Wednesday, March 28, 2007

Getting Lean...4/23

Here at PRMC, we hear efficiency, and we hear cuts....
I caught a guest post from Hospital Impact, a hospital blog that not only have I contributed (comments) to, and that I've read when I have the chance. The post is in the realm of what needs to be done...but it seem unlikely that Essent will ever do it--because it takes far more effort. Cutting FTEs is easy, making this a quality organization isn't in the cards...for them.

The balancing act of efficiency and quality
February 23rd, 2007
Guest post by Carolyn Kent

I'm going to venture into contentious territory and address what can be a touchy subject for hospital administrators: the application of lean manufacturing to a hospital setting.

First, a brief review. There are 5 basic principles to Lean (continuous process improvement):
1. Define value from the customer's perspective
2. Identify the value stream
3. Eliminate waste
4. Flow the process
5. Pursue to perfection

Is this management style transferable to a hospital environment? Cynics are quick to squash this idea, citing reasons such as "We don't make cars; we treat patients." (Harvard Business Review: Virginia Mason Medical Center) These individuals support personalized healthcare; after all, every patient is unique and by virtue of being such, deserves distinctive care. (No argument here)

Since, according to the cynics, achieving a lean state in a hospital is impossible due to the obligations to provide personalized care to every patient, one could naturally conclude that the hospital's management style should be one directed at increasing the quality of service, optimizing the patient experience, and improving customer satisfaction.

Again, cynics remind us that while this may be nice in theory, consistently delivering superior service across the board can be inefficient, as this approach to service consumes more personnel and time resources - things that are already limited.

So it appears that we are at an impasse. Lean process v. superior service quality - it's got to be one or the other in a hospital setting. Achieving lean presupposes standardization, which is nearly impossible in a hospital. Delivering superior service necessitates employee training, personal attention, significant time investments, regular performance measurement, et,c. all of which are counter to lean, right?

Let's revisit the first principle of continuous process improvement: Define value from the customer's perspective. It appears that lean and superior service delivery are inextricably linked thanks to the customer. Does this mean that they can co-exist after all? Is it too much of a stretch to assert that they may even complement one another?

How would we impart both continuous improvement and superior service quality into our process? Here are 7 quick steps to merge these seemingly dichotomous objectives:
1. Management must commit to the strategy
2. Determine the product line/department to start with
3. Gain a good understanding of lean (Lean Enterprise Institute)
4. Draw the current-state map of your selected process (MAMTC - Lean Building Blocks)
5. Determine the goals to strive for and the metrics to monitor
6. Draw the future-state map of your selected process (see "Lean Building Blocks")
7. Implement with a specific plan that includes benchmarking

Is it possible to achieve continuous process improvement in a hospital environment?

Is it possible to consistently deliver superior service to patients?

Is it possible to do both?

Carolyn Kent is Creative Strategy Specialist at Cleverley & Associates.


Anonymous said...

Seems like a re-visit to TQM, or 6-SIGMA. They'd never buy off on it. "Pursue to perfection"--with these guys? The "we want your input" hang your co-workers!

Anonymous said...

Guess they'd better work on just getting the pieces working, never mind pursuing perfection. Anyone wonder why the xray room by er wasn't being used? The door frame was coming out of the wall! Can you imagine squashed little old people?

When they got that "fixed", they had to fix the xray machine! And that's the newest one!

Xray machine or Porsche--what gets paid for first? We know the answer to that one!

Anonymous said...

I got a note from Carole Grant announcing a program that will teach us to do more with less etc.It looks to me like Cleverley et al might be a better choice to get the hospital out of the hole we are in.Without hearing the content of Caroles program, it would be unfair to criticize it; but it is very likely that focusing on patient quality care wont be the emphasis....well seee!

Anonymous said...

Granted, what Big Dick is paying for his Porsche won't cover merit raises, but it's a nasty slap in the face to the employees at PRMC, who must make do in a shabby facility with rode-hard-and-put-up-wet equipment.

The old St. Joe building was in kinda rough shape for some time before Essent got it, and paint and cheesy flooring won't fly.

