Management Blog Review 2012: Not Running a Hospital
Posted on January 3, 2013 Comments (4)
Paul Levy started the Running a Hospital blog when he was the CEO of Beth Israel Deaconess Medical Center. Thankfully he has continued the blog, renamed to Not Running a Hospital, after leaving that position. Paul provides a huge number (the lowest number of posts in a month was 32) of valuable posts focused on health care, but worthwhile for everyone interested in improving the practice of management.
In addition to his blog, during 2012 Paul published a wonderful book – Goal Play!: Leadership Lessons from the Soccer Field. In my first 2012 management blog review I take a look at Not Running a Hospital.
Some of the thoughtful posts by Paul in 2012:
- How to get better at harming people less – “Imagine what we as a society would do if three 727s crashed three days in a row. We would shut down the airports and totally revamp our way of delivering passengers. But, the 100,000 people a year killed in hospitals are essentially ignored, and hospitals remain one of the major public health hazards in our country.”
- Medtronic’s Lean Journey – “They knew they would have to think big, but then sweat the details. Over time they figured out how to collaborate.
There were five stages in the process:
1 — Define our operating standards, who we aspire to be.
2 — Set a global expectation to accelerate improvement.
3 — Develop the ability to assess current state.
4 — Create ongoing mechanisms to learn and leverage to close gaps.
5 — Continually check and adjust.”
- Sarah Patterson informs about Lean – “Would like Va Mason org to operate like an aircraft carrier. How to run a complex business safety.
Aircraft carrier = an airport on top of a nuclear power plant comprising a bunch of 19 year olds!
Aircraft carrier needs complete alignment with the mission. If not done well, puts others at risk.
Aircraft carrier requires an incredible commitment to adoption of standard work. Relentless focus on training.
Create jobs that are doable. Train people to do them. Hold people accountable to them.
Adopted TPS=customer first, highest quality, obsession w/ safety, staff engagement, successful economic enterprise
Senior leader regular gemba rounds to view one aspect of standard work.”
- UNM residents start to go Lean “The UNM hospital handles 90,000 emergency room visits per year but suffers from major congestion problems… [14% of patients] leave without being seen because of the waiting times… Our rough analysis — just based on perceptions of people in the room — yielded 853 minutes of gross time spent per patient for work that had a value of 71 minutes. This is remarkably close to the 14 hour average delay that the ED has documented. The next step, if we were actually doing this in the hospital, would be to identify measures that could be taken to redesign the work flow and conduct experiments to see what would be helpful in extracting waste out of this overall process.”
- What if they had had to pay? – “Here’s the terrible and hard-hearted question I pose: If the costs of this procedure and hospitalization had not been covered by Medicare, would the man’s children have proceeded along the chosen path? I am guessing not…. In the US, we don’t have a good societal process for making these decisions. In the United Kingdom, though, they do…”
- You don’t “do Lean” – “The lesson, though, is that Jim was at gemba, heard the (unintentional) call-out, responded respectfully, and analyzed and solved the problem while it was fresh.”
- How to stop a future cancer epidemic – “The theory of preventative care, including inoculations, is that we spend a little money now to offset big expenses later in life. But sometimes behavioral friction keeps this from happening, even when the technologies and approaches are proven. We are witnessing such a failure right now with regard to Human Papilloma Virus (HPV).” This same problem, a lack of long term and systems thinking, confounds improvement efforts everywhere. Tackling the problem is mainly a matter of psychology; if you are lucky it can be addressed also by building the capacity of people to appreciate systems and long term consequences.
“What” before “Why” – “Lean practitioners spend a lot of time on the 5 Whys, and John’s slide properly incorporates the “why” portion of a problem solving. But he also reemphasizes the need to understand ‘what’ happened. As he said to me before the talk, we often do not spend enough time at the site of the problem to comprehend fully its characteristics and nature. Failing to know what happened means that the root cause analysis can be off track, and the designed solutions therefore will not offer a complete or sustainable solution.”
The USA health care system is huge and has many factors that lead to ever exploding costs. Some costs can be addressed with improvements that gain better results for less money. Some costs maybe should be considered more controversially, such as is it worth spending given what we will gain. Paul asked this question: