Radio-frequency identification (RFID) tags on specimen bottles can help reduce errors in biopsy analysis, according to a new study by the Mayo Clinic.
That may sound like a fairly narrow, clinical issue, but I suspect it is bigger than that. And the study contains some intriguing suggestions of a lean approach.
The study, reported by The Washington Post, notes that the clinic’s Gastroenterology and Colorectal Surgery outpatient endoscopy unit (how’s that for a name) sends out more than 30,000 specimen bottles a year for pathologic reviews. And that is just one clinic.
How often do errors occur? The article says the study found 765 errors out of 8,231 specimen bottles (that’s 9.3 percent), with the errors consisting primarily of either the wrong patient label or no label being affixed to a specimen bottle.
But the rate dropped to 47 errors out of 8,539 bottles (0.6 percent) after a quality improvement initiative.
And from a lean standpoint, that is the interesting part. Use of technology like RFID tags is not in itself lean. But the decision to recommend the tags stemmed from a focus in the initiative on “correct data creation and transcription point reduction,” according to a news release. That sure sounds like an effort to find and attack the root cause of the problem – which does sound lean.
The Post article doesn’t discuss the consequences of errors on specimen bottles. I imagine these could range from a test having to be re-done to a patient being treated incorrectly.
I have a little concern about the recommendation. I suspect a lot of hospitals will be reluctant to spend money on new technology like RFID. And I can’t help but wonder whether there is a simpler (leaner?) and less costly solution.
However, I’m glad the Mayo Clinic conducted this kind of study, and I hope they do more in the future. I also hope the people there do think in lean ways.
10.15.2008
Lean Times Lead to Lean Strategies
When times get tough, the tough turn to lean.
Or so it would seem, according to a survey published by Epicor.
On behalf of the software company, research firm RBInteractive Research Group questioned 274 supply chain and corporate management professionals. The study was conducted over the Internet among subscribers to Modern Materials Handling, Supply Chain Management Review and Logistics Management magazines.
One of the study’s key findings is: “In response to the current economic climate, the top three business philosophies and strategies that manufacturers are adopting are lean production, TQM, and Six Sigma.”
Lean is at the top of list of strategic initiatives cited by the respondents, mentioned by 63 percent of those questioned.
The top items on the list of management philosophies that attracted interest from the respondents are lean (cited by 56 percent), TQM (37 percent), Six Sigma (33 percent), Supply Chain Operations Reference, known as SCOR (31 percent), and theory of constraints (16 percent).
The findings are not surprising, but they leave me with mixed feelings. On the one hand, I am glad that more companies are embracing lean (and other improvement strategies).
On the other hand, it is unfortunate that many companies think of lean as a strategy appropriate primarily for difficult times, and not for ALL times. Similarly, I fear that many of the companies moving towards lean just because times are tough don’t really understand it, and will not have successful lean transformations.
Am I being too pessimistic or cynical? What do you think?
10.13.2008
An Open Letter to Senators Obama and McCain
Dear Senator Obama and Senator McCain,
As one of you will be our next President, I wanted to write about the lean principles I discuss in this blog, and how relevant they are to your role as our nation’s next chief executive.
Lean is a business strategy of improving business processes to focus on providing customers with value and eliminating anything in those processes that does not add value – in other words, waste.
Since you both have spoken about eliminating waste in government, I assume this may be of interest. Some small segments of the federal government, particularly in the military, have been involved for at least a few years in applying lean principles to their operations – with positive results. Much more could be accomplished if the president gave his full support to adoption of a lean strategy throughout our federal bureaucracy.
However, that is not my main reason for writing. Rather, I wish to focus on some of the fundamental principles of lean, which I believe are particularly relevant to the U.S. government today.
When a lean organization strives to provide value, that means value as defined by the customer. To achieve that, an organization must be constantly listening to its customers – or in the case of government, to its citizens.
An integral part of this concept is the fundamental – and critical – lean concept of respect for people. From a business standpoint, that means respect for employees, customers and suppliers. Customers and suppliers are to be treated as business partners, not adversaries, and employees are to be respected as thinking individuals who can contribute to success, not as cogs in a machine.
Listening to citizens and treating them with respect is something that, for too long, our federal government has done poorly, if at all. Too many of our politicians have been focused on partisan battles, promoting their own agendas and providing favors to special interests. They are isolated, communicating only with those who share their views, ignoring or fighting those who don’t. They often devote their time to criticizing and attacking others, and trying to make themselves look good, rather than listening and working toward constructive solutions. The voice of the citizen can barely be heard over the constant bickering. And the services provided to citizens often fall short because government did not understand what was needed or how it should be provided.
I urge you, as our next president, to make listening to citizens – actively, by constantly soliciting their views – a core principle of your administration. I am sure the mechanisms already exist to achieve this, but too often those mechanisms are ignored, or are set up in such cumbersome ways they are nearly useless. That needs to be fixed.
Our government has been substantially out of touch with its citizens for quite a while. It is time to remind ourselves that government exists to serve the people, and that it can only do so by hearing what they have to say.
As one of you will be our next President, I wanted to write about the lean principles I discuss in this blog, and how relevant they are to your role as our nation’s next chief executive.
Lean is a business strategy of improving business processes to focus on providing customers with value and eliminating anything in those processes that does not add value – in other words, waste.
Since you both have spoken about eliminating waste in government, I assume this may be of interest. Some small segments of the federal government, particularly in the military, have been involved for at least a few years in applying lean principles to their operations – with positive results. Much more could be accomplished if the president gave his full support to adoption of a lean strategy throughout our federal bureaucracy.
However, that is not my main reason for writing. Rather, I wish to focus on some of the fundamental principles of lean, which I believe are particularly relevant to the U.S. government today.
When a lean organization strives to provide value, that means value as defined by the customer. To achieve that, an organization must be constantly listening to its customers – or in the case of government, to its citizens.
An integral part of this concept is the fundamental – and critical – lean concept of respect for people. From a business standpoint, that means respect for employees, customers and suppliers. Customers and suppliers are to be treated as business partners, not adversaries, and employees are to be respected as thinking individuals who can contribute to success, not as cogs in a machine.
Listening to citizens and treating them with respect is something that, for too long, our federal government has done poorly, if at all. Too many of our politicians have been focused on partisan battles, promoting their own agendas and providing favors to special interests. They are isolated, communicating only with those who share their views, ignoring or fighting those who don’t. They often devote their time to criticizing and attacking others, and trying to make themselves look good, rather than listening and working toward constructive solutions. The voice of the citizen can barely be heard over the constant bickering. And the services provided to citizens often fall short because government did not understand what was needed or how it should be provided.
I urge you, as our next president, to make listening to citizens – actively, by constantly soliciting their views – a core principle of your administration. I am sure the mechanisms already exist to achieve this, but too often those mechanisms are ignored, or are set up in such cumbersome ways they are nearly useless. That needs to be fixed.
Our government has been substantially out of touch with its citizens for quite a while. It is time to remind ourselves that government exists to serve the people, and that it can only do so by hearing what they have to say.
10.10.2008
A Passionate Doctor Cries Out for Change
For those promoting change, few if any attributes are more valuable than passion. In a lean transformation, for example, a change agent who is passionate about what lean can accomplish can inspire and motivate others.
Dr. Thomas F. Lansdale III, a Cleveland doctor with fierce passion for his profession, has caused a bit of a stir with an article in the Cleveland Clinic Journal of Medicine. Lansdale, currently in private practice and also an assistant professor at Johns Hopkins, spent more than 20 years working at three hospitals, including serving as chairman of a department.
Lansdale, as far as I know, is not a lean guy. But in the article, he laments the ways he believes hospitals have changed over the years and makes a strong case for the kinds of changes being sought by those applying lean to healthcare.
Somewhere along the way, I became increasingly aware that teaching clinical medicine to students, interns, and residents was getting harder and harder. The patients were sicker and stayed only 3.2 days in the hospital. What we were teaching wasn’t how to diagnose and treat diseases, but how to manage only their most serious complications—the respiratory distress from pneumonia, the ketosis of uncontrolled diabetes, the septic shock from infections. The wards became intensive care units, and the critical care units the province of “intensivists” who were more adept than we were at taming all the machinery and technology…
Worse, though, was the ebbing of the lifeblood of the hospital. Now the medical center, riddled with “centers of excellence” instead of departments, answered only to administrators who cared nothing about medical education, except for the Medicare dollars they would lose if they cut the training programs. They spent enormous amounts of money marketing the centers of excellence, and they cut everything else to manipulate the bottom line.
We remain absurdly complacent about rising iatrogenic infection rates, knowing all too well that we are allowing immunocompromised patients to die unnecessarily in our intensive care units. There are alcohol-based hand-washing gels everywhere, but no police or policy with teeth in it to enforce handwashing. We lurch toward physician computer order entry, clinging to the false belief that software programs will prevent adverse drug reactions and delivery of the wrong dangerous drug to the wrong patient.
We understaff our pharmacies so that they can’t get the medications to the patients on time or alert us to our own prescribing errors. We burn out our nurses despite years of loyal service. And worst of all, we capitulate to the for-profit insurance industry that informs us they won’t pay for day 4 of Mr. Jones’ hospitalization because he has failed to meet some arbitrary criteria in their manual.
That’s the kind of passion we need in the lean movement. Does anyone have an opening for Dr. Lansdale?
Dr. Thomas F. Lansdale III, a Cleveland doctor with fierce passion for his profession, has caused a bit of a stir with an article in the Cleveland Clinic Journal of Medicine. Lansdale, currently in private practice and also an assistant professor at Johns Hopkins, spent more than 20 years working at three hospitals, including serving as chairman of a department.
Lansdale, as far as I know, is not a lean guy. But in the article, he laments the ways he believes hospitals have changed over the years and makes a strong case for the kinds of changes being sought by those applying lean to healthcare.
Somewhere along the way, I became increasingly aware that teaching clinical medicine to students, interns, and residents was getting harder and harder. The patients were sicker and stayed only 3.2 days in the hospital. What we were teaching wasn’t how to diagnose and treat diseases, but how to manage only their most serious complications—the respiratory distress from pneumonia, the ketosis of uncontrolled diabetes, the septic shock from infections. The wards became intensive care units, and the critical care units the province of “intensivists” who were more adept than we were at taming all the machinery and technology…
Worse, though, was the ebbing of the lifeblood of the hospital. Now the medical center, riddled with “centers of excellence” instead of departments, answered only to administrators who cared nothing about medical education, except for the Medicare dollars they would lose if they cut the training programs. They spent enormous amounts of money marketing the centers of excellence, and they cut everything else to manipulate the bottom line.
We remain absurdly complacent about rising iatrogenic infection rates, knowing all too well that we are allowing immunocompromised patients to die unnecessarily in our intensive care units. There are alcohol-based hand-washing gels everywhere, but no police or policy with teeth in it to enforce handwashing. We lurch toward physician computer order entry, clinging to the false belief that software programs will prevent adverse drug reactions and delivery of the wrong dangerous drug to the wrong patient.
We understaff our pharmacies so that they can’t get the medications to the patients on time or alert us to our own prescribing errors. We burn out our nurses despite years of loyal service. And worst of all, we capitulate to the for-profit insurance industry that informs us they won’t pay for day 4 of Mr. Jones’ hospitalization because he has failed to meet some arbitrary criteria in their manual.
That’s the kind of passion we need in the lean movement. Does anyone have an opening for Dr. Lansdale?
10.08.2008
Ford Takes Mistake-Proofing to a New Level
Congratulations to Ford for applying some needed common sense to car design by creatively using technology for mistake-proofing.
Cars have many features designed to protect the driver and passengers from making mistakes or suffering from accidents. But this latest one is different.
It is called MyKey. According to a description in The New York Times, it is a programmable key that “allows parents to limit teenage drivers to a top speed of 80 miles per hour, cap the volume on the car stereo, demand seat belt use and encourage other safe-driving habits.”
I argued last month that the way to reduce traffic fatalities is to make it impossible for people to speed – by limiting how fast cars can go. I said, “Perhaps a clever auto manufacturer might begin by offering built-in speed limits on vehicles targeted to parents buying cars for their sons and daughters going off to college or just starting adulthood.”
MyKey will be standard equipment on the 2010 Ford Focus, and eventually all Ford, Lincoln and Mercury models. The limits it imposes are only through one key; there is also a master key that does not impose any limits.
“This is a huge step in the right direction,” said Ellen Gaddie, director of JourneySafe, an outreach program established by the Gillian Sabet Memorial Foundation, which was started by the parents of a California teenager killed in a 2005 crash. “Ford has identified all of the things we consistently talk about. Kids speed. Kids don’t wear seat belts. Kids like to play loud music while they drive.”
MyKey can sound a chime whenever the vehicle travels above 45, 55 or 65 miles per hour, and prevent the driver from turning off safety features like traction control, which inhibits spinning tires. It can also be set to mute the radio and chime repeatedly until the driver is buckled up.
“Teens have the lowest seat-belt use,” said Susan Cischke, Ford’s group vice president of sustainability, environment and safety engineering. “So we allow parents to turn up the annoyance factor a little bit.”
A purist might debate whether MyKey is, strictly speaking, mistake-proofing. That does not concern me.
Will MyKey have an impact on the number of traffic fatalities? I don’t know. But I like it.
Cars have many features designed to protect the driver and passengers from making mistakes or suffering from accidents. But this latest one is different.
It is called MyKey. According to a description in The New York Times, it is a programmable key that “allows parents to limit teenage drivers to a top speed of 80 miles per hour, cap the volume on the car stereo, demand seat belt use and encourage other safe-driving habits.”
I argued last month that the way to reduce traffic fatalities is to make it impossible for people to speed – by limiting how fast cars can go. I said, “Perhaps a clever auto manufacturer might begin by offering built-in speed limits on vehicles targeted to parents buying cars for their sons and daughters going off to college or just starting adulthood.”
MyKey will be standard equipment on the 2010 Ford Focus, and eventually all Ford, Lincoln and Mercury models. The limits it imposes are only through one key; there is also a master key that does not impose any limits.
“This is a huge step in the right direction,” said Ellen Gaddie, director of JourneySafe, an outreach program established by the Gillian Sabet Memorial Foundation, which was started by the parents of a California teenager killed in a 2005 crash. “Ford has identified all of the things we consistently talk about. Kids speed. Kids don’t wear seat belts. Kids like to play loud music while they drive.”
MyKey can sound a chime whenever the vehicle travels above 45, 55 or 65 miles per hour, and prevent the driver from turning off safety features like traction control, which inhibits spinning tires. It can also be set to mute the radio and chime repeatedly until the driver is buckled up.
“Teens have the lowest seat-belt use,” said Susan Cischke, Ford’s group vice president of sustainability, environment and safety engineering. “So we allow parents to turn up the annoyance factor a little bit.”
A purist might debate whether MyKey is, strictly speaking, mistake-proofing. That does not concern me.
Will MyKey have an impact on the number of traffic fatalities? I don’t know. But I like it.
10.06.2008
Cisco: A Lean Company Under the Radar
Not every company on a lean journey seeks or gets a lot of publicity regarding that effort. One such company is Cisco.
I had not heard previously about Cisco’s lean strategy. I don’t recall ever reading an article about it, and I’ve never heard anyone from Cisco speak at a conference.
But I recently became aware that Cisco is, indeed, taking a lean approach. And while it is hard to say whether lean has had much of an impact yet – Cisco is still fairly early in its lean journey – the company is very successful.
A recent Forbes cover story profiled the high-tech provider of networking products and services, noting that Cisco has bounced back from a near-disastrous 2001 to much better times, and appears poised to get major revenues related to the growth of large data centers.
The article, by Quentin Hardy, brings out some interesting aspects of how Cisco is run. That information comes when CEO John Chambers talks about why certain high-level people left Cisco.
"They were good people, but they were command and control people," he says. "I have to have collaboration, with sustainable, repeatable processes below the CEO level."
Much the way the Nexus switches unify the sprawling complexity of a data center, Chambers has searched for ways to handle the human chaos of engineering and selling a diverse set of products for the world. In the last few years, Chambers replaced a traditional structure of senior managers leading large divisions with a puzzling series of groups, councils and boards, each made up of people from radically different backgrounds. Some groups and councils deal with functions like manufacturing, others with concepts like ecology.
John McCool, who took over running the switch business, sits on a Cisco Green Board, an Enterprise Business Council, a Development Council and an Enterprise Architecture Group. All but the Green Board have budget responsibilities, and he has to form common concepts and goals with people he barely knows, while running his own business and hearing from his lieutenants about what happened at their group meetings.
How does he keep from going nuts? "Good question," McCool says. "This is an evolving problem. The forces compete. The trick is knowing when to move back and forth." Given the complexity of a world run on data centers, he adds, "This is the way a lot of companies are going to have to go."
I also discovered that the Cisco website features an interview, from March of last year, with Angel Mendez, the company’s SVP of worldwide manufacturing. He comments,
Since Cisco outsources close to 100% of its manufacturing, Cisco developed its own lean manufacturing model in partnership with our contract manufacturers and suppliers. We call this model Cisco Lean. The success of Cisco Lean to date is due to the close partnership with our supply chain partners and long-term benefits for everyone in the extended supply chain, as well as our customers.
The long-term benefits include:
· Reduced inventory across the extended supply chain
· Greater lead time and on-time shipment predictability
· Simplified processes including planning, payment, costing, materials management and inventory transactions
· Increased customer efficiency because of better Cisco delivery reliability
Implementation of Cisco Lean has been a highly controlled process, phased over several quarters and planned in close cooperation with our contract manufacturing partners. Earlier in Cisco's fiscal year, four of our five primary contract manufacturers transitioned to the lean process, and Solectron, our last contract manufacturing partner to be transitioned, completed the lean process during the current quarter. This phased process has helped us minimize any disruption to our customers, contract manufacturers, and suppliers.
Regardless of how well or poorly Cisco is implementing lean, they seem to understand it. And I suspect their implementation is not half bad.
I had not heard previously about Cisco’s lean strategy. I don’t recall ever reading an article about it, and I’ve never heard anyone from Cisco speak at a conference.
But I recently became aware that Cisco is, indeed, taking a lean approach. And while it is hard to say whether lean has had much of an impact yet – Cisco is still fairly early in its lean journey – the company is very successful.
A recent Forbes cover story profiled the high-tech provider of networking products and services, noting that Cisco has bounced back from a near-disastrous 2001 to much better times, and appears poised to get major revenues related to the growth of large data centers.
The article, by Quentin Hardy, brings out some interesting aspects of how Cisco is run. That information comes when CEO John Chambers talks about why certain high-level people left Cisco.
"They were good people, but they were command and control people," he says. "I have to have collaboration, with sustainable, repeatable processes below the CEO level."
Much the way the Nexus switches unify the sprawling complexity of a data center, Chambers has searched for ways to handle the human chaos of engineering and selling a diverse set of products for the world. In the last few years, Chambers replaced a traditional structure of senior managers leading large divisions with a puzzling series of groups, councils and boards, each made up of people from radically different backgrounds. Some groups and councils deal with functions like manufacturing, others with concepts like ecology.
John McCool, who took over running the switch business, sits on a Cisco Green Board, an Enterprise Business Council, a Development Council and an Enterprise Architecture Group. All but the Green Board have budget responsibilities, and he has to form common concepts and goals with people he barely knows, while running his own business and hearing from his lieutenants about what happened at their group meetings.
How does he keep from going nuts? "Good question," McCool says. "This is an evolving problem. The forces compete. The trick is knowing when to move back and forth." Given the complexity of a world run on data centers, he adds, "This is the way a lot of companies are going to have to go."
I also discovered that the Cisco website features an interview, from March of last year, with Angel Mendez, the company’s SVP of worldwide manufacturing. He comments,
Since Cisco outsources close to 100% of its manufacturing, Cisco developed its own lean manufacturing model in partnership with our contract manufacturers and suppliers. We call this model Cisco Lean. The success of Cisco Lean to date is due to the close partnership with our supply chain partners and long-term benefits for everyone in the extended supply chain, as well as our customers.