Which is more expensive in the long run- patching up bad stuff with duct tape over & over until it all falls down, or spending the money now on new and good equipment with maintenance contracts (hello, lab, X-ray, nuclear med, resp. therapy- I'm thinking of you) that will save money over the long run, or perform the proper repairs to keep the old building standing until a new one can be built (remember that line from Day One?)

Hey, even old cars will nickel-and-dime you to death, so my dad told me.

If Big Dick can afford to drive a Porsche, more power to him, but so far his choice of wheels is only adding to his healthy reputation for arrogance.

And IMO, arrogance is a major requirement for E$$ent executives.

fac_p said...

In some organizations, the areas of the budget are widely separated--capital improvements and maintainence. Sometimes FTE costs and locums are the same way.

So, if you spend more on locums, but less on FTEs, you're ahead if you use locums? Crossroads logic...and Porsche bonus....frank

Anonymous said...




" We Do More With Less''

Anonymous said...

I am a product of the "getting lean" promo. I have been reduced, demoted call it what you want. I no longer have benefits and am no longer considered an FTE.I am new to this site and it has been a real eye opener.

Anonymous said...

Welcome to the club! Glad to see another thinking individual who is seeing things as they really are, not the Potemkin village E$$ent presents to the public.

Anonymous said...

We are so used to "doing more with less" that now we can do practically anything with nothing.

Anonymous said...

7:58 AM,

Don't say that too loud, or Big Dick will taake you up on

Anonymous said...

Shouldn't it be:


We do Less with Even Less!

Anonymous said...

Not sure if this is related or not, but did you read the article in the local fishwrap about the change in board leadership?

New hospital chairman the right medicine

Staff reports
The Paris News

Published April 22, 2007

After 11 years of service as chairman of the hospital advisory board and 17 years of service as a member of the board, Jo Ann Parkman has handed the gavel to Bobby R. Walters. We join hospital personnel and administrators, physicians, and civic leaders and organizations in welcoming Walters to his new post and expressing appreciation to Parkman for her years of service.

Parkman was the right prescription for a medical community in transition in the late 1990s and in recent years.

When Parkman took the gavel, she served St. Joseph's Hospital, but it became apparent that this community's two hospitals would have to become one to meet the changes taking place among healthcare providers. It was not an easy task, but Parkman provided leadership as the hospitals merged and became Christus St. Joseph's Healthcare Center.

It was Parkman who again stood at the helm of the advisory board just a few years later when it became apparent the private healthcare institution would need to be sold to Essent Healthcare, a for-profit company, to meet the challenges of continuing to provide quality healthcare.

We applaud Parkman for the way she helped to guide the hospital and medical community during this difficult time of transition as well as the way she has directed the Paris Regional Medical Center Advisory Board in recent years. Parkman approached her task as chairwoman the same way she has approached other civic and business endeavors, giving her utmost as she put service above self.

Experience tells us Walters will approach his new role as chairman the same way Parkman did. As president of Paris Junior College, he moved the college forward while promoting its value as an important cog in this community.

Just as Parkman faced many challenges during her tenure, Walters faces a daunting task. Paris is not the regional medical hub that it once was, and steps must be taken to restore the medical community to its former glory and move it to new heights in the future. The economy of this community greatly depends on the medical community. Business and industry look at the medical community when determining whether to locate facilities here, and the delivery of healthcare puts millions of dollars into the local economy. It must be strong.

As we honor Parkman, we express confidence in Walters' ability to move Paris Regional Medical Center in a positive direction. The new chairman isn't a Parkman refill, for she was a unique prescription for her time of service. But we are convinced Walters will be a shot in the arm for a regional medical community that shows some signs of ailing.

If you read it closely, you may actually notice the Snooze admits there are problems right here in River City. They don't go into specifics (don't wanna kick the kiesters they kiss), but this is as close to the truth that the Snooze has gotten.

Will wonders never cease?

fac_p said...

One can wonder if the board has been a part of the two greatest heathcare blunders in the history of Paris:

Purchasing the "north campus."
Selecting Essent.

The first precipitated the second, and it might have been all Monty, all the time, but maybe there is a reason for all of this now...and part of the reason just left. If the chairperson gets the kudos, they also get the raspberries....