Lean applied in hospitals

Lean applied in hospitals

by | Dec 23, 2018 | Business, Healthcare, Management

Beyond heroes – a lean management systems for healthcare by Kim Barnas

Just finished reading my Kindle edition of this lean book.  Great reminder of what I learned a couple of years ago, completing my lean training.  Describes how lean was adopted in Theda Healthcare in the US.  Not all plain sailing. But lots of lessons learned. And lots of progress made.

Leadership and culture

Barnas puts the challenges to leadership/ management up front – side by side with culture.  If lean puts continuous improvement at the centre then how do we sustain the improvements?  Q leadership and culture. ‘Leadership succeeds only when it learns to evolve’ and ‘new management duties encouraged everyone to be more respectful, improvement focused and process orientated’. 

Principles of lean management system

Barnas describes these, for Thedacare, as:

  • Managing by process
  • Using A3 and
  • Plan-Do-Study-Adjust (‘PDSA’)

Standard work

The emphasis on ‘Standard work’ attracted my attention: ‘they use standard work for all value creating and incidental work in the enterprise – designed, documented and continually audited, revised and improved by line managers and work teams’.  Barnas sees stability in work processes underpinning continuous improvemet.

End to end value streams

Thedacare sees the patient as the ‘product’ and the flow of the patient through a cycle of care as the value stream.  Barnas noted that most patients pass through more than one value stream. And Thedacare set end to end improvement goals across some of those value streams – with 3 or 4 multidisciplinary kaizen teams.                                                

KPI mad or not?

by | Nov 25, 2018 | Book reviews - business, Management

Is business now KPI mad?  In fact are organisations KPI or metrics mad? Just finished reading ‘The Tyranny of Metrics‘ by Jerry Z. Muller.  And it does give reason to think again about the curent obsession with KPIs  and ‘if you can’t measure it you shouldn’t be going it’.

Muller provides a good background – why we have seen the focus on KPIs.  And it’s not a new phenomenon.  It seems attractive to professional managers – if we can figure out what’s important to the performance of the organisation or company why not measure that?  To some extent the various reporting processes – annual inancial statements, monthly management accounts, variance analysis against budget and/or forecast – are all part of this measurement process.

Key performance indicators

Key Performance Indicators (KPIs) seem attractive – capture the essence of performance in a discrete set of numbers (preferably calculated automatically).  But unfortunately some of this attraction is the weakness.  Selecting a KPI which is calculable – but which may be too simple to measure what si actually a moe complex process.  And lot’s of important activities may not lend themselves to trasditional KPIs at all.

Cross industry challenge

Muller does a good job of  looking through different industries and sectors – be they health, policing, univestities, etc.  Ineach case he points out eamples where the metric is not comprehensive or causes people to game the metric. Almost more worrying, he lists lots of exampels where the metric causes sub optimal behaviour.

Conclusion

So what’s the answer? Do we stop measuring – because it’s too hard, demotivates people, encourages the wrong behaviour.  The balance of the book is so critical of metrics that one could find oneself headed that direction.  I do not believe this is the intent – and I do not think it the right conclusion.  Rather we need to review again the strategic and operational objectives (in a more holistic way) and determine whether there are appropriate measures in respect of each of these.  We need metrics which will motivate performance in line with organisation or corporate objectives.