The long-term benefits include:
· Reduced inventory across the extended supply chain
· Greater lead time and on-time shipment predictability
· Simplified processes including planning, payment, costing, materials management and inventory transactions
· Increased customer efficiency because of better Cisco delivery reliability
Implementation of Cisco Lean has been a highly controlled process, phased over several quarters and planned in close cooperation with our contract manufacturing partners. Earlier in Cisco's fiscal year, four of our five primary contract manufacturers transitioned to the lean process, and Solectron, our last contract manufacturing partner to be transitioned, completed the lean process during the current quarter. This phased process has helped us minimize any disruption to our customers, contract manufacturers, and suppliers.
Regardless of how well or poorly Cisco is implementing lean, they seem to understand it. And I suspect their implementation is not half bad.
10.03.2008
What Really Caused the Financial Crisis
As I ponder the financial crisis that has gripped our nation, I find myself thinking about a story I heard at a lean conference a few years ago.
An automotive supplier was describing a meeting officials of his company had with officials from Toyota, which was one of its customers. To gain future business, the supplier was offering to lower its price. The Toyota officials asked how the supplier would compensate for receiving less revenue. The supplier replied, “We’ll eat that.”
But Toyota rejected the proposal, saying it would only hurt the supplier and damage the supplier’s ability to provide parts in the future. Instead, Toyota proposed working with the supplier to help him improve operations and reduce expenses, so that he could offer the lower price and still maintain his margin.
In a lean mindset, you treat your customers and suppliers as partners – people you work with to see that they succeed along with you, rather than adversaries or suckers you try to squeeze to your benefit.
What does this have to do with the financial crisis? The roots of the crisis lie in sub-prime mortgages. Too many banks gave too many mortgages that were too good to be true to too many people who couldn’t afford them.
When, for example, you give a couple with limited resources an adjustable-rate mortgage with interest-only payments for two or three years, it doesn’t take a genius to see that when the payments go up in two or three years, that couple may not be able to afford the mortgage and could lose their house.
But banks were so eager to cash in on the housing boom, they didn’t worry about that. They assumed that property values and/or incomes would always go up, and some way would be found to keep the money flowing. They concerned themselves only with getting new business, not with doing what would be best for their customers and themselves.
We know now how well that worked out.
I said the roots of the crisis lie in sub-prime mortgages. Actually, it would be more accurate to say the roots of the crisis lie in greed and a lack of respect for people.
Let’s hope we learn something from what happened.
An automotive supplier was describing a meeting officials of his company had with officials from Toyota, which was one of its customers. To gain future business, the supplier was offering to lower its price. The Toyota officials asked how the supplier would compensate for receiving less revenue. The supplier replied, “We’ll eat that.”
But Toyota rejected the proposal, saying it would only hurt the supplier and damage the supplier’s ability to provide parts in the future. Instead, Toyota proposed working with the supplier to help him improve operations and reduce expenses, so that he could offer the lower price and still maintain his margin.
In a lean mindset, you treat your customers and suppliers as partners – people you work with to see that they succeed along with you, rather than adversaries or suckers you try to squeeze to your benefit.
What does this have to do with the financial crisis? The roots of the crisis lie in sub-prime mortgages. Too many banks gave too many mortgages that were too good to be true to too many people who couldn’t afford them.
When, for example, you give a couple with limited resources an adjustable-rate mortgage with interest-only payments for two or three years, it doesn’t take a genius to see that when the payments go up in two or three years, that couple may not be able to afford the mortgage and could lose their house.
But banks were so eager to cash in on the housing boom, they didn’t worry about that. They assumed that property values and/or incomes would always go up, and some way would be found to keep the money flowing. They concerned themselves only with getting new business, not with doing what would be best for their customers and themselves.
We know now how well that worked out.
I said the roots of the crisis lie in sub-prime mortgages. Actually, it would be more accurate to say the roots of the crisis lie in greed and a lack of respect for people.
Let’s hope we learn something from what happened.
10.01.2008
Too Many Drugs Are Flushed Down the Drain
An Associated Press investigation estimates that U.S. healthcare facilities regularly flush away at least 250 million pounds of unused drugs every year.
That is cause for concern because of health issues:
The massive amount of pharmaceuticals being flushed by the health services industry is aggravating an emerging problem documented by a series of AP investigative stories — the commonplace presence of minute concentrations of pharmaceuticals in the nation's drinking water supplies, affecting at least 46 million Americans.
