“Curmudge, you should be distraught, but of course you never are. You arrived at work at 9:15 today, and I know that you intended to be here by 9:00. Fortunately, work hours are not a big deal with volunteers.”
“I had an appointment with a physician across town at 8:15 this morning, and I felt certain that it would be over and I’d be here by 9:00. I’m usually with the doc for five minutes at the most, and that was the case today.”
“Oh-oh. Something must have been messed up at the office. Would you tell me about your experience? Perhaps we can learn something from it. But please, no profanity or histrionics.”
“To begin with, Julie, I think the doc is great, and the receptionist has always been very accommodating. The first sign of a problem was when I arrived at the multi-specialist office building at 7:55; the line of people waiting to register stretched out the door. Ultimately, I got inside and registered by 8:10 after having confirmed all the personal information that was already in their records.”
“Since you didn’t get here until 9:15, that must not have been the end of your delays. Obviously you spent some time in the waiting room.”
“Finally the nurse (name unknown—she didn’t introduce herself) took me back to an exam room. Per our well-practiced drill, I removed my shirt and froze until the doc arrived. As expected, she was there and gone in five minutes. I stopped at the desk on the way out, made my return-in-six-months appointment, and headed for work at 8:55.”
“So, professor, what is today’s lesson, other than ‘don’t take off your shirt in a cold exam room’?"
“There was a very pertinent posting on daily kaizen last November. The title was Getting In-Flow, and it details what the author did to improve her office. To a patient, flow means moving through the appointment smoothly without needless periods of waiting. To the office staff, flow is a day without surprises, disruptions, or highs and lows in work load.”
“As we have learned, Curmudge, the office needs to practice heijunka, or level loading. If they can’t have more patient registrars at 8:00 a.m., maybe they can eliminate the operation and use registration kiosks. And in addition, they should plan ahead and not schedule potentially long appointments at the beginning of a day. I remain puzzled at how a physician’s office can be one-half hour behind by 8:15. They seemed to accept the fact that delays and lack of flow were normal.”
“Good observations, Julie. Would now be an appropriate time for me to share my observations about patient waiting?”
“It would. True flow means no waiting. Isn’t it incongruous to realize that health care facilities are still being designed to accommodate a waste—waiting—by having ‘waiting rooms’?”
“Back to reality, Ms. Perfectionist. Except for OB and Peds, a major fraction of our patients are senior citizens. We often assume that because they don’t have employment obligations or a crowded social calendar, they shouldn’t mind waiting. That may be true in the short term but quite inaccurate in the long term. By definition, a senior citizen’s days are numbered—with the number often quite unknown. If there’s something he/she wants to accomplish while still on this earth, he’d better get busy on the task. There’s no time to wait.”
“So what do you conclude, Curmudge?”
“Health care providers should implement flow and try to make their waiting rooms obsolete. Of course, my specific conclusion from my most recent office visit is that the practice of Lean in health care is not yet universal.”
Affinity’s Kaizen Curmudgeon
Friday, January 13, 2012
Wednesday, January 4, 2012
Motivation
“Hey Jaded Julie, would you like to hear some anecdotal evidence that supports an obvious conclusion?”
“If the conclusion is obvious, it doesn’t need evidence; but I’m always willing to listen to your strange stories.”
“In a stateside Army unit with no immediate plans for deployment, more soldiers show up for sick call than in a deployment-ready light infantry unit or in a Special Forces unit that deploys regularly. Soldiers in the stateside unit apparently want to be relieved from heavy duty or outside work.”
“Well, I know where you got that factoid. Obviously, the stateside soldiers aren’t motivated. It’s also obvious that you have some more examples.”
“In early 19th century warfare, when battles were won by conquering fortified cities, a unit of volunteers called the Forlorn Hope would be the first to charge through the first breach in the city’s defenses. Although the soldiers faced almost certain death (thus the name Forlorn Hope), they would be promoted if they survived.”
“That sounds like insanity, Curmudge. But it’s not limited to long ago. Think of the suicide bombers in Afghanistan. That is certain death, but their motivation has something to do with virgins in the afterlife. Apparently they never heard Professor Harold Hill (in ‘Music Man’) sing, ‘a sadder but wiser girl for me.’ But enough of this banter. What does this have to do with Lean?”
“For Lean’s ongoing existence, motivation has to be continuously refreshed. If we lag in our motivation to continuously improve, it will be reflected by a lag in our Lean transformation. Maybe that’s what happened in those organizations that suffered Lean burn-out.”
“I’ve got it, Curmudge. Fresh ideas are needed to help us maintain our patient focus. Acronyms like C.A.R.E. and AIDET. Personalized Care is more than just a marketing theme; it’s what we do. The newest motivators are the ‘Always’ teams. This term comes from the choices about recommending Affinity found on patient surveys: Always, Usually, Sometimes, Never.”
“Some of our motivational reminders are more enduring than acronyms or slogans. Consider Affinity’s Values: service, integrity, teamwork, justice, creativity, stewardship. They are lettered on the wall of our team room. One should take a moment and consider whether they are guiding our actions.”
“It’s time for the bottom line, old guy. What is it?”
“Motivation is more than slogans, acronyms, or programs developed by committees. It must happen every day in gemba, and it’s the responsibility of leaders at every level. Workers will be motivated when they see that their daily improvements are paying off in efficiency, less waste, and better patient safety and outcomes.”
“Hey Curmudge, what keeps you motivated?”
“As I said long ago, I am an inveterate learner and teacher. But most of all, it’s the people.”
Affinity’s Kaizen Curmudgeon
In case you missed it earlier, this year’s holiday story from Curmudge and Julie may be accessed elsewhere.
“If the conclusion is obvious, it doesn’t need evidence; but I’m always willing to listen to your strange stories.”
“In a stateside Army unit with no immediate plans for deployment, more soldiers show up for sick call than in a deployment-ready light infantry unit or in a Special Forces unit that deploys regularly. Soldiers in the stateside unit apparently want to be relieved from heavy duty or outside work.”
“Well, I know where you got that factoid. Obviously, the stateside soldiers aren’t motivated. It’s also obvious that you have some more examples.”
“In early 19th century warfare, when battles were won by conquering fortified cities, a unit of volunteers called the Forlorn Hope would be the first to charge through the first breach in the city’s defenses. Although the soldiers faced almost certain death (thus the name Forlorn Hope), they would be promoted if they survived.”
“That sounds like insanity, Curmudge. But it’s not limited to long ago. Think of the suicide bombers in Afghanistan. That is certain death, but their motivation has something to do with virgins in the afterlife. Apparently they never heard Professor Harold Hill (in ‘Music Man’) sing, ‘a sadder but wiser girl for me.’ But enough of this banter. What does this have to do with Lean?”
“For Lean’s ongoing existence, motivation has to be continuously refreshed. If we lag in our motivation to continuously improve, it will be reflected by a lag in our Lean transformation. Maybe that’s what happened in those organizations that suffered Lean burn-out.”
“I’ve got it, Curmudge. Fresh ideas are needed to help us maintain our patient focus. Acronyms like C.A.R.E. and AIDET. Personalized Care is more than just a marketing theme; it’s what we do. The newest motivators are the ‘Always’ teams. This term comes from the choices about recommending Affinity found on patient surveys: Always, Usually, Sometimes, Never.”
“Some of our motivational reminders are more enduring than acronyms or slogans. Consider Affinity’s Values: service, integrity, teamwork, justice, creativity, stewardship. They are lettered on the wall of our team room. One should take a moment and consider whether they are guiding our actions.”
“It’s time for the bottom line, old guy. What is it?”
“Motivation is more than slogans, acronyms, or programs developed by committees. It must happen every day in gemba, and it’s the responsibility of leaders at every level. Workers will be motivated when they see that their daily improvements are paying off in efficiency, less waste, and better patient safety and outcomes.”
“Hey Curmudge, what keeps you motivated?”
“As I said long ago, I am an inveterate learner and teacher. But most of all, it’s the people.”
Affinity’s Kaizen Curmudgeon
In case you missed it earlier, this year’s holiday story from Curmudge and Julie may be accessed elsewhere.
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