Book: If Disney ran your hospital

I finally got around to start reading the book “If Disney ran your hospital’ by Fred Lee. I have heard a lot about it last year, and I am curious whether it can help our lean journey. Or will my predisposition be confirmed that the approach to care will be too simplistic, as if we should just entertain the patients more? Well, the first chapter did not disappoint me. Fred Lee has worked in a hospital for a long time and his mother, sister, partner, and daughter are nurses. One can feel that he is used to think from a care perspective. The most important connection with ‘lean thinking’ is in the first place his reflection on ‘value’, the core of lean thinking.

Fred reflects on the value that is of importance to gain patients’ loyalty. The elements care providers have to pay special attention to in order to accomplish this loyalty are:
- Be alert on peoples needs, before they ask for it (initiative)
- Help each other (teamwork)
- Recognize the feelings of people (empathy)
- Respect the dignity and privacy of others (courtesy)
- Explain what is happening (communication)

Intuitive this list gives me a good feeling. However, does it offer new points of application for the care we are giving at this moment?
Regularly I see good examples of all five points, and I also see examples of situations where we could improve. Thus all five are relevant, however they do not cover any blind spot. We are already conscious of all of them.

Our hospital is besides with lean thinking also occupied with the theme ‘compassionate care’ (or literally translated: loving care). At the first sight ‘empathy’ and ‘politeness’ (dignity and courtesy) seem to match directly with this theme, and ‘communication’ indirectly. ‘Teamwork’ and ‘initiative’ are more closely linked to lean thinking. Though with some effort one can link all concepts with each other. ‘Respect’ is for example also one of Toyota’s core principles. When we train a team in continuous improvement, we underline the aspect of respecting each others ideas and giving each other room to experiment. First try to understand the other, before you want to be understood yourself.

As part of an improvement project, we recently interviewed a patient. This patient declared to be insecure about several aspects. He did not know who ‘his’ medical practitioner was (because he had to deal with several medical practitioners), although it was regularly asked by others in the hospital (to fill in a form). Furthermore, he did not know when he would receive the results of medical examinations. He did not dare to ask for it for two days, because he did not want to be annoying. This resulted in insecurity and agitation by the patient. This interview confirms the importance of ‘be alert on peoples desires’ (initiative) and ‘communication’ for care providers. Although we think we put a lot of effort in these elements, patients have a different experience. I am curious how these concepts will be further elaborated on in the book.

Our care unit General Surgery is being trained on regular basis by trainers of the Efteling (large Dutch amusement park). At this moment they even have their own educated trainers as part of their theme ‘The customer is king’. They are very enthusiastic and make the combination with lean thinking in their development of care pathways. When working with them, I feel indeed an above average patient centered attitude and willingness to go an extra mile for the patient. We can come up with the best way to organize a care process, though for each patient we have to be alert on their individual needs. Vice versa, when the processes are not well organized, one can work as much patient centric as possible, however the patient will not experience good care.

Fred Lee makes the connection between improvement of ‘outcomes’ vs. improvement of ‘perceptions’ (the latter is thus where his book is about). He explains the two perspectives as:
- Focus on team responsibility vs. focus on personal responsibility
- Define and analyse processes vs. take action based on information – just do it
- Understand variation of processes vs. understand the perception of patients
- Improve the competence and skills of care providers vs. improve behaviour and attitude
- Emphasize what people have to do vs. emphasize what people have to say
- Search for measurable outcomes vs. search for impact on impressions
- ‘Make no mistakes’ thinking vs. ‘as well as possible’ thinking
- Eliminate inaccurateness vs. eliminate avoidance

The common application of the lean thinking principles has more resemblemnce with the left site, however also the right site is clearly recognizable. For example ‘taking action based on information – just do it’ fits with ‘continuous improvement’ as a regular aspect of the daily work. Furthermore the personal responsibility is emphasized many times. Nevertheless, lean thinking commonly has less focus on behaviour and attitude. I can see connections between ‘lean thinking’ and the story of Fred Lee, and I will curiously continue my reading.

P.S. My gratitude goes to Nynke Reitsma for translating my Dutch blog