hands,” a JBA event where Lean students observe and participate in an RPIW on the factory floor. I told sensei Nakao that I was partnering with Genie Industries and would be starting kaizen events at Genie, requiring my clients to attend as part of their certification. He said, “Black-san, you should call it ‘wash your hands’ training because Toyota engineers doing kaizen washed their hands daily.” The implication, of course, is that their hands were getting dirty in the gemba.

On a Boeing jet going to Japan. On the left is Mrs. Nakao, with Mr. Nakao on the right.

Bruce Gissing

Gissing was my boss at Boeing. I initially prodded Gissing about going to Japan to understand what “world-class” really meant. It was Bruce’s vision, experience, and presence that made the trip happen. Under his leadership, all of Boeing’s top executives visited Japan in the early 1990s, beginning Boeing’s transformation toward operating according to world-class principles and practices, as well as implementing the Toyota Production System.

Here’s how Gissing described the culture at Boeing before Lean:

“‘If it ain’t broke, don’t fix it’” was an underlying theme. We had gone through market cycles, but always came out of them bruised but not hurt. The “method of choice” for contending with the cycle was massive layoffs. The Boeing psyche when a consultant suggested that we could improve our operations was skepticism. Our retort was always ‘we are different’—simply put, we were arrogant.”

Gissing speaking to Toyota executives on our first trip to Japan in 1990

Gissing had the vision to see the writing on the wall and push for needed changes. After the Japan trip, Gissing put us on a rigid schedule to implement our action plans. The formation of the Boeing Commercial Airplane Group Strategy Council in February 1991 set the stage for a major full-court press focused on world-class competitiveness principles learned in Japan. I will always be inspired by Gissing’s courage to steer Boeing on a bold course to success.

Healthcare Needs a Vision

2/17/2017

Some of the most brilliant minds and compassionate people go into healthcare. So why do we still see over 440,000 preventable hospital deaths every year? Question: do most healthcare leaders have a vision for their organization’s future? And have they “operationalized” it, as Dr. W Deming would say?

Vision separates “good enough” from “excellent.” Vision gives inspiration when the job gets tough. Vision makes the impossible, possible.

History shows this pattern: Vision comes first. Success follows.

In his research on the power of vision, Joel Barker came across a Dutch scholar’s work on successful civilizations. In Barker’s words, the scholar found this sequence of events, over and over: “First a compelling vison of the future was offered by leaders. Then that image was shared with their community and [the community] agreed to support it. Then, together acting in consort, they made the vision a reality.”

Today we see the same thing happening. Watch this video, about the difference between Detroit after it began to deteriorate in the late 20th century and Hiroshima, which was totally destroyed in 1945 and has been completely restored today.

Hiroshima emerged from tragedy because its leaders promoted a positive, forward looking vision for the city. As the auto industry declined, American leaders abandoned Detroit’s future and its decay followed.

Lean gives us the tools to start setting our visions for healthcare. Imagine a future with zero wasted medicine, zero wasted steps to and from supplies. A future where doctors and nurses are able to spend more time with patients and less time on logistics. A future where healthcare is both financially solvent for healthcare facilities and affordable for the patient.

We need leaders to present the bold visions that lead to huge transformations. Change happens step by step, and commitment to the goal falters without clear inspiration. Healthcare needs a vision.

This isn’t fiction—lack of vision affects healthcare around the world today. Consider the recent cutbacks by the NHS in England.

“An NHS body has suspended all hip replacements, cataract operations and other non-urgent surgeries for more than two months in an attempt to save more than £3 million…[the policy] will put about 1,700 people at risk of their condition worsening and leave many in pain.

Here’s the reaction from a U.K doctor about the rollback, and it’s spot on: “The CCG is trying to make short-term savings, which may have major consequences for patients. While patients wait for treatment, their conditions could deteriorate, sometimes making treatment more complex and costly. In addition, standing down surgeons and their teams is inefficient and a waste of scarce resources.”

Instead of doing the work to use their resources more efficiently, the NHS is making cheap cuts to their system, harming patients and employees.

So what would a positive vision for healthcare look like? I want to point you to the work of Atul Gawande, M.D., best-selling author of The Checklist Manifesto, Better, and Complications.
Gawande lays out the only sustainable vision for healthcare I’ve seen to date:

“We have a thirty-billion-dollar-a-year National Institutes of Health, which has been a remarkable powerhouse of medical discoveries. But we have no National Institute of Health Systems Innovation alongside it studying how best to incorporate these discoveries into daily practice---no NTSB equivalent swooping in to study failures the way crash investigators do, no Boeing mapping out the checklists, no agency tracking the month-to-month results.”

Our healthcare system has a good product; our doctors and nurses on the front line deliver the best care with the best medical technology available. But systemic waste gets in the way of their jobs. Healthcare leaders have got to invest in operations that streamline the care process with the priority of eliminating preventable deaths and mistakes with no compromise.

Lessons from a Lean Leader: Ngaire Woodroffe Brown

2/3/2017

When I talk about Lean transformation, oftentimes I’m met with, “That’s too radical, too complex for our organization right now.”

In reality, Lean is just the opposite. Healthcare facilities, large and small, can use the Toyota Production System to make many simple changes that add up to huge gains in revenue and patient satisfaction.

One Lean Leader who really lives out this core concept of Kaizen is Ngaire Woodroffe Brown. As the director of the Wascana Rehab Centre in Saskatchewan, she shaved 15 hours of lead time from inpatient care delivery processes. Additionally, her team gained an extra seven minutes of face time with patients just by reducing the number of steps the staff had to travel to and from patient rooms and supply stocks.

In an interview with me in 2015, Woodroffe Brown emphasized the lessons from Wascana’s Lean transformation:

“It’s not all about technology” Woodroffe Brown implemented no new technology—her team made more efficient use of the resources they already had.
“Take it one step at a time” Taken as a whole, Lean can seem daunting. Taken step-by-step, the changes seem obvious.
“People are the foundation” Your staff knows where the trouble areas are. Listen to them.
“Keep it simple” Clean supplies. Manuals in the correct place. Never underestimate the power of the simple things that make sure personnel can flow without worrying about materials.

Watch Woodroffe Brown's interview below:

I Believe in Zero Preventable Deaths

1/20/2017

Today I want to talk about why I’m passionate about this work. I want to talk about preventable deaths due to hospital errors. I want to talk about transforming healthcare so we can get to a mindset where, instead of feeling as though mistakes are “only human” and perfection is out of reach, ZERO preventable deaths are acceptable. We have a roadmap for this goal: Shingo’s Zero Quality Control.

Why is it when deaths happen one at time, there is less attention than when deaths happen in groups of 5 or 10, even if they add up the same? Fact: hospital mistakes kill enough people every day to fill two 747 planes. That’s as if we allowed two full 747s to crash, EVERY DAY, and did nothing! Every two months, it’s like 9/11 is occurring again. In anything else, we would not tolerate that degree of preventable harm. But in healthcare, we do!

Unfortunately, statistics only say so much. Here are the real faces of a few medical errors in Canada, where JBA worked on the Saskatchewan Province hospital system.

A 45 year-old Manitoba man died of a bladder infection in 2008 while in his wheelchair in a waiting room for 34 hours. No one even offered to help him when he asked or started vomiting. In 2013, a woman in Nova Scotia had a breast removed after a lab error mixed up her biopsy results with another patient’s. And this woman in Saskatchewan – after almost four years of agony and complications – insisted on diagnostic tests that revealed a piece of surgical mesh puncturing her bladder.

Examples are everywhere in the world. People being hurt or killed because of preventable mistakes. In one case a monitor was left on a boy’s finger during an MRI. Burned his finger to the bone. Another example: During routine surgery the doctor didn’t follow standard protocols. The patient bled to death – bled to death— during a routine procedure.

The World Health Organization shows that 1/3 to 1/2 of these medical defects can be prevented. Well, how? Through a systematic approach to patient safety that focuses not on people (who indeed may make misatkes), but on processes, which can be made mistake-free. Applying Shingo’s Zero Quality Control method of Poka-Yoke CAN deliver safer, higher-quality care. That’s how!

This is a famous Shingo quote. In particular the last sentence: “In contrast, a zero QC system pursues the active objective of eliminating defects.” Not just “reducing mistakes,” which implies that some (lower) level of mistakes would be acceptable. No, you MUST believe in and pursue the objective of zero defects.

When JBA got to Saskatchewan, we applied Shingo’s method to one of the most broken systems: surgery wait times. Waiting for necessary surgeries hurts patients’ health outcomes. At the time, the average wait for non-emergency inpatient surgery was 294 days, and 291 days for outpatient surgery. That’s almost 10 months. 4,000 people waited more than a year! This was not acceptable.

We achieved results by changing a culture that believed that waiting and mistakes were unavoidable. Our mistake-proofing training began by forming teams and selecting projects where direct harm had been caused to patients. Teams selected defects ranging from timely triaging of hospital emergency department patients to incorrect or insufficient cleaning of hemodialysis machines. Standard requirements included value stream maps and thorough patient/procedure quantity analysis. Each team then went on our week-long North American Tour. They studied and learned concepts at manufacturing and healthcare companies, all reiterating that zero defects WAS POSSIBLE. When they got home, the teams implemented corrective action plans. They collected defect data in 30-, 60-, and 90-day follow-ups, and utilized PDCAs and A3 thinking. Projects were not considered complete until they could report out a defect rate of less than a 1%, with 76% of projects reaching completion.

Achieving zero preventable deaths and preventable harm is possible. It is the moral obligation of all healthcare leaders from the top down in all of our major healthcare organizations and systems in America to lead this effort. I believe that our frontline caregivers are doing what they can within the system they have to protect patients but the current system isn’t working.

There are two leaders that have said it best, Atul Gawande and Donald Berwick, both MDs. In a quote from Gawande’s book “Checklist Manifesto” page 184:

"One essential characteristic of modern life is that we all depend on systems--on assemblages of people or technologies or both—and among them our most profound difficulties is making them work. In medicine, for instance, if I want my patients to receive the best care possible, not only must I do a good job but a whole collection of diverse components have to somehow mesh together effectively. Healthcare is like a car that way. In both cases having great components is not enough.

"Were obsessed in medicine with having great components—our best drugs, the best devices, the best specialists—but pay little attention to how to make them fit together well. This approach is wrong-headed. Anyone who understands systems will know immediately that optimizing parts is not a good route to system excellence. We give the example of a famous thought experiment of trying to build the world's greatest car by assembling the world's greatest car parts. We connect the engine of a Ferrari, the brakes of a Porsche, the suspension of a BMW, the body of a Volvo. What we get of course is nothing close to a great car; we get a pile of expensive junk.

"We have a thirty-billion-dollar-a-year National Institutes of Health, which has been a remarkable powerhouse of medical discoveries. But we have no National Institute of Health Systems Innovation alongside it studying how best to incorporate these discoveries into daily practice--no NTSB equivalent swooping in to study failures the way crash investigators do, no Boeing mapping out the checklists, no agency tracking the month-to-month results."

I am passionate about this work because I know we can do better. I know we use the Toyota Production System to save lives.

For more on how to achieve zero defects, check out my webinar here.

A look back at a talented team

1/9/2017

On the blog today, I want to mention the recent announcement of Susie Creger’s retirement from Rona Consulting. I echo all the complimentary words written by Rona about Susie. Susie’s outstanding service to healthcare improvement will not be forgotten.

I’d like to give you the background story to the series of remarkable events that led to Creger’s role in Lean transformation.

Creger and King with me in Japan 2002 attending the first of many Virginia Mason 14 day Japan Gemba Kaizen Study Missions. Kaplan continues to lead these important missions to Japan, maintaining the rigor needed to craft meaningful study missions.

1: A chance meeting

Let’s go back 15 years. When I met with Mike Rona, president of Virginia Mason Medical Center and his boss Dr. Gary Kaplan in early January 2001, I realized the depth of their interest and their willingness to take a tough approach to changing the way VMMC did business.

The date was October 17, 2000. I was on my way from Seattle, Washington, to Madrid, Spain, to meet with the minister of health to discuss how Spain could improve its healthcare system through the application of Lean. My presentation to him was on my laptop computer.

As I settled into my seat, the businessman beside me introduced himself as Mike Rona, president of Virginia Mason Medical Center.

What an opportunity! Someone intimate with the healthcare field was right next to me—someone on whom I could try out my presentation. As we leveled out at 37,000 feet, I pulled out my laptop and said, “You really need to see this.”

When we headed for different connecting flights in Atlanta, I gave Rona a copy of my first Lean book A World Class Production System which the Boeing Company had sponsored. I figured I’d probably never hear from him again.

To my surprise, while still in Spain, I received an e-mail from Rona with more questions about Lean. Then I received a phone call asking me to meet with Rona and his boss, Dr. Gary Kaplan, Virginia Mason’s CEO.

2: A culture open to change

Lean leaders must be open to change to achieve success. My chance meeting only set transformation in motion because of Rona and Kaplan’s willingness to change. When I met with Rona and Kaplan in early January 2001, Rona and Kaplan were all ears, enthusiastic about Lean and obviously committed to changing how Virginia Mason operated. At that time, they were under pressure from the surgeons to build eight more operating rooms (ORs) at a cost of millions. One of their challenges was to increase OR capacity, but they didn’t have the money to fund what was thought to be needed.

They kept asking me, “How can we do it?” I told them capacity could be increased without a big expenditure, but only if they agreed to my plan.

The plan I had in mind for Virginia Mason was similar to the one we’d applied at Boeing. First, start by focusing at the point most vital to serving the patient. In the case of VMMC, that meant the OR. Second, define the value stream, and designate a portion of that value stream as a model line—that is, an area of surgery where you could drill down a mile deep and an inch wide. Third, create a Kaizen Promotion Office (KPO) and establish the infrastructure to support kaizen.

Creger and King (Nurse Kaizen Leaders whose OR expertise and nursing skills helped shape the first KPO), receiving their certification with Smith and Miller.

3: A fight for great talent

In order to execute the plan, we needed to build a solid team. That’s when I told both Rona and Kaplan and Ruth Anderson, Administrative VP that we needed to populate the Kaizen Promotion Office (KPO) with two nurses from OR operations. I asked who their best and brightest nurses were and was told about Susie Creger and Rosemary King who worked in the OR as special OR supply leads. Then I was told they were too valuable to take out of those positons I scheduled a time to meet with them, but let the issue rest for the moment.

The first thing I did was to walk the route patients took from where they parked their car to where they entered the flow of perioperative services, gastroenterology and the ED and then were discharged. I walked with Dr. Steve Rupp, the Chief of Perioperative Services at my side as we created the first value stream map at Virginia Mason. Obviously we ended up value streaming the OR and the turf of Creger and King. I interviewed them on the spot. I then told Anderson and Rona they had to be reassigned immediately as we needed them in the first group to start certification. A good consultant identifies the expertise needed to achieve success, and then fights to bring that talent together.

Identifying talent: what made Creger and King so special?

The pair:
1. Were highly competent in their field
2. Were respected by surgeons and their peers
3. Had a strong work ethic
4. Always put the patient first
5. Never said "I can't," "We don't have time," or "That won't work." They were willing to innovate.

Only later did I find out that Creger and King were pulling double duty, going through certification and still working in the OR, a testament to their commitment to improvement. I got them changed to full time KPO leaders, a team which then included Virginia Mason’s Diane Miller and Danielle Smith. Miller is now the VP of the Virginia Mason Institute.

4: Results

The first year is always difficult, and the experience at VMMC would be no exception. The first Rapid Process Improvement Workshop, held the week of April 23 to 27, 2001, involved four teams with aggressive targets, all achieved. The results were excellent for the kickoff effort, but the real learning of the week, as reported by VMMC, was “that teams of process-knowledgeable people could make a major change in a one-week period.”

Creger and King were absolutely integral to the improvement effort. Their willingness to work double-time, their agility in switching on to the KPO team, and their invaluable years of experience as OR nurses helped catapult VMMC to successful implementation. I wish Creger the best in her retirement, and will always remember the combination of circumstance and determined commitment to change that brought together such a dynamic team at Virginia Mason.

On the far left are Rona, Creger and King posing with first group of VM Kaizen Fellows attending 14 day Japan Kaizen Fellows Training in 2005. Rona and Kaplan and VM’s leadership immediately embraced the Kaizen Fellows program and Rona led many of the Kaizen Fellows trips. I required this first group of Kaizen Fellows to prior to the trip to review each value stream map for every sentinel event over the last 5 years, noting changes that had been made, possible changes they would pursue upon their return, and areas for which they were seeking insight as they went though our 12 days together. Others presented major inpatient and outpatient value streams as well as plant layout opportunities. Each Kaizen Fellows trip included not only rigor but rigorous documentation with a continuous feedback loop during the trip back to VM leaders and then a final report presentation when the team returned home. Those initial Kaizen Fellows trips produced significant turns of the PDCA wheel.

World Class Team Structures

1/6/2017

World-class healthcare organizations are structured differently from the rest. They have a "high performance organizational design."

Traditional organizational designs don't allow employees to make nimble changes to the process of care delivery. Traditional designs don't allow staff to be as patient-focused as they need to be. And traditional designs don't permit the kind of rapid, successful deployment of excellent patient care that typifies world-class organizations.

A "high performance organizational design" is different from traditional hierarchical structures.

This chart illustrates how traditional organizational designs change to become high performance. The traditional structure in Stage 1 is a hierarchy. Obviously, top executives are at the top, workers at the bottom. A pyramid structure. Not much direct communication. Not much teamwork. Not much responsiveness to problems. Not much flexibility. Lots of rigid, formal structure. Plenty of work for producers of organization charts.

Stage 2 on the chart shows how the pyramid begins to flatten out on the top. Less distance between top management and the workers, fewer layers of management, more teamwork. Companies that aspire to become World-class are often in this phase.

Stage 3 illustrates a World-class structure. A team structure. There is no long chain of command. There are minimal layers of management. There are fewer structural barriers to communication.

The advantages of team-centered organizational designs are many. Communication is incredibly direct. All functions needed for a project are present on the team. New knowledge is created and integrated at a level far beyond what a traditional structure can achieve.

People and processes can be shifted to meet new innovations in patient care, and new requests from patients. There is much more flexibility and responsiveness. Responses are more focused and efficient.

Perhaps the most dramatic advantage is that frontline staff are empowered and rewarded. They are no longer at the bottom of the pyramid following instructions. Processes established by managers are no longer far removed from the hospital floor and the patient. Processes get improved by the ones who know best how to make them better—the doctors, the front desk, the nurses, everyone who makes the hospital hum.

World-class Lean leaders know how to step back and restructure to capitalize on their human potential. Most importantly, world-class organizations aren’t afraid to re-organize until they get it right.

Be sure to check out my other posts on world-class organizations. And as always, feel free to reach out to me for more ideas about how to make the transformations in quality patient care that will set your organization apart.

Deploying Quality Patient Care

12/23/2016

Last post, I talked about how world-class healthcare organizations focus on process. Before that, I talked about the importance of placing the patient at the center of that process. Today, I’m going to put that all together and talk about the end goal of any world-class healthcare facility: quality care.

In healthcare, your reason for being is quality care. To be a world-class healthcare organization, you must excel at deploying rapid, effective patient care.

Rapid quality care deployment begins with a sense of urgency.

World-class healthcare facilities feel a "survival sense of urgency" throughout the organization, always aware that patients may move on to other care providers offering better care.

This sense of urgency can be directly generated by outside forces. It is a defensive posture. Or, this sense of urgency can also be generated as an attack on a "crisis" whose impact has not yet been felt.

This is urgency generated by internal forces, ordinarily by the organization’s leadership. It is an offensive posture. Internal urgency is what I see from leaders who are ready for change. Leaders who are ready to overhaul their systems and commit to delivering the best care to every patient, every time.

News services must be quality assured, they must meet customer expectations, they must be state of the art, and they must be available immediately. This sense of urgency intensifies improvement and quality assurance efforts. It intensifies focus upon customer expectations. It intensifies efforts to incorporate new technology. And it pulls together all organization’s human capital to get new services and standards of care ready for the very next patient who walks in the door.

The result is that world-class organizations accomplish amazing development speeds for new care technologies and new methods of care delivery. Patients are satisfied—and impressed. Quality care deployment is rapid and effective.

Longer-term benefits are realized. Patient satisfaction increases. Quality improves dramatically. Patient care achieves total quality goals. Patients return again and again because they trust that they are going to get a safe, quality product, fast.

Up next on the blog: building a world-class leadership structure.

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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.

Patient Voices Prevent Tragedy

Bold Leadership for Culture Change

Using the Fishbone in Healthcare

My Mentors

Yoshiki Iwata

Chihiro Nakao

Bruce Gissing

Healthcare Needs a Vision

Lessons from a Lean Leader: Ngaire Woodroffe Brown

I Believe in Zero Preventable Deaths

A look back at a talented team

1: A chance meeting

2: A culture open to change

3: A fight for great talent

4: Results

World Class Team Structures

Deploying Quality Patient Care

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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Categories

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Yoshiki Iwata

Chihiro Nakao

Bruce Gissing

​1: A chance meeting

2: A culture open to change

3: A fight for great talent

4: Results

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.

Get monthly blog updates in your inbox

Categories

Archives

1: A chance meeting

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.