Miscommunication is a form of waste, since it can drag out a process or lead to improper outcomes.
And in hospitals, apparently it is a significant form of waste, according to the Health Blog of The Wall Street Journal, which reported on a study in the Archives of Internal Medicine.
A review at two Canadian teaching hospitals reveals that in a two-month period, 14% of all pages were sent to the wrong physician—meaning to a resident who was scheduled to be off-duty or out of the hospital—and 47% of those were urgent messages. Extrapolating, that’s about 2,000 misdirected pages per year per hospital that require an immediate response, but don’t get one, the study found.
In one example cited in the study, an incorrect pager number was posted on a whiteboard.
The study did not look at how patients were ultimately affected by the delays caused by the paging mistakes. I hope someone does investigate that part of it.
From a lean standpoint, how can this problem be addressed? While I don’t usually push technology as a solution, that may help. There may be some kind of IT system that sends pages at the push of a button, with the numbers already programmed in.
But this probably is not just about incorrect numbers. There may also have been misinformation about which doctor was on duty.
Is it a question of standard work? Probably. Of eliminating handoffs? Perhaps. What are your suggestions?
Some disturbing news about hospitals: Just as interest in lean is growing, and there is increasing public pressure for improved quality, hospitals are cutting the resources devoted to infection prevention.
The Association for Professionals in Infection Control and
Epidemiology surveyed more than 2,000 of its members in March as to the effects of the recession, and the results are not encouraging. Some of the findings:
Cuts are affecting the essence of infection prevention – a quarter of respondents
have reduced surveillance activities to detect, track and manage healthcare associated infections (HAIs).
Cuts have impaired infection prevention programs – a third of the respondents say cuts in staffing and resources reduce their capacity to focus on infection prevention.
Three quarters of survey respondents work at acute care hospitals; Six in 10 also
supervise infection prevention for outpatient clinics.
If hospitals did the right kind of economic analysis, they would recognize that cutting infection prevention efforts will likely increase infection rates, which will cost them more money.
If this is an area of interest for you, I urge you to read the entire survey report. It is a political document, as the association is pushing its own goals. But it also a chilling document, and I hope it can serve as a call to action.
Software development projects often run behind schedule and over budget. They are ripe for application of lean principles, and a new book coming out this month focuses on that issue.
A Tale of Two Systems: Lean and Agile Software Development for Business Leadersby Michael Levine uses a pair of fictional development projects to explain what makes one project fail and another succeed. Traditional practices involve a process-centric “waterfall” approach, while lean and agile principles approach things differently.
Levine has a 26-year career in technology, and currently leads the operations and technology groups at Wells Fargo Home Mortgage. His hands-on experience makes him the perfect person to have written this valuable book.
Do you have a question or comment about a book(s) that you would like addressed in Book Talk? Email me directly at Ralph.bernstein@taylorandfrancis.com.
We’ve created a Facebook page for Productivity Press. Like the blog, it is and will always be a work in progress. Right now it includes feeds from this blog, and I’m starting to post announcements of new books on it.
I’m sure there will be additional types of material as we move forward. If you have any suggestions, feel free to make them.
I hope you’ll check out our page, and perhaps become one of our “fans” on Facebook.
By the way, I am interested in learning more about how those of you in the lean community use social media. Are you a part of Facebook, LinkedIn or other social networking sites? What do you use them for? Do you find they have value for you?Share your experiences below.
With lean initiatives, you are constantly striving to achieve perfection. But at the same time, you may want to benchmark your company’s performance against others in your industry to see how you are doing, and as a first step in figuring out why other companies are doing better than yours.
Certainly a customer may be interested in knowing who the best suppliers are.
In healthcare, interest in benchmarking has created a market opportunity being seized by a young company called Health Grades.
There are numerous companies whose websites offer ratings of doctors and hospitals, but those are often based on the opinions of other doctors or patients.
As profiled in an article in Forbes, Health Grades is taking a more objective approach.
At least 31 states now release health outcome data for hospitals on the Internet; much of it is focused on surgical procedures such as coronary bypass. Medicare has its own hospital comparison site, which counts how often hospitals follow certain safety procedures.
Much of this data is scattered across the Web and of variable quality. Health Grades is among the first to make rating hospitals into a business, gathering data for every hospital and putting it all together in one easy-to-use site. It makes money by selling detailed reports (the basic ones are free), licensing its name to hospitals that do well and offering consulting services to ones that do poorly…
Today Health Grades' methodology is an industry standard, and top hospitals pay for its advice. Three years ago David Pate, who runs the parent hospital of the renowned Texas Heart Institute, was alarmed to see that the Houston hospital had a 2% death rate for bypass surgery--slightly above the expected number. Pate hired Health Grades, which found three processes lacking. Patients on blood thinners were not being properly monitored; some were getting overdoses of contrast dye during ct scans; too many patients on ventilators were catching pneumonia. The bypass mortality is down to 1.8%. The hospital still doesn't earn Health Grades' highest rating for bypass surgery.