Researchers are finding evidence that even extremely diluted concentrations of pharmaceutical residues harm fish, frogs and other aquatic species in the wild. Also, researchers report that human cells fail to grow normally in the laboratory when exposed to trace concentrations of certain drugs.
The AP story focuses on growing demand for healthcare facilities to find better, safer ways to dispose of the drugs. They should certainly do that.
But anyone who thinks in lean terms knows that another question needs to be asked: WHY are so many drugs being wasted?
The story, written by Jeff Donn, Martha Mendoza and Justin Pritchard, says the discarded medications “are expired, spoiled, over-prescribed or unneeded. Some are simply unused because patients refuse to take them, can't tolerate them or die with nearly full 90-day supplies of multiple prescriptions on their nightstands.”
The words “over-prescribed” and “unneeded” are the ones that catch my attention. That sure sounds like waste. And where there is waste, there are almost certainly opportunities to reduce it, if not eliminate it.
I don’t know how that can be achieved because I don’t know enough about the causes. Why are unneeded drugs on hand? Why do doctors over-prescribe? The answers to these questions need to be found so the waste can be cut back. That will do as much good as finding better methods of disposal.
That is cause for concern because of health issues:
The massive amount of pharmaceuticals being flushed by the health services industry is aggravating an emerging problem documented by a series of AP investigative stories — the commonplace presence of minute concentrations of pharmaceuticals in the nation's drinking water supplies, affecting at least 46 million Americans.
Researchers are finding evidence that even extremely diluted concentrations of pharmaceutical residues harm fish, frogs and other aquatic species in the wild. Also, researchers report that human cells fail to grow normally in the laboratory when exposed to trace concentrations of certain drugs.
The AP story focuses on growing demand for healthcare facilities to find better, safer ways to dispose of the drugs. They should certainly do that.
But anyone who thinks in lean terms knows that another question needs to be asked: WHY are so many drugs being wasted?
The story, written by Jeff Donn, Martha Mendoza and Justin Pritchard, says the discarded medications “are expired, spoiled, over-prescribed or unneeded. Some are simply unused because patients refuse to take them, can't tolerate them or die with nearly full 90-day supplies of multiple prescriptions on their nightstands.”
The words “over-prescribed” and “unneeded” are the ones that catch my attention. That sure sounds like waste. And where there is waste, there are almost certainly opportunities to reduce it, if not eliminate it.
I don’t know how that can be achieved because I don’t know enough about the causes. Why are unneeded drugs on hand? Why do doctors over-prescribe? The answers to these questions need to be found so the waste can be cut back. That will do as much good as finding better methods of disposal.
9.29.2008
Medical Schools Need Greater Capacity
In a previous posting, I described the disconnect between supply and demand for doctors in the United States. That article noted that not enough doctors go to rural areas, and that some specialties go begging for doctors while others have too many applicants for available residencies.
I also mentioned a commentary by a Harvard Medical School professor about the shortage of doctors. I didn’t describe it in detail, but his commentary noted that the Association of American Medical Colleges is requesting medical schools to increase enrollments by 30 percent over the next seven to 15 years.
Is there a shortage of doctors because not enough people want to become doctors? Or is it because medical schools lack the capacity to produce enough doctors?
A recent article in the Miami Herald (not available online) makes it clear that the problem is capacity, not supply.
The article notes that Florida International University will be opening a new medical school a year from now, with an initial class of 40 students. The university has already received more than 1,600 applicants from around the country for those 40 slots.
The article, written by Oscar Corral, also notes the bigger picture:
Traditionally, medical schools across the country are flooded with applicants every year and accept less than half of them.
In 2007, 42,315 people applied to medical schools in the United States and only 17,759 were accepted, according to the Association of American Medical Colleges.
I mention all this because increasing capacity is one of the biggest benefits that can be achieved through application of lean principles.
Of course, medical schools are not factories. And while I’m sure there are many opportunities to eliminate waste in school processes through lean techniques, that doesn’t necessarily translate into the kinds of capacity improvements that would occur in manufacturing.
Can a lean approach help increase capacity in a medical school? How would that be achieved? If anyone has experience that is relevant, please share it below.
