Jul 9, 2010

Lean healthcare ideas taking root in Ireland

The flow of lean to healthcare has increased rapidly in the last few years, and Andy Brophy is one of those folks who arrived there from manufacturing. Andy is based in County Offaly, Ireland, and shared some updates with me the other day.

In healthcare organizations large and small, releasing employees, mainly through attrition, will save some money, but someone will have to do the work these people have been doing. Either the remaining staff will be overburdened or someone must eliminate the waste that keeps them from doing the work in the time available to do it.

Removing waste from work doesn't always start with an efficiency study. Andy emphasizes that a focus on cost cutting doesn't usually create a lot of commitment, but that hospital workers want to improve care. And improving care reduces costs in many instances.

Andy worked with one hospital to reduce injuries due to falls. Employees focused attention on the position of patients, making sure they were seated or in bed at a height they could stand up from, for example. Data showed that many falls occurred during shift changes, when patients tried to do on their own what they needed help with: going to the bathroom or getting water. Ensuring that shift change didn't cause gaps in patient assistance made a difference. Visual controls were used to flag patients who were fragile or otherwise had a greater risk of falls, so closer attention would be paid to their safety.

Other initiatives focused on what nurses were spending their time doing. It's typical to find that they spend large chunks of time walking or searching for things. When 1,000 small improvements can be made in a week of effort, labeling and changing storage locations can begin to melt away the waste and put nurses at the bedside, where they really want to be. When nurses are with the patients, there are fewer falls, mistakes, and other adverse outcomes. The important thing is that the nurses themselves, along with other patient care and support staff, identify changes and implement them. Management supports and sustains the process, but it's owned by the people who do the work.

Andy subscribes to the school of thought that people are full of creative and innovative ideas. The title of his book, "Innovative Lean: A guide to releasing the untapped gold in your organisation, to engage employees, drive out waste and create prosperity," co-authored with John Bicheno of the Lean Enterprise Research Center at Cardiff University, tells it all.

He says, "Ideas are not treated as ad hoc actions or suggestions. There is a system where ideas are visually displayed on boards, implemented fast, and recognised. People are coached to recognize 'hidden' waste and the idea system is integrated into daily problem solving. The employee’s manager mentors and supports him or her during implementation. Employees are coached as to what constitutes a good idea. A 'bad idea' is a training opportunity -- the intent behind it is teased out and put forward again. The key is to tap into people’s intrinsic motivation, the natural desire that they have to make a positive difference. The greatest reward for employees is to see their ideas used."

The type of idea process flow that Andy introduces is:
1. Employees write down ideas every time they see an opportunity for improvement and post them on the local idea board with a picture if possible.
2. The idea generator evaluates and filters their idea with their peers, and their supervisor responds within 24 hours.
4. The person who comes up with the original idea implements it themselves or with their work team. If additional help is needed from a support function like maintenance, it is provided and the idea originator oversees the completion of their task.
5. Record implemented ideas in an idea log electronically.
6. Monthly metrics include: number of ideas per employee/team, volume of implemented ideas, participation rate and implementation time.

"If the cycle above flows smoothly the improvement activity will also flow slickly," Andy says, "One idea will lead to another and continuous improvement will translate into improved performance and higher employee engagement."

My talk with Andy helped me see that lean is making the leap from manufacturing into healthcare because principles are becoming explicit and teachable. A critical mass of experience in healthcare improvement is being collected by groups like Andy's, at Lean Enterprise Institute's healthcare education efforts led by Mark Graban, at the Institute for Healthcare Improvement (IHI).

Now lean and quality leaders in hospitals can draw on examples and benchmarks that make sense to people there. Using examples from automobile assembly is no longer necessary.

What's next? Extracting principles from experience makes lean possible in a whole array of industries: Auto repair shops, trucking companies, government agencies, public utilities, and more. It's a trend to watch.

1 comment:

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