Holiday Greetings from the Kaizen Curmudgeon and Jaded Julie

“Julie, don’t you think it’s time for us to take a break from all this Lean and leadership and problem-solving stuff and wish our readers a Merry Christmas?”

“Merry Christmas doesn’t sound very politically correct, Curmudge. We should say ‘Happy Holidays’.”

“Politically correct, Julie; what’s that?”

“The dictionary says it means ‘marked by or adhering to a typically progressive orthodoxy involving race, gender, sexual affinity, or ecology’.”

“Does it say anything about age? If it did, I wouldn’t be old; I’d be ‘generationally challenged’.”

“Sorry, Curmudge, but age isn’t mentioned.”

“Well then, I can’t be politically correct. Besides, did you ever hear of a politically correct curmudgeon? That sounds like an oxymoron.”

“An oxy what, Curmudge? Oh, never mind.”

“Despite saying we weren’t going to, let’s think for a moment about Lean. The main principles of Lean are continuous improvement and respect for people. If we have respect for all people, we don’t have much need for political correctness. To me, respect is genuine, but political correctness sounds like something dreamed up by a correct politician. And that really is an oxymoron.”

“I looked it up, Curmudge. An oxymoron is ‘conjoining contradictory terms’. Your example really helped me to understand it. But we still haven’t decided how we’re going to express our best wishes to everyone.”

“The fact that we don’t work in a secular hospital makes it simple, Julie. We can say, without reservation, ‘Merry Christmas’. And to those for whom Christmas isn’t meaningful but have December holidays we’ll wish a heartfelt ‘Happy Hanukkah, Eid al-Adha, Kwanzaa, and Boxing Day’.”

“Happy Holidays, Curmudge.”

“Merry Christmas, Julie.”

Affinity’s Kaizen Curmudgeon

Jaded Julie Learns about Dr. Deming

"Julie, when we met last time you convinced me that the training of nurses prepares them to be excellent problem-solvers. All you need is to learn the language of Lean problem solving, and you’ll be off and running.”

“That’s a good choice of words, Curmudge, since nurses are either running or walking fast most of the time. By the way, I hope that the ‘language of Lean problem solving’ doesn’t mean that I have to learn a bunch of new Japanese words.”

“Not a problem, Julie. Lean problem solving is based on the Deming Cycle: Plan, Do, Check, Act. It’s named for an American, Dr. W. Edwards Deming, and the cycle is also used for process improvement. Of course, before you can implement the Deming Cycle, you have to understand the nature of the problem you are working on. So of necessity, the cycle is preceded by a fifth element, Grasp the Situation. Here it is shown as a diagram.”
“That ‘Grasp Situation’ sure looks a lot like Assessment and Diagnosis in the Nursing Process. I’m beginning to see what you are driving at.”

“Grasping the situation is a universal starting point for any investigation. In industry we used to call it penetrating the problem. It’s logical that one must know where he is before planning how he’s going to get to where he wants to go. Getting to the true source of a problem—the so-called root cause—will be the topic of a separate discussion. However from your experience as a nurse, Julie, I’m confident that you can understand the concept. Plan and Do in the Deming Cycle correspond to Planning and Implementation in nursing, and Check—sometimes called Study—is the same as your Evaluation.”

“What about Act, Curmudge? To me, that sounds a lot like Do.”

“You’re right, Julie. The difference is simply its location in the cycle. It’s what you do following evaluation. Actions might include accepting at this point the problem solution you have achieved or the process improvement you have developed. If the process meets the targets established in the Plan, accept it as a standard. Otherwise one could plan ways that might yield a better solution or process and go around the cycle again.”

“I understand, Curmudge. If this is typical, Lean tools should be easy for a nurse to use.”

“Lean tools are straightforward. The real challenge of Lean is learning, accepting, and implementing its culture. The basic Lean culture originated in Japan, and those of us in the older generation grew up not thinking very highly of those guys.”

“Nevertheless, I bet if you and I put our heads together, we can resolve some of those cultural differences. Don’t forget, Curmudge, yours is a much, much older generation.”

“Watch that much, much older stuff, Julie. These are my fingers on the keys.”

“Sayonara, Curmudge.”

Affinity’s Kaizen Curmudgeon

This Time, Jaded Julie is the Teacher

“I confess, Curmudge. I’ve been looking ahead and can see that sometime you are going to teach me about problem solving.”

“That’s right, Julie. We’ll talk about problem-solving techniques used by groups. Things like root cause analysis and brainstorming.”

“Did you know that health care professionals do a lot of individual problem solving?”

“Of course I do. I’ve learned a lot since I began studying at Google University. I sense, however, that you are poised to teach me about problem solving in nursing, so I’ll sit back and let you be the teacher. But remember, Julie, the hands-on aspects of nursing are not my thing.”

“Okay, we’ll start with a placement test of your nursing knowledge. What are the two kinds of diagnoses?”

“That’s simple. Right and wrong.”

“No, no, Ancient One. The two kinds of diagnoses are medical and nursing. It looks as if we’ll have to start your nursing education at square one. Medical diagnosis is the act of distinguishing one disease from another, and a nursing diagnosis captures an individual patient’s reactions to actual or potential health-related problems. Nursing diagnosis is part of the Nursing Process, which includes Assessment, Diagnosis, Planning, Implementation, and Evaluation.”

“So when do you do this Nursing Process?”

“We do it virtually all the time. It should be second nature to an RN. If a patient experiences problems that would be expected from their diagnosis, our planning, implementation, and evaluation are relatively straightforward.”

“But what if your assessment reveals that the patient is experiencing unanticipated difficulties? That’s when your diagnostic and problem-solving talents kick in, right? I didn’t see anything in the nurses’ station labeled ‘Panic Button’.”

“No, but we have to determine right away if we should have pressed the button if we had one. Differentiation of criticality is one of our most important skills. That requires immediate recall of a lot of knowledge plus judgment and critical thinking. That’s why we assess and fulfill the training needs of new hires.”

“You’re not alone up there, Julie. I presume that in a critical situation you can get help from other nurses, the charge nurse, a hospitalist, or the rapid response team.”

“And if the problem is in an instrument, I can call BioMed or read the policy and procedure or the instrument manual. Remember ‘RTM’?”

“I seem to recall a slightly different abbreviation, but I definitely approve of the one you just used. But Julie, I suspect there are needs for a nurse’s critical thinking skills beyond just knowing when to call for help.”

“There sure are. A nurse’s knowledge and judgment are among the first lines of defense against medication errors and other threats to patient safety. Here are a few examples:
· In calls to physicians and hand-offs to the nurse on the next shift, practice SBAR (Situation, Background, Assessment, Recommendation).
· Know what physician orders to expect so you are not fooled by poor handwriting and can question an order that might contain an error.
· Be acquainted with a medication’s contraindications so you can discern when to have your dosage calculations checked by a colleague.”

“You could probably fill several pages with additional examples. Perhaps one of our future discussions should be devoted to patient safety. We wrote about this topic in our pre-Kaizen Curmudgeon days, and we ought to revisit it.”

“So, Curmudge, do you now appreciate the importance of problem solving in nursing?”

“I certainly do. Next time I’ll share with you how your training as a nurse has prepared you for Lean problem solving.”

“Curmudge, I can hardly wait.”

Affinity’s Kaizen Curmudgeon