Lean in a French Hospital

“Have you ever been in a French hospital, Curmudge?”

“No, Jaded Julie, but we came very close. Mrs. Curmudgeon contracted food poisoning in Paris several years ago. We stayed in the hotel because my wife was too sick to move—except frequently to the bathroom. I went to the local pharmacy, and the pharmacist provided something that seemed to be effective. Perhaps pharmacists there can dispense without a prescription more powerful stuff than here. Although my wife felt like dying, she eventually got better.”

“It sounds as if the French have become more helpful to Americans than in years past.”

”I suppose so. You can depend on the French; they are always there when they need us.”

“Curmudge, did you say that right? Considering the source, I guess you did. So anyway, tell me about the paper you found—the one about a hospital in France.”

“I was googling ‘Lean in nursing’ and encountered the paper, Lean as a Learning System in a Hospital Ward. I’ll give you the URL*, but Word refuses to open the file. Perhaps it has the same French bug that my wife had. At least it can be accessed via Google.”

“Please proceed, Professor. We’ve already used a half page.”

“The staff at the hospital, Hôpital Nord 92, used Lean tools, especially 5S, and encountered what the authors call the ‘pillowcase syndrome’. If one squeezes at one end, it bulges elsewhere. When they made an isolated improvement, it shifted the burden to another element in the system. The authors, Ballé and Régnier, attributed their lack of meaningful progress to the lack of basic stability in their unit. Although the ‘basic stability’ problem has been described by Smalley in the manufacturing context**, it can be translated into health care.”

“Okay, Curmudge. I think at this point you want me to ask, ‘How can one achieve basic stability in a patient care unit?’”

“The folks at Park Nicollet Health Services in Minneapolis provide some inspiration in their listing of the ‘7 Flows of Medicine’***. These are factors that they consider in designing changes in processes or delivery of services:
· Flow of patients
· Flow of providers
· Flow of medications
· Flow of supplies
· Flow of information
· Flow of equipment
· Flow of instruments and processes”

“I think I get it, Curmudge. The better one can control these flows, the greater the unit’s basic stability. Did the nurses at Nord 92 improve any of their flows, perhaps without even knowing of Park Nicollet’s list?”

“Yes, they really made significant progress toward basic stability. They initiated a ‘clear corridor’ policy so that wheelchairs and trolleys (carts) were properly located and not scattered all over. Materials handling and storage were studied and improved. They adopted a ‘supermarket’ (first in, first out) policy for storage areas. A clear benefit of these changes was that anything out of date or out of place would stand out. Success in these projects convinced the nurses that there might be value in achieving basic stability in nursing care itself. At the end of the paper, the nurses were developing checklists and devising what we would call ‘standard work’ for some of their processes and procedures.”

“That’s great, Curmudge. I understand that we’ll talk more about Nord 92 in our next conversation. By the way, did your wife ever return to Paris?”

“Never. And she refuses to eat foie gras.”

Affinity’s Kaizen Curmudgeon

*http://lean.enst.fr/wiki/pub/Lean/LesPublications/HospitalLearning.pdf

**http://www.superfactory.com/articles/Smalley_Basic_Stability.htm

***http://www.msp-ifma.org/0702prgnotes5S3PLeanCaseStudyDSpiegle.ppt