I also mentioned a commentary by a Harvard Medical School professor about the shortage of doctors. I didn’t describe it in detail, but his commentary noted that the Association of American Medical Colleges is requesting medical schools to increase enrollments by 30 percent over the next seven to 15 years.
Is there a shortage of doctors because not enough people want to become doctors? Or is it because medical schools lack the capacity to produce enough doctors?
A recent article in the Miami Herald (not available online) makes it clear that the problem is capacity, not supply.
The article notes that Florida International University will be opening a new medical school a year from now, with an initial class of 40 students. The university has already received more than 1,600 applicants from around the country for those 40 slots.
The article, written by Oscar Corral, also notes the bigger picture:
Traditionally, medical schools across the country are flooded with applicants every year and accept less than half of them.
In 2007, 42,315 people applied to medical schools in the United States and only 17,759 were accepted, according to the Association of American Medical Colleges.
I mention all this because increasing capacity is one of the biggest benefits that can be achieved through application of lean principles.
Of course, medical schools are not factories. And while I’m sure there are many opportunities to eliminate waste in school processes through lean techniques, that doesn’t necessarily translate into the kinds of capacity improvements that would occur in manufacturing.
Can a lean approach help increase capacity in a medical school? How would that be achieved? If anyone has experience that is relevant, please share it below.
9.26.2008
Acting Like Big Brother Won’t Help Hospitals
Hospital infection rates are higher than they should be because many hospital workers don’t wash their hands as often as they should. That is well-established, and many hospitals involved in improvement efforts are focusing on improving the rate of hand-washing.
More than a year ago, I discussed the issue of just how you get people to wash more often. I cited a blog post by Mark Graban, which included suggestions by author David Mann. Mann made the point that processes can be set up to change behavior, with approaches that include better education of employees, visual controls to instruct people and a process for allowing people to anonymously report offenders.
But not everyone understands that. I was disturbed by a recent posting on The Wall Street Journal Health Blog about a company called Arrowsight. The firm is marketing a service to hospitals specifically designed to improve hand-washing rates, which it says “has worked in food processing and manufacturing plants.” The service: video surveillance.
In an earlier pilot, launched in January of 2007, the company says its hospital video auditing service boosted hand-hygiene compliance to 90% from 38% in three months. The improvement was durable, remaining above 90% for twelve months running…
While live auditors won’t be monitoring worker’s every move 24/7, the Arrowsight system is programmed to search huge volumes of video very efficiently. It’s smart enough to catch such triggers as a door opening to a hospital room to capture whether staffers washes their hands after entering.
If the compliance rate remained high for 12 months, that is only because employees know they are still being watched.
More importantly, video monitoring flies in the face of the lean principle of respect for people. It can only make workers suspicious and resentful, and hurt morale. And it certainly does not encourage anyone to be a creative, thinking employee who contributes improvement ideas.
I hope hospitals will resist this approach.
More than a year ago, I discussed the issue of just how you get people to wash more often. I cited a blog post by Mark Graban, which included suggestions by author David Mann. Mann made the point that processes can be set up to change behavior, with approaches that include better education of employees, visual controls to instruct people and a process for allowing people to anonymously report offenders.
But not everyone understands that. I was disturbed by a recent posting on The Wall Street Journal Health Blog about a company called Arrowsight. The firm is marketing a service to hospitals specifically designed to improve hand-washing rates, which it says “has worked in food processing and manufacturing plants.” The service: video surveillance.
In an earlier pilot, launched in January of 2007, the company says its hospital video auditing service boosted hand-hygiene compliance to 90% from 38% in three months. The improvement was durable, remaining above 90% for twelve months running…
While live auditors won’t be monitoring worker’s every move 24/7, the Arrowsight system is programmed to search huge volumes of video very efficiently. It’s smart enough to catch such triggers as a door opening to a hospital room to capture whether staffers washes their hands after entering.
If the compliance rate remained high for 12 months, that is only because employees know they are still being watched.
More importantly, video monitoring flies in the face of the lean principle of respect for people. It can only make workers suspicious and resentful, and hurt morale. And it certainly does not encourage anyone to be a creative, thinking employee who contributes improvement ideas.
I hope hospitals will resist this approach.
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