As I told you in my last posting, I've been reading a fascinating book entitled The Nun and the Bureaucrat by Kouis M. Savary and Clare Crawford-Mason. It's a book about two healthcare organizations, SSM Healthcare, headquartered in St. Louis, Missouri and the Pittsburgh Regional Healthcare Initiative (PRHI), who are using Systems Thinking and the Toyota Production System to heal themselves and they're both making significant progress.
To quote the authors, "Systems Thinking may sound complicated and technical, as if only scientists or mathematicians could grasp it. However you don't need a college degree to understand systems thinking." For regular followers of my blog, you know I've written extensively about the Theory of Constraints Thinking Processes and while it is a different concept than systems thinking, the basic message is still the same. Systems thinking simply means focusing on the organization as a whole and transforming it as a whole rather than paying attention only to various parts or departments,
In this book, doctors, nurses, administrators, executives, aides, the regular people we find in hospitals, tell in their own words how they overcame doubts that they could provide "perfect patient care," identify errors, reorganize how they worked together, learn a new systems way of thinking, develop "new eyes" to design better and better methods, and get to the root causes of problems. These same people talk about how they now view their workplace and how they question the old way of doing things that they all admit they had been using for years without questioning them.
The key to systems thinking is to have everyone working together toward the same aim or goal, so one of the first things that must happen is to clearly articulate and then communicate the goal of the organization to everyone. For example, suppose that the leadership of your organization stated the goal to be perfect patient care. When everyone understands what the overarching goal of the organization is and that success is dictated by working toward the goal and working together to achieve it, great things can happen. Again, for those of you that have followed my blog on a regular basis, you have read about using the Goal Tree (a.k.a. Intermediate Objectives Map) method to develop the Goal, Critical Success Factors and Necessary Conditions. However you develop the organization's goal, it is important to make sure it is communicated to everyone in your organization so that everyone is focused on it.
The other methodology these two organizations used was the Toyota Production System (TPS). Waste is a huge problem for virtually all organizations, but within hospitals it is a pervasive problem. It's probably because typical hospitals got such a late start in recognizing and understanding the basic premise of just what waste is. As most of you know, waste is not just about money lost in hospitals, it's about duplication of work, rework, a lack of consistency, shortages of supplies and a host of other sources. Many times in hospitals nurses and other hospital employees have had to come up with work-arounds just to get things done, But finally, at least for these two healthcare organizations, they were introduced to TPS and everything it has to offer. The employees fought it at first, because its roots were in manufacturing and after all, how could a manufacturing solution apply to healthcare. These same employees had their own epiphanies and are now fully supportive of TPS.
According to the authors of this great little book, the key take-aways on waste at least for these two organizations were:
- Waste is a problem for all organizations, because it is hidden in many seemingly reasonable and traditional disguises.
- Waste is more and more difficult to identify as the organization becomes bigger and more complex.
- Waste can range from misuse of the time, talents and commitment of healthcare employees to poor inventory supply systems or failure to follow-up with patients,
- Waste is not just money. The huge waste of effort and supplies in hospitals, if corrected, could reduce the cost of healthcare by as much as 50 percent.
- One of the most useful powers of systems management is that it continually uncovers hidden waste and offers methods to reduce it.
One last lesson that healthcare organizations are learning is the importance of sharing what they've learned with each as they progress on this endless journey. Yes, they are competing for the same patient base, but they also believe in putting the customer, the patient, first, so competition isn't a barrier for them.
Bob Sproull
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