Three leaders from the International Consortium for Health Outcomes Measurement (ICHOM) – a nonprofit founded by organizations known for progressive business practices and rigorous research: Harvard Business School, The Boston Consulting Group and the Karolinska Institutet – published in Harvard Business Review that analyzes the success some healthcare organizations have had in implementing patient outcomes measurement programs. The article lists five steps that should be applied when implementing major change or process improvement within healthcare systems. This blog post is the third in a series of five that critique and nuance each ICHOM step from a Kaizen perspective.
Preparing to Drive Change
The third imperative outlined by the ICHOM is to allow an investment of time and resources for process improvement. The level of investment that each organization deems necessary is going to be unique to their circumstances. Here, we will discuss key commitments of time and resources. They may seem to go beyond those generally allocated for process improvement, but our experience has shown them to be critical to our success at Sheridan Healthcare.
At our Kaizen events we expect full time participation from all team members that includes physicians, nurses, nurse practitioners, physician assistants, and all other pertinent clinical and ancillary personnel. In the interest of keeping our clinicians’ time as value adding as possible, we do try and tailor our clinical Kaizen events to 3 intensive days so as to maximize their time. This approach has proven more effective than scattering process improvement meetings over several weeks or months. While the five day kaizen is still king, we have become adept at distilling the essence it’s most fundamental, and yet complete, form. In part two of this series, we outlined our model mix of players for a cross-functional team. Regardless of the seniority of the members this team, it is essential that they spend the time observing, analyzing, and experimenting with possible solutions that may improve their processes.
To support this powerhouse group it is vital that all ancillary resources must be put on call during the planning and preparation phase. This ensures the team’s success is not hindered by a lack of supporting resources. Every department within the corporate office or the hospital must have someone ready to respond to the kaizen team’s needs. With a little advanced notice we can maximize the team’s time and minimize interruptions to supporting departments. Examples of resources commonly pulled into the event for brief supporting roles are IT professional for technical support, compliance officers, registrars, and materials management. It is well known to many process improvement professionals that changes to the physical workspace are perhaps the most effective way to ensure process changes stick; so, members of the facilities staff are often made available to make structural modifications to rooms.
Given the heavy resource and time allocation to develop and implement process change, we are obliged to provide the best facilitation services at our disposal. Sheridan Healthcare covers the cost of transporting a nationally certified facilitator to each clinical kaizen location in order to ensure the Kaizen runs smoothly and effectively though our standardized format. We invest heavily in the training and certification of our facilitators. They are required to pass the AME / SME Lean Bronze Certification and submit a portfolio for review, as well as complete our internal facilitator training program constructed with TWI elements.
Time and Space to Grow
All teams are provided a dedicated work space that serves as their home base throughout the Kaizen. This is where they illustrate their observations, brainstorm, deliberate, experiment and report out to leadership each day. For the entire duration of the event, it is essential for them to have an area for uninterrupted work. Often overlooked, this workspace should be near the area targeted for Kaizen. This allows teams to observe often, vet ideas, interview other frontline workers, and implement changes quickly. Nothing stagnates a team quite as easily as a 15 minute walk back and forth multiple times a day. If you want to lose touch with what is really happening in the work area just separate the team by a whole lot of distance. Although many hospitals have tight quarters and relatively little space to spare something can usually be done to put the team in proximity to the work area in question.
At Osceola Regional Medical Center in Kissimmee, Florida, a Kaizen was being held to improve the interventional radiation (IR) biopsy process. There didn’t appear to be any suitable space for the Kaizen team. But our determined team members were able to identify an old, and rarely used, waiting room with just a couple of chairs and almost no wall space. Since it was adjacent to the IR suite, we thought it would do just fine. A de facto waiting area was set up for patients near the entrance to the IR suite, and it had to be ‘right-sized’ due to the tight quarters. The team was then able to conduct the Kaizen successfully. Once the event had concluded, the staff was so pleased with newly freed up space that they decided to keep the changes in place. Our Kaizen team room was converted into a plan earmarking it for IR suite expansion.
Not every vital resource is immediately tangible. We find it is equally necessary for the team to have an emotionally supportive environment where they will feel comfortable expressing all sorts of crazy ideas and testing them. It is necessary for teams to have the confidence to think creatively in an uninhibited manner, and to develop innovations; at Sheridan we call this ‘Try-Storming’ a blend of brainstorming with a bias towards action.
In one memorable case, the team was developing a way-finding system that visitors could use to direct themselves to different parts of a corporate park and through multiple office buildings without getting lost. The team offered a free lunch to visitors who could find their way between two different locations, monitoring time, errors, and ultimately arrival at the desired destination. They tested every method they could think of, from colored strings on the ground to “airport terminal” style overhead signage. After a day of lighthearted but poignant trials the team came to a very real and objective conclusion, that terminal and gate markers with overhead signage were the most effective method for directing people to specific locations through a complex yet open floorplan. This experiment is an example of how it is essential for teams to have the time and resources to play with their ideas before committing to which work best. In this case, a relatively small investment of resources for experimentation resulted in a significant payoff.
Your team, department, or organization will never achieve their operational goals without first committing fully to the shared vision. And once activities have been aligned to drive directly towards that vision you can confidently dedicate the resources necessary to execute wisely. Ensure adequate time for all key stakeholders to understand, create, and implement new processes. We are often asked how someone can afford to dedicate physicians and executives as fulltime kaizen team members, our response is: how can you afford not to? Do you have time to rework the ideas, do you have the resources to implement ineffective solutions? We implore our partners to take the time and do it right, because the return is well worth the investment. Few things are as detrimental as lip service and half measure, they will drain resources and moral. Ensure you are working on the fewest number of crucial objectives and then prioritize the teams’ efforts above all else, facilitate their ability to make fast and effective change.
Previous Series Installments:
Part 1: Making Champions of Believers
Part 2: Assembling Your Dream Team