“Hey Jaded Julie, remember when we talked about falls back on February 12?”
“Of course I do. You said your wife was vertically challenged; I figured that meant she falls a lot.”
“Well, she did it again.”
“Was she hurt?”
“This fall was worse than usual. She tripped on a marble step, fell on the hard surface, and dislocated her right shoulder.”
“Oo, sounds bad. Where did it happen?”
“In a hotel in Prague, Czech Republic. We spent the rest of the day in the local hospital getting her shoulder relocated. Being the connoisseur of health care that you are, I thought you’d want to learn what a Czech hospital is like.”
“Are you sure you didn’t push your wife just so we’d have something to talk about?”
“I’m sure. Now I have to wait on her hand and foot. With her right shoulder, arm, and hand immobilized, she can’t even unscrew the top of a tube of toothpaste.”
“So the hotel called an ambulance, and they rushed your wife to the hospital, right?”
“Right. The ambulance ride was unremarkable except that I had to pay the equivalent of $100 in Czech money before they unloaded her. Then they rolled the gurney down the middle of the hallway that served as the ED waiting room. Only a few waiting patients looked up. They put her on an unpadded stainless steel table for a perfunctory triage.”
“Per…what? Well, a dislocated shoulder is pretty obvious.”
“After that, they plopped my wife into an ancient wheelchair, and we joined the line of sick and injured in the hallway. My wife’s requests for pain medication were ignored. After about an hour, a doctor came by and said that we would have to wait a couple more hours (four hours after her last meal) before he could work on her shoulder. They moved her to an inpatient room to wait. Her wheelchair was pushed by a silent, absolutely expressionless male.”
“Was the room what you’d expect in the United States?”
“Not at all. The whole hospital was 1940’s vintage. Perhaps that’s understandable, because only 20 years have passed since the ‘velvet revolution’ when the Czechs threw out their communist rulers.”
“You were telling me about the room.”
“Cast iron beds, four per room. Gas lines were on, not in, the walls. My wife had one roommate, an older woman who had had surgery on her foot. The hospital was not crowded.”
“I think I can understand why.”
“After awhile, they took my wife out for x-rays. They used what appeared to be old-fashioned plates, and the x-ray technician also read the x-rays. I had to pay cash on the barrelhead, the equivalent of about $30, for each x-ray. Finally, they took my wife to reduce (relocate) her shoulder. After some sort of IV anesthesia but before it could take effect, the doc put her shoulder back into place. It required three attempts. Three people held her down; I could hear her screams where I waited in the hallway. After another follow-up x-ray (another $30 worth of Czech currency), she was taken back to her room. We had to wait another four hours before being released. Fortunately, the hospital accepted my credit card.”
“I presume your fluency in Czech made the hospital stay easier.”
“My fluency is limited to ‘hello,’ ‘goodbye,’ ‘please,’ ‘thank you,’ and how to order a beer (pivo). In our rush to the hospital, I left my Czech phrasebook back at the hotel.”
“But don’t most Czechs speak English?”
“Children and doctors do, but the nurses didn’t. Our communication was almost comparable to that of a Czech couple in a U.S. hospital.”
“If you had been able to communicate, you could have taught the Czechs about Personalized Care.”
“I’m sure they never heard of Lean or Quint Studer. A little AIDET or C.A.R.E. would have been nice. I fear that what might be viewed as standard work was a bunch of rigid rules left over from communist days. I’m surely glad my wife didn’t have to have any sort of incision; one would be very fearful of nosocomial infections in that place.”
“How well did the hospital staff do with hand hygiene?”
“The nurse who cared for my wife put on rubber gloves when she emptied the roommate’s urine bag. But I don’t recall her washing her hands or using hand sanitizer. Nevertheless, she was the one cheerful, friendly person that we encountered.”
“So how would you sum up your experience in the hospital?”
“They probably practice acceptable medicine. I’ll know that better if my wife makes a full recovery. However, their reduction of her shoulder without effective anesthesia is not typical practice in the U.S. In my view, the hospital (which we later learned was a state hospital) was drab, dreary, depressing, unfriendly, rigid, and totally devoid of a healing environment.”
“And do you have any final words for the Czech hospital?”
“I sure do. ‘Na shledanou.’ It means ‘goodbye.’”
Affinity’s Kaizen Curmudgeon
Thursday, April 23, 2009
Thursday, April 16, 2009
The 5P Pyramid--Up to Levels 4 and 5
“Here we are on Level 3, Curmudge, where we stopped last week. The climb up here wasn’t nearly as difficult as it was the first time.”
“Practice makes perfect, Jaded Julie. Soon we’ll have it hardwired.”
“I see a sign over there. Can we talk about that before we go higher?”
“Of course. It’s a Communication Board, sometimes called a Performance Indicator Board. Among other department goals, it displays the brand goals and metrics that the team has chosen to indicate their progress toward achieving the Affinity promise of personalized care.”
“Metrics? That’s like meters and kilograms, right?”
“In ‘Leanspeak,’ a metric is something that is measured, such as patient satisfaction scores.”
“I remember, Curmudge. Something that is not measured tends not to get done. The communication board needs to be kept up to date so that a problem becomes immediately evident and can be tackled ASAP.”
“Are you ready to go up to the higher levels, Julie? It’s windy up there today, but we won’t stay long.”
“You’re right about the wind, but the view of downtown is pretty good. The most distinctive features are the 222 Building, Appleton Center, the old Zuelke Building, and the County Jail. But here on the pyramid things look pretty much as Liker depicted them in The Toyota Way. (1)”
“That must mean that the Toyota concepts of People and Partners (Level 4) and Problem Solving (Level 5) are enduring. We discussed those back in January of 2008. Fortunately, the application of these Toyota concepts to hospitals has been addressed by Studer (2) and Stubblefield (3) (the People concept, Level 4), and by Graban (4) (Problem Solving, Level 5). We may devote a whole discussion to these people in the future.”
“I recall your mentioning that all these books are must reading for health care leaders. Is there anything in them that bears upon our Affinity promise of personalized care?”
“Almost everything, Julie. Both Studer and Stubblefield agree that satisfaction of patients is directly related to satisfaction of employees. We achieve that by providing employees a place to work where they feel they have a purpose, are doing worthwhile work, and can make a difference. The authors emphasize that continuous leadership development is absolutely essential. Graban’s discussion of problem solving reinforces what we already know about going to gemba and getting to the root cause of errors, which can be serious patient dissatisfiers and the most critical problems in a hospital.”
“Thanks for bringing me up here, Curmudge. Maybe the image of a pyramid will help me retain what I have learned for a few thousand years.”
“Lots of luck, Julie. Let’s hike down the back trail. It’s not nearly as steep as the way we came up.”
“So what are we going to talk about next week, Curmudge?”
“It’s a secret.”
“A secret! I bet that just means you haven’t thought of anything yet.”
“Not true, Julie. I planned next week’s conversation a couple of weeks ago. When I can’t think of anything for us to talk about, that will mean that the synapses in my brain are getting lost and senility is setting in.”
“Oh? You mean that isn’t already happening?”
Affinity’s Kaizen Curmudgeon
(1) Liker, Jeffrey K. The Toyota Way. (McGraw-Hill, 2004)
(2) Studer, Quint. Hardwiring Excellence. (Fire Starter Publishing, 2003)
(3) Stubblefield, Al. The Baptist Health Care Journey to Excellence. (John Wiley, 2005)
(4) Graban, Mark. Lean Hospitals. (Productivity Press, 2008)
“Practice makes perfect, Jaded Julie. Soon we’ll have it hardwired.”
“I see a sign over there. Can we talk about that before we go higher?”
“Of course. It’s a Communication Board, sometimes called a Performance Indicator Board. Among other department goals, it displays the brand goals and metrics that the team has chosen to indicate their progress toward achieving the Affinity promise of personalized care.”
“Metrics? That’s like meters and kilograms, right?”
“In ‘Leanspeak,’ a metric is something that is measured, such as patient satisfaction scores.”
“I remember, Curmudge. Something that is not measured tends not to get done. The communication board needs to be kept up to date so that a problem becomes immediately evident and can be tackled ASAP.”
“Are you ready to go up to the higher levels, Julie? It’s windy up there today, but we won’t stay long.”
“You’re right about the wind, but the view of downtown is pretty good. The most distinctive features are the 222 Building, Appleton Center, the old Zuelke Building, and the County Jail. But here on the pyramid things look pretty much as Liker depicted them in The Toyota Way. (1)”
“That must mean that the Toyota concepts of People and Partners (Level 4) and Problem Solving (Level 5) are enduring. We discussed those back in January of 2008. Fortunately, the application of these Toyota concepts to hospitals has been addressed by Studer (2) and Stubblefield (3) (the People concept, Level 4), and by Graban (4) (Problem Solving, Level 5). We may devote a whole discussion to these people in the future.”
“I recall your mentioning that all these books are must reading for health care leaders. Is there anything in them that bears upon our Affinity promise of personalized care?”
“Almost everything, Julie. Both Studer and Stubblefield agree that satisfaction of patients is directly related to satisfaction of employees. We achieve that by providing employees a place to work where they feel they have a purpose, are doing worthwhile work, and can make a difference. The authors emphasize that continuous leadership development is absolutely essential. Graban’s discussion of problem solving reinforces what we already know about going to gemba and getting to the root cause of errors, which can be serious patient dissatisfiers and the most critical problems in a hospital.”
“Thanks for bringing me up here, Curmudge. Maybe the image of a pyramid will help me retain what I have learned for a few thousand years.”
“Lots of luck, Julie. Let’s hike down the back trail. It’s not nearly as steep as the way we came up.”
“So what are we going to talk about next week, Curmudge?”
“It’s a secret.”
“A secret! I bet that just means you haven’t thought of anything yet.”
“Not true, Julie. I planned next week’s conversation a couple of weeks ago. When I can’t think of anything for us to talk about, that will mean that the synapses in my brain are getting lost and senility is setting in.”
“Oh? You mean that isn’t already happening?”
Affinity’s Kaizen Curmudgeon
(1) Liker, Jeffrey K. The Toyota Way. (McGraw-Hill, 2004)
(2) Studer, Quint. Hardwiring Excellence. (Fire Starter Publishing, 2003)
(3) Stubblefield, Al. The Baptist Health Care Journey to Excellence. (John Wiley, 2005)
(4) Graban, Mark. Lean Hospitals. (Productivity Press, 2008)
Thursday, April 9, 2009
The 5P Pyramid--Level 3
“Well Curmudge, we’re still here on the second level of the 5P Pyramid (1). Let’s either go higher or get off this thing.”
“We’ll go on up, Jaded Julie, but first let’s review where we are. The second ‘P’ stands for Promise, which is Affinity’s promise of personalized care.”
“I’m puzzled about two of the elements of personalized care that we mentioned last week. If doctors and nurses are already fully committed to their current patient load, where are they going to find the additional time for patients that we promise in Personalized Care?”
“The answer, Julie, is Lean.”
“Lean! That seems to be your one-word, default solution to every problem. It’s like giving every patient chicken soup for every ailment.”
“Actually Julie, common sense should provide the solution to most problems. Lean is just one of several ways to organize common sense, and it’s the one we use at Affinity. You’ll see after we have climbed to Level 3. If you’re up to it, you can lead; and I’ll belay you from down here.”
“Oof! We’re here on Level 3. That was a challenging climb; you did pretty well for an old guy. Hey, look over there! Chiseled into the wall is the name of this level, ‘Process.’ And right next to it is ‘Lean.’ Tell me, O Grizzled Wizard, what all this means.”
“The concept shouldn’t be too much of a stretch, Julie. We should be able to achieve our promise of personalized care by improving and enhancing our processes. We use Lean concepts and tools—kaizen events, going to gemba, value stream mapping, root cause analysis, A3 reports, standard work, and visual control—to remove waste and inefficiency from our processes.”
“That’s how the physicians and nurses gain the extra time for their patients.”
“Right, Julie. We also implement things we have learned from Quint Studer (2), like AIDET, rounding, and key words at key times. These should enhance each patient’s experience and help us further to accomplish our promise of personalized care. All of this must become ‘the way things are done around here.’”
“I’ve got it Curmudge! If each of us can hardwire the elements of the Affinity 5P Model of Excellence into our personal brand, we will have achieved the Affinity Brand Promise.”
“Nicht so schnell (not so fast), Julie. You’ve got the right idea, but we still have the top two ‘P’s of the pyramid to explore.”
“Let’s rappel off this thing, Curmudge, and come back next week. My husband would never believe me if I told him that I spent the weekend on a pyramid with a septuagenarian.”
Affinity’s Kaizen Curmudgeon
(1) The 5P Model of Excellence may be found in the Affinity Brand Tool Kit in the right margin of the Affinity Intranet Homepage.
(2) Studer, Quint. Hardwiring Excellence. (Fire Starter Publishing, 2003)
“We’ll go on up, Jaded Julie, but first let’s review where we are. The second ‘P’ stands for Promise, which is Affinity’s promise of personalized care.”
“I’m puzzled about two of the elements of personalized care that we mentioned last week. If doctors and nurses are already fully committed to their current patient load, where are they going to find the additional time for patients that we promise in Personalized Care?”
“The answer, Julie, is Lean.”
“Lean! That seems to be your one-word, default solution to every problem. It’s like giving every patient chicken soup for every ailment.”
“Actually Julie, common sense should provide the solution to most problems. Lean is just one of several ways to organize common sense, and it’s the one we use at Affinity. You’ll see after we have climbed to Level 3. If you’re up to it, you can lead; and I’ll belay you from down here.”
“Oof! We’re here on Level 3. That was a challenging climb; you did pretty well for an old guy. Hey, look over there! Chiseled into the wall is the name of this level, ‘Process.’ And right next to it is ‘Lean.’ Tell me, O Grizzled Wizard, what all this means.”
“The concept shouldn’t be too much of a stretch, Julie. We should be able to achieve our promise of personalized care by improving and enhancing our processes. We use Lean concepts and tools—kaizen events, going to gemba, value stream mapping, root cause analysis, A3 reports, standard work, and visual control—to remove waste and inefficiency from our processes.”
“That’s how the physicians and nurses gain the extra time for their patients.”
“Right, Julie. We also implement things we have learned from Quint Studer (2), like AIDET, rounding, and key words at key times. These should enhance each patient’s experience and help us further to accomplish our promise of personalized care. All of this must become ‘the way things are done around here.’”
“I’ve got it Curmudge! If each of us can hardwire the elements of the Affinity 5P Model of Excellence into our personal brand, we will have achieved the Affinity Brand Promise.”
“Nicht so schnell (not so fast), Julie. You’ve got the right idea, but we still have the top two ‘P’s of the pyramid to explore.”
“Let’s rappel off this thing, Curmudge, and come back next week. My husband would never believe me if I told him that I spent the weekend on a pyramid with a septuagenarian.”
Affinity’s Kaizen Curmudgeon
(1) The 5P Model of Excellence may be found in the Affinity Brand Tool Kit in the right margin of the Affinity Intranet Homepage.
(2) Studer, Quint. Hardwiring Excellence. (Fire Starter Publishing, 2003)
Thursday, April 2, 2009
The 5P Pyramid
“Okay, Mr. Continuity, last week we discussed branding, and it looks as if you have some sort of pyramid in mind for today. The two topics must be related somehow in your brain, but I fail to see the connection.”
“At the moment, Jaded Julie, I envision a logical connection, but we’d better get it onto paper quickly before I forget what it is. One’s personal brand, which we talked about last week, is largely developed during his or her preschool years. ‘Share your toys.’ ‘Don’t hit people.’ ‘Don’t throw sand.’ These early admonitions help to develop the basic elements of your personal brand, and barring significant emotional events, they should stick with you for the rest of your life.”
“I presume you could cite a reference for that gem of knowledge, but you probably read it 50 years ago.”
“Right, Julie. Now let’s fast-forward 20 years. The service and compassion elements of your personal brand have led you into a profession in health care. When considering employment, you recognize that the Philosophy of Affinity Health System, ‘To live out the healing ministry of Christ,’ is also a good fit with your personal brand. So here we are, at the first ‘P,’ Philosophy, on the base of the 5P Pyramid, better known as the Affinity 5P Model of Excellence (1). Welcome to Affinity, newly graduated Nurse Jaded Julie.”
“You did it, Curmudge! You made the link between personal brands and the 5P Pyramid. And, Old Guy, you did it before your morning nap.”
“Now our job is to climb the pyramid—learning as we go—just as we did over a year ago on Liker’s 4P Toyota Way pyramid.”
“At least we’re not climbing in the dead of winter like we did last year.”
“The next level is Promise. It is Affinity’s contribution to the pyramid. Promise is the additional ‘P’ that makes the pyramid 5 P’s high.”
“I’ve read where the central feature of Affinity’s Promise is Personalized Care. This must mean that when a patient comes to Affinity, we promise to give them personalized care, whatever that is.”
“What it is, Julie, is defined by our Affinity Promise Statement, ‘We promise to provide personalized care by listening, treating you with respect, and putting your needs and interests first.’ We bring the Promise Statement to life for our patients by assuring that their experiences with Affinity encompass these six elements:
· They are seen within a few days of requesting an appointment.
· They spend more time with nurses.
· They spend more time with doctors.
· They receive quality clinical care close to home.
· We help the patient develop a partnership with their caregivers.
· They will not feel herded through their visits to Affinity.”
“You know, Curmudge, if we could help everyone at Affinity append these elements to their personal brand and then put them into practice with every patient, we’d have an unbeatable corporate brand.”
“Exactly, Julie. When a person needs health care, they would think of Affinity first. It would be just like thinking of a drink in a coke bottle-shaped bottle when you are thirsty.”
“Curmudge, I owe you an apology. I shouldn’t have doubted your ability to link personal branding to the 5P pyramid.”
“Julie, as one of John Wayne’s characters once said, ‘Never apologize; it’s a sign of weakness.’”
“Who’s John Wayne?”
Affinity’s Kaizen Curmudgeon
(1) The 5P Model of Excellence may be found in the Affinity Brand Tool Kit in the right margin of the Affinity Intranet Homepage.
“At the moment, Jaded Julie, I envision a logical connection, but we’d better get it onto paper quickly before I forget what it is. One’s personal brand, which we talked about last week, is largely developed during his or her preschool years. ‘Share your toys.’ ‘Don’t hit people.’ ‘Don’t throw sand.’ These early admonitions help to develop the basic elements of your personal brand, and barring significant emotional events, they should stick with you for the rest of your life.”
“I presume you could cite a reference for that gem of knowledge, but you probably read it 50 years ago.”
“Right, Julie. Now let’s fast-forward 20 years. The service and compassion elements of your personal brand have led you into a profession in health care. When considering employment, you recognize that the Philosophy of Affinity Health System, ‘To live out the healing ministry of Christ,’ is also a good fit with your personal brand. So here we are, at the first ‘P,’ Philosophy, on the base of the 5P Pyramid, better known as the Affinity 5P Model of Excellence (1). Welcome to Affinity, newly graduated Nurse Jaded Julie.”
“You did it, Curmudge! You made the link between personal brands and the 5P Pyramid. And, Old Guy, you did it before your morning nap.”
“Now our job is to climb the pyramid—learning as we go—just as we did over a year ago on Liker’s 4P Toyota Way pyramid.”
“At least we’re not climbing in the dead of winter like we did last year.”
“The next level is Promise. It is Affinity’s contribution to the pyramid. Promise is the additional ‘P’ that makes the pyramid 5 P’s high.”
“I’ve read where the central feature of Affinity’s Promise is Personalized Care. This must mean that when a patient comes to Affinity, we promise to give them personalized care, whatever that is.”
“What it is, Julie, is defined by our Affinity Promise Statement, ‘We promise to provide personalized care by listening, treating you with respect, and putting your needs and interests first.’ We bring the Promise Statement to life for our patients by assuring that their experiences with Affinity encompass these six elements:
· They are seen within a few days of requesting an appointment.
· They spend more time with nurses.
· They spend more time with doctors.
· They receive quality clinical care close to home.
· We help the patient develop a partnership with their caregivers.
· They will not feel herded through their visits to Affinity.”
“You know, Curmudge, if we could help everyone at Affinity append these elements to their personal brand and then put them into practice with every patient, we’d have an unbeatable corporate brand.”
“Exactly, Julie. When a person needs health care, they would think of Affinity first. It would be just like thinking of a drink in a coke bottle-shaped bottle when you are thirsty.”
“Curmudge, I owe you an apology. I shouldn’t have doubted your ability to link personal branding to the 5P pyramid.”
“Julie, as one of John Wayne’s characters once said, ‘Never apologize; it’s a sign of weakness.’”
“Who’s John Wayne?”
Affinity’s Kaizen Curmudgeon
(1) The 5P Model of Excellence may be found in the Affinity Brand Tool Kit in the right margin of the Affinity Intranet Homepage.
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