Courage

Not the typical title or picture you see on a continuous improvement blog, but I believe courage is in the heart of it.
Courage is a quality that any keen continuous improvement professional should posses, or at least learn and grow with time.
Courage to name things as they are without sugar coating, calling a problem a problem, admitting that oneself, the organization, or the system is not perfect, especially in front of a board, a CEO, or other executives, is definitely something not very common nowadays.
Courage is to listen to others actively and attentively  without interrupting them to tell them something, or worse trying to downgrade or mask their point of view in favor of one's own. We, quality professionals always preach others about accepting other ideas and differing opinions, but it's hardly practiced amid heated discussions.
Courage is to give the chance to junior staff with less experience and professional level to speak up, even if that means disagreeing with us in the middle of a meeting, and to let go our egos and the fact the we know more and bring better ideas to the table, because we are senior !
Courage is to promote other people skills and knowledge and letting them shine without feeling threatened or jealous.
Courage is to stay persistent in the face of resistance, when the majority can't see what you are seeing, no matter who is resisting as long as the change is worth the try and is needed. Courage is to see things we started through, despite all the surprises and shifting priorities, because it's a commitment we made at the beginning to the customers and to the people who have spent energy and effort on it.
Courage is to speak up and say what need to be said without fear of failure, criticism or rejection.

Courage is not only about bravery in a battlefield or being fearless in an adventure, but it's also about raising the bar in the middle of comfort zones. True continuous improvement is a constant battle; so, how courageous are we?

The Lean CEO

A great book by Jacob Stoller , a business and management consultant and speaker, which talks about how many organizations made the transformation to lean as a management system instead of the traditional business models followed everywhere.
The book is a collection of interviews with CEOs who went through that experience, the struggles they faced, and the outcomes and successes they realized.
For me, the book is one of the best if not the best that describes the cultural aspect of lean transformation, in terms of overcoming long standing beliefs, how to bring leadership and front-line on board, and how rapidly Lean thinking spreads once early successes are realized. Such aspect is usually discussed in many books on Lean, but not as vivid as it's in The Lean CEO.
The book is full of lessons learned and reflections, some of which I would like to mention.

Lean Transformation is a leadership responsibility
So much has been said about the role of leadership in any cultural change, and specifically in terms of quality improvement. But this book clearly shows real life examples of such role, leaving no doubt about it. Lean transformation is also not for the faint hearted, and the journey can be long, bumpy and could mean walking alone initially. Therefore, strong leaders are the ones who could continue the journey.

All roads lead to Lean
The journey to Lean varies from one place to another, one culture to another, and from a leadership style to another. The book shows the diversity of paths and methodologies the CEOs took to start and achieve Lean transformation. I believe that this is a very important to understand. There is no single recipe to initiate or even practice Lean, so people looking for exact ways to do it may set themselves for failure. However, on the other hand, principles of Lean transformation is almost universal and can be learned from experts.

Learning from others
Lean has started in manufacturing and became crystallized as a management philosophy through Toyota Production System. However, it's proven now that Lean is applicable to almost every field or industry. CEOs outside manufacturing went to factories to learn the tricks of the trade, Senseis and Lean experts who have worked in different industries were asked to come and help. Successful Lean transformations were accelerated through learning and building on the knowledge of others. I think one of the reasons why some organizations still struggling with Lean is because they either think they could do it alone without the help of others, or they are reluctant to learn from different industries.

The books is a great addition to the Lean body of knowledge, and it doesn't matter if you are an expert or just a beginner, going through the experiences of those CEOs will help a lot in bridging cultural gaps in any Lean journey. It's a must read!

Lost in communication

Despite all the talk about how important is communication in healthcare, there are still gaps that can be easily prevented.
All the hospitals I visited  as a patient or as a companion, even to those which are top-notch in terms of quality and technology, show signs of communication gaps between nurses and doctors, especially in the outpatient setting. This may not be a big issue for some, but that what makes it hard to justify not being fixed.
When you visit a clinic for the first time,the nurse may ask for some info about you chief complaint, and your past history. You would expect that such information will be relayed some how in writing or through those sophisticated HIS applications many hospitals use nowadays, or at least, through verbal communication. Few minutes later, you step inside and meet the doctor, and he usually repeats the same questions of the nurse, not because he wants to verify something, but clearly because he doesn't know about your conversation.
Why ? why such repetition of information which wastes everyone's time? why can't nurses and doctors share information together and save the patient repeating the same story, as if he/she is treated by two different care providers ? Aren't physicians, nurses, and other providers part of  one team? What is the ROI of expensive information systems if it can't make communication smoother with less redundancies ?
Obviously, working in silos is still a big problem in healthcare, even within a close outpatient environment, and that would definitely hinder information flow.
The impression on the customer-the patient in this case-may be bigger than the problem itself. The first impression one would get is that there is not any team but several individual providers attending to you, and this would greatly impact the level of trust in the care.This may also be the first sign of many small communication gaps down the care stream that could jeopardize patient safety at any stage.
To close this gap and prevent the wasted time and efforts, one could think of many countermeasures that can be chosen according to the setting. One could be verbal communication which strengthens the bond between the care providers, or filling in  electronic forms that appear in front of the physician's screen and his job would be to go over them in details.
Let's imagine the ideal scenario, you visit a doctor for the first time, the nurse would take a brief history and your vital signs, then she would put that in your records, then you see the doctor, he would tell you that you had such and such, and ask you to elaborate more. Now that is a good first impression about a collaborative care team.

My 1st Lean Project

The 1st Value Stream Mapping I facilitated with emotional mapping of patient's experience depicted too

In 2014, it was a great opportunity to apply lean concepts and tools in the hospital I worked in. One of the unique services the hospital offers is the manufacturing of prosthesis and orthosis (P&O) to patients who either need artificial limbs, or those who need some kind of orthopedic support for various conditions.
The P&O center just started to expand and fine tune its operations to meet the huge demand in the population as one of if not the most advanced center in the region. To deal with patient expectations and streamline the processes, lean was a good option to start with. Manufacturing in a hospital, what greatest fit for lean one could dream of?
The leaders in P&O and other departments within the value stream were very receptive to the idea, and that what encouraged me to facilitate a lean project for the first time.So, sort of testing the water, we decided to experiment with 5S to organize the fabrication workshop before moving to a new building, and that was a great eye opener for all. The amount of clutter and wasted space and time was huge due to disorganization of the workplace, and the P&O leaders pushed hard to rectify that.
The project started with a 3-day VSM activitiy,with participation of all department leaders who were involved at some points in the delivery this service to our patients, which was also a huge opportunity to look at departmental silos in a new way, and work towards patient service as one team. This was followed by a transformation plan over 7 months.
Being the first project, we lacked a lot of experience, so learning from lean experts like Karen Martin was a necessary step. Her books, webinars and personal advise made the learning curve much smoother, for me personally, and for the project.
During and after the project, we saw improvements in some metrics, although some areas are still challenging either because of resources, external factors, and sometimes because of sticking to the old ways of doing business, a cultural barrier.
Overall, the project was a success at many levels, at least in terms of changing  mindsets, behaviors, and in involving all staff in improvement efforts.
This was published as a case study by INSEAD, and accepted in the poster competition during the IHI Middle East Forum 2015 in Doha.You may visit Lean P&O to view the poster.
Some Lean experts may rightfully say that this doesn't represent a complete lean transformation, but I do believe it was a great step forward to introduce various Lean and Kaizen concepts, tools and techniques to the staff and to the organization.

What about you , do you remember your first lean project? what learning can you share with us?

So, WHY LEAN?

a scrub nurse handing surgical instrument- an early measure to reduce waste in healthcare

I could trace my interest in Lean Healthcare back to 2012, when I saw a profile update of one of my LinkedIn contacts saying that he became certified in Lean Healthcare. At that time, I was a certified Six Sigma Black Belt who didn't have the chance to practice much SS except for a couple of shy half attempts.
After a huge interest in SS, I discovered that it's not my cup of tea perhaps for its heavy dependence on statistics, which isn't very practical in the complex healthcare system (in my humble opinion), and the fact that it is not a very popular improvement methodology in the hospitals I worked in, or in any the healthcare systems I know for that matter.
 Another reason for making the shift to lean is that successful SS implementation need a team of trained and certified black or green belts. At many times, this means relying on external consultants. Later on, I discovered that SS doesn’t emphasize the cultural elements of respect for people, going to the Genba, and continuous improvement; all of which made Lean more appealing.
After studying Lean in depth, I found it more practical, applicable, and with the strong and growing evidence of successful implementation in healthcare worldwide. Every day, Lean proves to be the solution of many healthcare problems that we face globally, being it quality, safety, or cost issues. It became my method of choice in thinking about problems or improvement in general, and hence, I always lean towards Lean!