“It would appear from the title, Curmudge, that we are going
to brew up a mixture from the topics that we’ve discussed for the past several
weeks.”
“That’s the plan, Julie. Remember Generic General Hospital that we used as a model
several years ago? Well, that’s
where we are going this week.”
“Will we be guiding the hospital in their quest for a Shingo
Prize?”
“No way. That’s
not a job for fictional characters, even in a fictional hospital. You and I will be like the Greek chorus
in ancient Greek drama; our task will be to observe and comment on the action.”
“What, Ancient Scholar, will you think of next? Oh well, raise the curtain…oops, they
didn’t have theater curtains back then.”
“Generic General had begun its Lean journey a few years ago,
but its progress had seemingly reached a plateau. Perhaps having a new goal, the Shingo Prize, would inspire
everyone.”
“Golly Curmudge, we’ve already discussed how demanding the
Shingo requirements are. The whole
hospital will have to become oriented toward a Shingo culture, and everyone
will need to think about Shingo all the time.”
“Obviously, Julie, they can’t do that while caring for
patients. Shingo will have to
permeate everyone’s habits. Recall
that culture is the product of one’s habits, and habits are those actions that
we do automatically without thinking in response to a cue. As we said last week, the habit loop is
cue-routine-reward.”
“Everyone in the hospital has one big habit. The cue is the alarm clock waking us in
the morning (or before our shift), and the routine action is practicing our
profession. For those caring for
patients, it’s meeting the standard of care. Then the reward at the end of the day or shift is going home
to our family, if we have one.”
“The ‘family’ part does make a difference. The reward in this example is almost
universal. Getting home on time is
valued by everyone from housekeepers to physicians. This may be a key to encourage people to continuously
improve the efficiency of their work.”
“Now Curmudge, let’s consider the role of habits in
patient-care gemba. Most of the
procedures that we nurses do become habits. We learned them in training and perfected our techniques
under the guidance of our prefector during orientation. Improvements might occur due to
technology or changes in professional standards, but individual improvements
are likely to be minor.”
“In a long-ago posting we defined procedures as involving
one person, and said that processes are linked procedures often requiring more
than one. Although processes may
seem habitual, they may present more opportunities than procedures for
participants to think critically about improvements. Higher on the complexity scale are the hospital’s value
streams. They would commonly be
the subjects of continuous improvement efforts.”
“What about Lean and Shingo training, Curmudge? I suspect that it would become more
intense as one moves up the professional and management scale.”
“I agree.
Continuously scanning for the eight wastes of health care should be
habitual for all RNs and above.
Lean leadership, as we discussed in our posting on 10/28/11
and the two preceding postings, should become an imperative habit for all in
management. And holding middle
managers accountable must become a habit of those at higher levels.”
“And how will middle managers learn their role in the world
of Shingo?”
“Think about our own education, Julie. Although we went to class to get
difficult concepts clarified, we always had to sit down with the textbook and
grind the material into our brain.
In the quest for a Shingo Prize, our supervisors will be our teacher/coaches,
and the textbook will be the parts of the Shingo booklet that are pertinent to
our work. Because Shingo is
essentially a testing regimen for an organization’s Lean transformation, one
might also need to study parts of the currently available Lean textbooks and
attend workshops on Lean management systems. People will find
time to study, and they’ll build upon what they already learned in Lean
training.”
“From reading the Shingo booklet I learned that the Shingo
examiners will demand that the hospital select and maintain at least three years’
worth of meaningful metrics that demonstrate their progress. Length of stay (LOS) would be commonly
used, but more metrics will be needed.
It’s hard to forecast what those metrics will be, but people might
follow the old laboratory guidance, ’say what you do, do what you say, and
prove (with data) that you have done it.’ ”
“Every major program in any organization needs an
overarching goal. In a hospital,
‘Winning a Shingo Prize‘ won’t be meaningful to most people, especially
patients. The folks in top
management and Marketing will have to concoct a ‘keystone’ goal that is patient
focused. In a faith-based
hospital, it might be based on the organization’s mission and values.”
“Hey Curmudge, I hope there’s more to be said about the
reward part of the habit loop.
Going home at the end of the day is generally assumed and not given much
thought. Perhaps we need a sort-of
perverse reward that will shake people out of their lethargy, like your turning
on your headlights whenever you start your car. Your reward is to not get run down by a bigger car.”
“It’s alarming, Julie, that some writers predict hard times
for some hospitals in the near future (1). If that should come to pass, the ultimate personal reward
would be to become a surviving person in a surviving hospital, i.e., to not be
let go. The very thought of the
writers’ forecast should gain everyone’s attention. It should be the cue that fires up habits needed to win a
Shingo Prize.“
“I shudder at the gloomy forecast. If it really happens, it will trash all efforts at achieving
a Lean transformation.”
“It would be an absolute last resort. But remember, Julie, if fictional
characters like us can be sacked, it could happen to real people.”
“Enough of this conjecture. Let’s return to your carpeted gulag. The granite blocks in this ancient
Greek amphitheater are hard on the feet and the seat.”
Kaizen Curmudgeon
(1) Becker’s Hospital Review, September 26, 2012. PPACA
Could Directly Eliminate 400K Hospital Jobs in 2013, Average Hospital Would
Shed Over 100 Positions.
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