I see this as a positive development, as it can help to raise awareness of what can be achieved. The danger is that some hospitals will see the highest current levels of performance as the best that can be achieved, and not embrace a true lean mind-set of continuous improvement.
I’ve long been a fan of Jerry Flint, the automotive columnist for Forbes. In his latest writing, Flint offers a well-thought-out analysis of what brought the U.S. auto industry to its knees.
He spreads the blame around, and has plenty of harsh words for governments, both here and abroad, in regard to how they supported or failed to support their automakers.
But the heart of his column focuses on what we lean advocates have been saying all along: Detroit failed to provide value for its customers.
Car plants become profitable when running full and with overtime. To do that, the car companies must build vehicles the customers want. Detroit's managers not only didn't care about the factories, they didn't care about the products or understand American car buyers.
And why didn’t they build the right products? Flint blames the adversary relationship between unions and management – which is another way of saying the corporate culture was light years away from lean.
The Big Three workers are older, tired and often from urban environments. Doing less was always the goal, and they bragged about it, too, which is why auto workers may not be particularly popular, even in their own towns. Foreign manufacturers, with American plant managers, won over their factory workers with a new culture: uniforms for everyone, democracy in the parking lot and no executive dining rooms.
The foreign culture was about more than parking spaces. Its real focus was on eliminating class warfare from the factory floor. The Japanese and the Germans, too, put particular emphasis on teamwork and quality. Detroit talked a lot about quality but did not always deliver on its promises…
Listen to Robert Dewar, who worked at Ford's Sharonville, Ohio, transmission plant in the late 1970s: "Final quality fluctuated with the amount of power granted to the Quality Control Department. When sales were strong and growing, QC was treated like an annoyance that was getting in the way of making the numbers. If a QC supervisor tried to be a hero, and made a stand, production simply went to engineering and got an 'engineering deviation,' which allowed the use of defective parts in the interests of production. So much for control of quality…"
Times have changed. The worker-management battles in Detroit's factories may have ended. The union and companies may embrace each other, and the quality may be as good as the foreign competition. Unfortunately, Detroit may have already damaged its reputation beyond repair.
G.M.’s core problem is its corporate and workplace culture — the unquantifiable but essential attitudes, mind-sets and relationship patterns that are passed down, year after year.
Over the last five decades, this company has progressively lost touch with car buyers, especially the educated car buyers who flock to European and Japanese brands. Over five decades, this company has tolerated labor practices that seem insane to outsiders. Over these decades, it has tolerated bureaucratic structures that repel top talent. It has evaded the relentless quality focus that has helped companies like Toyota prosper.
The importance of culture can never be overestimated.
We sell a lot of new titles, but also many “backlist” titles. Today I thought I would talk about our Shopfloor series, which is not new, but has been a solid part of our offerings for many years.
This Shingo-prize-winning series of paperback books was conceived as a way of teaching lean concepts to workers on the shop floor through clearly written descriptions accompanied by illustrations. Each book focuses on a particular lean concept: 5S, TPM, identifying waste, mistake-proofing, cellular manufacturing, and so on.
Some of these books are also part of learning packages. For example, we offer the Kaizen for the Shopfloor Learning Package, which includes five copies of the book, a leader’s guide, a laminated job aid, a copy of another book not in the series, and additional materials on a CD.
If you are looking for solid training materials that have endured over time, the Shopfloor series is a good place to start.
By the way, we are developing a similar series of books for the healthcare market. One of the first of these is 5S for Healthcare, scheduled for release later this year.
Do you have a question or comment about a book(s) that you would like addressed in Book Talk? Email me directly at Ralph.bernstein@taylorandfrancis.com.
I never imagined that lean principles could be combined with religious principles. But two men in Wisconsin are doing exactly that, creating the concept of what they call Lean Ministry.
Their goal is to achieve spiritual transformation and continuous spiritual improvement. And yes, they really are applying lean principles to achieve that goal.
One of the two is Charles Duffert, a retired Naval officer and business executive who currently teaches lean and six sigma methodologies at a junior college. The other is Dr. Tom Nebel, Director of Church Multiplication and Leadership Teams for Converge Worldwide, the new misional name of the Baptist General Conference.
If the goal of a lean manufacturer is to focus on creating value for customers, Duffert and Nebel suggest that the goal of a lean church is to focus its resources on the transformation of its people.
They describe other attributes of a lean church, and even give examples of the seven types of waste in church operations. Some of these are:
Overproduction: Teaching or preaching to large batches of disciples at the same time under the assumption that they are all in need of the same message and are all at the same place on the timeline of the transformation process.
