Please visit my (translated) Dutch blog

This weblog used to get frequent translations from my Dutch blog. It is however not updated anymore because Google Translate does a pretty good job at it. I still blog weekly in Dutch on http://leandenkenindezorg.blogspot.com/ and you can use this link to have it translated into English.


Nurses: what is the meaning of lean for you?

To prepare for a training, the Elisabeth Nursing Surgery Ward (B2) posed all nurses the following question:

What is the meaning of lean for you?

This offers the opportunity to get an idea of how lean thinking is experienced by nurses. Before interpreting their answers, it is good to know that they have had a basic introduction of lean thinking one year ago, and especially started to employ 5S for Workplace Organization with enthusiasm. Furthermore they have put the Lean principles impressively into practice during the development of care pathways. However it was not explicitly communicated to the nurses that they were applying lean (and that explains why you don't see that in their answers).

Their answers to the question per nurse:


Book: Toyota Kata

I started reading the book Toyota Kata by Mike Rother and I read the first three chapters so far. He argues that the world has only looked at the visible aspects of Toyota, the processes, methods and principles. He stated that you should not look at those aspects, because the real explanation what makes Toyota so special is invisible. He refers to way of thinking and the routines that are normal at Toyota: the Kata’s. This is a Japanese term, normally used in martial arts for patterns that are repeated again and again into perfection. The book describes two Kata’s at Toyota:
  • The Improvement Kata
  • The Coaching Kata
If you get past his slightly arrogant introduction that he finally figured the real secret out, he offers a number of rich insights. He explains quite well how organizations keep repeating the same mistake when they want to change something: they fall in the blind implementation mode. The consequence is that they try to make the change process as predictable as possible. We find it hard to accept the fact that organizational development is an inherently unpredictable process.

It is the art to release the urge to want to control what changes at what moment (I recognize that this can be difficult). It is the art to continuously adjust the direction based on new insights. In an implementation mode, there are unpredictable events and problems that distract you from your goal. But those unexpected events are always there. How many time is spend on making plans and how much time is spend on explaining why they are not implemented as planned?

A wise strategy would accept the inherent unpredictability of development processes and would seek strength in the adaptive capacity of the organization. You need some method that provides the needed confidence that good progress will be made. And that method is often lacking as one falls back into the implementation mode.

He states it is exactly the ‘Improvement Kata’ and ‘Coaching Kata’ that enable Toyota to adapt adequately. Rother described how Toyota makes improvement very specific in three conditions:


Article: 'Approach to efficiency is not well thought through'

Recently, an article ‘Approach to efficiency in healthcare is not well thought through’ (Aanpak effieicny in de zorg is ondoordacht) appeared in 'Medisch Contact' by W.H. van Harten, E.W. Hans en W.A.M. van Lent. In this article, they assess the business methods of the last years in Dutch hospitals, including lean management. They conclude that the methods are often accidentally or fashionably chosen. They also argue that there is little scientific evidence for the methods. Click here to read the whole article (in Dutch).

What I like about the article is the long-term perspective with which they look at the application of the methods. I also l and that they base this on the current problems of individual hospitals and they thus emphasize the importance of customization. Their final conclusion is:
“The variety of combinations of organizational development, type of problems and available methods requires a customized solution. Approaches that stress a culture of continuous improvement and that leave room for personal interpretation, such as lean management, seem therefore to offer currently the most perspective and besides that, they are easy to maintain. And that is very important, because introduction takes years in large organizations.”
I illustrate a few statements about the various methods:


How to mobilize an entire nursing unit

A recurring question is how you can mobilize an entire team, unit or department to work with lean. Too often, I see small groups of enthusiastic people who are wondering how to get the rest involved. One element you can use is a training for the entire unit. For the department of Orthopaedics this seemed to work well.

Recently, the department of Orthopaedics organised one evening and one day training in the Lean principles and tools for the entire care unit (60 nurses). They were very well prepared! Four months before the training day, they started to prepare and work towards it. All three departments (secretary, nursery department and outpatient clinic) got a digital camera in November to photograph improvement points or irritations (based on an idea of Neruosurgery, see previous blog), which provided more than 50 photographs of concrete waste or unsafe or unpleasant situations. These pictures have been printed on A3 size and laminated. At the training a reward was given to the person with the most striking picture. These pictures were used as starting points for improvements. Smart, because in this way you directly got 50 points of improvements provided by the people themselves on which they want to work.
They also made a movie for the training. They have put the process in scene from the moment that the OR calls for a patient to come for surgery until the patient is ready to leave the nursing department. This process takes 15 minutes, because the patient must change clothes, visit the toilet, medication is given and the bed prepared. The movie showed a lot of types of waste (that were actually not put in scene, but really happened). Employees recognized these immediately. A few examples:


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?


Photo contest to bring lean thinking closer

Part of lean thinking is activating and recognizing all grey areas in your team. The ward Neurosurgery of the St. Elisabeth Hospital created a beautiful intervention for this: a photo contest to visualize improvement opportunities.

They purchased a digital camera and placed it on an easily accessible place. Everyone of the ward was invited to take a picture of something that annoys them at that time. A few weeks later this resulted into 40 (!) photos. The prize for the best photo was two cinema tickets (cinema= seeing….of waste). Here is the winning photo:

Angela Rutten, who is quality officer of the department, gives an explanation of the photo: