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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