Frontiers of Health Services Management - Spring 2013 - (Page 10)
include cross-departmental or system concerns or major safety and quality problems
that could affect the entire hospital.
Standard work for leaders and supervisors. this component refers to standardizing the work that leaders do every day at
gemba to ensure reliability. the work includes running huddles, performing daily
status sheet reviews, performing visual
management, training staff on PDSa and
a3 thinking, and auditing standard work
on the floor. Meetings are minimized and,
How can any of us be “too once standardized, they become streamlined because
busy” to be involved in
all participants know what
delivering reliable care to to expect.
Audits of standard work.
our patients?
Standard work is defined as
“the best-known steps required to perform
a job” (taylor 1911). imai’s (1997) teachings
make clear that nothing can be improved
until it is standardized. in healthcare, we
have few standardized processes, resulting in the variation in performance experienced by hospitals. a lean organization
notates the standard work for processes,
such as admitting new patients, and then
audits the process on a regular basis to
know whether steps continue to be followed and remain the best-known steps.
Because circumstances change, standard work changes. today’s best-known
way may not be tomorrow’s. if standard
work is changed, every worker must be informed and trained, if necessary, in the new
standard work. that way, the change can be
measured and we can determine if the new
way is better than the one used before.
Visual progress tracking. the huddles
that take place every day in a lean healthcare environment are often located at the
visual progress-tracking boards in clinical
and administrative units. ideas for improvement are reviewed and important
driver metrics are displayed on these
boards. Driver metrics are the measures
that each unit or clinic uses to determine
whether it is contributing to the organization’s true north. the metrics represent
those measures that a business unit can
influence on a daily basis.
lean healthcare organizations, such as
atrius Health’s Harvard vanguard Medical associates clinics in the Boston area,
use visual tracking of clinic and administrative performance to determine if the
process is performing to standard. for
example, the lab at the Kenmore clinic,
in Boston, tracks the turnaround time for
routine blood tests. the frontline lab staff
know how many specimens come to them
mislabeled and immediately work with
nurses and technicians to understand the
root cause and apply countermeasures to
correct the problem.
Andons. an andon is an indicator that
calls “time out” when a problem is identified by a frontline worker. thedacare uses
andons to stop work and convene a team to
solve the problem immediately. if the team
cannot solve the problem, it is sent up the
chain of command for immediate consideration. Having the opportunity to escalate
the problem to the appropriate level of
management is important. the point of
this intense problem-solving process—still
using PDSa—is to prevent defects from
being passed on to the next patient. if the
problem is solved and new standard work
is implemented immediately, the same
problem will not happen again.
Changing the Leader’s
Behavior
applying all the concepts i have described
to this point is possible only when leaders are willing to change. i meet regularly
with ceos, many of whom claim they are
10 • f ro ntier s o f h ea lth s e r vic e s ma na g e m e nt 29 :3
Table of Contents for the Digital Edition of Frontiers of Health Services Management - Spring 2013
Frontiers of Health Services Management - Spring 2013
Contents
Frontiers of Health Services Management - Spring 2013
A Management, Leadership, and Board Road Map to Transforming Care for Patients
Pursuing the Perfect Patient Experience
Adapting to the New Healthcare Market
High Reliability: Truly Achieving Healthcare Quality and Safety
Making Lean Progress Last: Why Sustaining Excellence Requires the Right Leadership Framework
Frontiers of Health Services Management - Spring 2013
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