Overprocessing: Separating the congregation into batches by age or gender and placing them in classes with the assumption that God transforms people by age and gender. Also, music, instruments, worship teams, choirs and other productions having more entertainment value than impact on the transformation process.
I have always supported the idea that lean principles can be applied to just about any organization. Duffert and Nebel are embracing that concept to give churches focus in defining and achieving their mission. While my own religious beliefs may be different from theirs, I wish them well.
When I asked Adam if there were any particular industries that were hiring, he said, “Companies that will stand to potentially benefit from this dramatic move to green, however you want to define that. We’re seeing a lot of funding going on, with venture capital firms. It’s unbelievable how many of these green-type ventures they’re funding.”
And Adam said funding is taking place for all types of green companies. Generally, he said, “In some way, shape or form, they either help companies measure or abate or solve environmental-related issues. The environment has become not just saving the planet, but a business issue. Those companies are definitely hiring tremendously.”
Lean can clearly play a key role in green efforts, something I’ve written about before, since both lean and green can help eliminate waste.
In addition to startups, Adam said there is another type of company where lean and green connect.
“Within established companies, they are starting to connect the dots between lean and green. What we’re seeing here, just at the very beginning, is companies saying it’s not just about lean. In some companies, lean has become its own silo, which is kind of a paradox, because lean is about breaking down silos.
“They’re trying to connect product design, R&D, and connect with green from the resource management perspective – to figure out how this actually affects our customers, and everything involves supply chain. Do we have the people within our organizations to connect those dots? A lot of times the answer is coming up no. “
Companies looking today for executives with lean expertise want high-level people with a broad range of skills who fit what may be a very specific job description.
For job-seekers, that means your search has to be very targeted.
That is what I learned by speaking with Adam Zak, the head of Adam Zak Executive Search, a recruiting firm that specializes in filling lean positions (particularly those at higher levels).
I speak with Adam periodically about the state of the lean job market. This time he told me that yes, companies are hiring, but there is no “fluff” anymore in job descriptions.
As an example, he talked about a company that created what he called “one of the tightest descriptions ever written.” It was written that way because of the process that led to its creation.
“They clearly defined what that business unit’s goals were for the next 12, 18, 36 months, and what could derail them from achieving those goals,” he explained.
“They really took a very close and critical look at what are the resources they have, what do they not have, so what is the person going to need to accomplish? Then and only then did we set about creating a description.”
What this type of approach means to the job candidate, he said, is that “if you don’t hit nine-and-a-half or nine of the 10 requirements the company has laid out, you don’t stand a chance. On the other hand, the person who is well-qualified and willing to take the risk of jumping ship right now, that person, if they’re a strong potential fit and can really deliver performance and competence, has a much better chance of standing out, shining, and truly making a name for themselves.”
The biggest demand is for high-level people, such as division managers, he said, adding that companies “are looking for much more specific types of expertise, and jettisoning those people who may have been valuable contributors in the past but, going forward, are probably not the folks to have on board…
“Lean is different today. It is no longer just the Toyota Production System stuff…
“Companies are asking for people who have lean skills, Six Sigma skills, who understand the theory of constraints, who understand the broad nature of continuous improvement and how it ties into short- and long-term performance, how it ties into operational excellence.
“Every executive preparing for an interview should think about how can I drive performance better and faster, and how can I help this company move to cash more quickly.”
Adam noted that “Tech companies in general are doing much more hiring than the rust belt industries. There is money (venture capital) available both for startups as well as established companies.”
With startups, he said, “I actually heard a venture capital guy in Silicon Valley who said that if we begin our company, and we do lean and build it in, build in how we are going to form an organization, then at its roots we are talking about a company that believes in not wasting, not over-hiring and really being close to the customer. Lean is becoming very important for early stage organizations.”
Adam’s advice: ”For companies, use this time to truly understand the resources you have, your strengths both in talent as well as in ideas for innovation, new products, and how to better and more effectively approach customers in new markets. Now is the time to really be investing for the future. There’s an old lean saying, you’ve never been able to downsize your way out of a poor economic situation. You really have to be doing something for growth.”
For individuals, he suggests, “Now more than ever you have to use a rifle and not a shotgun in terms of focusing your attention on where you can add value. That’s going to take work… When you find that job, and when you understand how you can make that contribution and communicate that to the people who run the business, you will be the guy they hire.”
While job candidates typically post their resumes on LinkedIn and Facebook, Adam notes, “so did 15 million other people. What makes you different? When people connect with me and know how to solve problems, and have some idea of where, they’ve got a leg up on everyone else sending me a resume. “
Adam also said there are real lean opportunities today in connection with the growing green movement. I’ll describe what he said in my next posting.
