As part of my work to support the Healthcare Value Network I have the opportunity to visit many great organizations that are applying lean thinking to health care. I’ve written about being an HVN member before.
Yesterday I had the good fortune to visit our member organization in Vancouver, British Columbia – Vancouver Coastal Health.
Here are some of the things I saw.
This impressive team of 3 women have had a huge impact on the maternal unit at Richmond Hospital. Laura is a midwife and facilitates the education process on the unit. Lynn is the facilitator. I asked her how she learned what she knows. She told me that her dad worked at Toyota and that influenced her. Wendy, the manager of the unit is a really dynamo. She visited some other HVN organizations, got some ideas and made it happen. She tried a lot of different things. She and her team were not afraid to make mistakes.
This team did not start simple or easy. They tackled a big hairy audacious goal (BHAG) – the percentage of C-Sections done on the unit. They wanted to work on something real – something that mattered to patients and to physicians. This was their current state value stream map.
They involved the patients and asked them how they wanted to process to go.
They worked on it, and worked on it and made some terrific improvements, including a protocol that everyone could agree on for when it makes sense to perform a c-section on the unit and not transport the mother to the OR.
They developed these nifty “line of site” tools that show how the department is doing every day, as well as possible causes for not achieving the measures. They borrowed the original idea from 2 other HVN member organizations, then they went through lots of iterations of these, and will likely continue to revise and improve them.
They use a kind of self-assessment to determine how they are doing. The current state is on a spider diagram. This is similar to the work we are doing with the HVN assessment team.
They devised a way to audit key processes. The current one is “documentation”. This board is located where staff walk in to the department. The red card shows how we are doing today. There is also information to show why it’s a red card and not a green one. The staff then know what they need to do. No need to have a long conversation about it.
Keeping staff up to date on clinical education is also important. They have a simple method and board for that as well. This board is also located in the hallway where staff come to work. Anyone can stop by and read what’s new and then move on.
They have also developed and documented lots of standard work. They call it “standard operating procedures” or “SOP”. The documents feature lots of photos. Here’s an example of a draft of one of their SOPs.
These documents don’t just appear. It requires some teamwork and detailed-thinking to produced these documents and keep them up to date. Here’s a team working on some of these SOPs. Some of the team members are from another part of the organization (not on the maternal unit). They are working on their green belt.
In the intensive care unit, they are determining what to work on next. There are lots of priorities (based on a study of their value stream).
Everyone gets a chance to vote on the items they would like to see worked on. The “top vote getters” go on a PICK chart to determine the “one thing” they are going to do next.
On another unit I saw another approach. They call it “releasing time to care“.
The unit has a vision statement and the photos of the staff are featured.
They get lots of thank-you notes from patients.
Part of a this approach is called a “well organized ward” (WOW). This is similar to 5S in the lean world.
This unit has accomplished a lot! Here’s a running list for everyone to see.
They also have a method to determine what they are going to work on next. Everyone gets a chance to vote on the options to pick the next “one thing”.
So one unit calls their improvement work “lean”, another calls it “releasing time to care”. Is this a problem? (that there are two approaches in one organization).
I think the answer is “maybe”. Improvement needs to be owned by the people who do the work, yet at the same time where there is variation there is potential for waste and duplication of efforts. Top management needs to facilitate collaboration – win-win. This can’t be mandated, but needs to happen.
I saw some other great things on my brief tour.
Here’s a flow diagram showing a family’s journey in the care system.
Here’s an example of some 3P space redesign work for a pharmacy.
There’s good stuff happening in this organization!
