Posted by chris on June 30th, 2008 | 2 Comments »

There is a rigour to Lean thinking that can appear supremely cold and calculating. However, its unwavering focus on “what the customer sees as value” should curry favour with those who are receiving (e.g., paying for) the end product, which ideally equips companies to look after their people and their environment. Welcome to the triple bottom line.

See… it’s not all about the relentless pursuit of cost savings.

There are some very real inefficiencies (waste, or “muda”) that can be rid from any system with this approach. This may be part of the reason we are seeing such approaches embraced in non-traditional areas, including the service industry and, yes, health care.

The Flo Collaborative

The Flo Collaborative kicked off in September 2007 in order to examine and improve the flow of care in Ontario health care. Two Ontario hospitals acted as pilot sites for projects under the Flo Collaborative, working with the regional Local Health Integration Networks (LHIN) and Community Care Access Centres (CCAC). The overall “flow” of care crosses several different organizations; for example, a client/patient moves from admission into a hospital medical unit, receives treatment and care within the hospital, and then transitions from the hospital to receive an appropriate level of care. The approach for improvement includes “The Model for Improvement,” Lean methodology, Six Sigma Tools, and PDSA cycles.

Not surprisingly, many initiatives that offer the possibility for “quick wins” target frontline staff who are actively engaged in their current standard processes. Andrew Ward, Senior Manager at the Erie St Clair CCAC, worked on the pilot project in Windsor between his CCAC and the Hôtel-Dieu Grace Hospital. He explains, “Often times, staff are well aware of shortcomings within the process but remain silent in expressing their ideas for improvement.” He adds that now, because of the Flo Collaborative, staff have greater opportunities to discuss and try new process changes. Often resistance to change is common in such improvement projects; however, Andrew still found an appetite for the improvements: “Many times we overlook that the frontline has lived with their current system inefficiencies and that they want the change, as well.” As with other change efforts, people have to feel comfortable contributing their individual insight to realize the overall process improvements.

Assessing and Influencing Authority
Asked about lessons learned in getting the all-important “buy-in” from “naysayers,” Andrew sees great potential in gaining involvement from the beginning. He says that it is well worth the initial investment in time to determine who has informal authority, in addition to those with formal authority. “No process change is made in a vacuum,” he explains. “Many things must be considered prior to making an adjustment in staff workflow.” Project leads and others within the team need to feel involved in order to want to share information.

There are some natural barriers that people can hit if they take a “business” approach to anything related to health care. Nonetheless, there are some significant improvements to be gained from a systematic approach, such as that with the Flo Collaborative. Like in any change initiative, it is ever so important to unlock the knowledge of the frontline by enabling good two-way communication. Andrew concludes, “By taking the time and identifying team members of formal and informal authority from the beginning, process changes will yield higher and more sustainable outcomes.” Don’t be mistaken: just because it’s soft, doesn’t make it easy.

This originally appeared in the June 2008 e-Newsletter for the Canadian Supply Chain Sector Council (www.supplychaincanada.org).

 

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Posted by chris on June 24th, 2008 | 3 Comments »

I had the very good fortune of hearing Deepak Chopra speak at the conference of the Ontario Association of Community Care Access Centres (OACCAC) this week. He was speaking to a room of various individuals involved in the delivery of health care at a community level, but his messages were wide sweeping.

According to Dr. Chopra, the trend toward well-being is the single biggest trend in the world today. He extrapolated to include economic well-being and environmental well-being, in addition to personal well-being. In short, people want the best end result to complex situations that include many interdependencies. In order to overcome the challenges of today, thus achieving well-being, we need to speak in non-violent metaphors. This demands a paradigm shift.

He navigated an impressive range of topics and, perhaps playing to his audience, spent a significant amount of time discussing biological and neural happenings. I say “perhaps playing to his audience” because he spent time as well on quantum physics.

The key message was indisputably focussed on the best way to bring about the best change. Given the state of the health care system–and that Ontario’s Minister of Health and Long-Term Care recently changed–the forum was a good one. The talk was teeming with fascinating insight and inspiring stories, but one of the most tangible pieces of advice that he shared was around leadership. Although Deepak Chopra leads a session on the Soul of Leadership at the Kellogg School of Business, the advice was accessible and applicable to all who were there… a “Micro Leadership” message, if you will.

Effective leaders do two things, according to Dr. Chopra: (1) self reflect to self understand; and (2) remain open to opportunity. (Although he says many leaders mention luck, he defines “luck” as opportunity meeting preparedness.)

Clearly if everyone adopted this line of thinking, things would be easier. Although many hung on his every word (and bought the book after), not all were or will be able to embody or sustain this approach. Those who do, have a responsibility to (1) focus on the greater good and (2) look for ways to merge opposing interests with those of the former. Tough work, to say the least. Here are but two applications from follow on sessions that I attended:

1. Dr. Joshua Tepper from Ontario Health Force spoke about opportunities and necessity to have medical schools and colleges breed practitioners with cross-discipline awareness. What better way to find new opportunities than to have more people working together. The functional disciplines will have to be very comfortable with one another and secure in themselves to be open to this. You can imagine all the reasoning for not collaborating: what is they start doing our work? who decides if we don’t agree?

2. Jeff Dolweerd discussed a LEAN case study underway the Central CCAC. The rigorous focus on value from the client’s perspective identifies clear ways to create value more effectively. In a situation where supply is staff and demand is uncertain, the answer lies in getting people to work more flexibly, both with hours and job roles. Sounds simple, until you run into a union mindset (like this one), which may not be able to open up to possibility. (Not to suggest that privatization is the answer; it is definitely a possibility!)

I thoroughly enjoyed Deepak Chopra’s talk and it set a perfect tone for the rest of the day, in my opinion. Not everyone will “get” or will be able to follow his prescription to lead. For those that do, given that we are very emotional beings, it may be tough to stay that course. According to Chopra “there is a creative solution to every problem.” I have cast doubt on that thought on this blog, but I have pause to reconsider now. It is there; we are all tasked to find it.

 

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