posted by admin at 5:42 pm
I had the priviledge of watching a talk by David F. Chalmers at the National Healthcare CXO conference put on my Marcus Evans in Las Vegas. David is the director of the Healthcare Facility Research at Rice University and his talk on Lean Architecture was incredibly interesting and expanded what I thought possible with regards to how hospitals use their space. By the questions from the audience, I would gauge that he’s also still ahead of his time. Most of the questions started like this, “That’s a great idea, but…” Basically, folks were still coming up with reasons that they couldn’t implement these ideas rather than talking about how they could. There are hospitals, however, (even a former client that we helped prepare for a move) using these ideas and putting this research into action. I’ll attempt to summarize his main points here but you should really order his book as I have to get the full ideas and here his incredible personal story. As a teaser for the book, though, here are some of the highlights:
1. David argued that all new hospitals make the mistake of embedding technology into the architecture of the hospital rather than having the building be modular. Putting things like oxygen and suction into the walls means that when technology or space needs change it’s much harder to change the space because it means tearing down walls. Instead, he argues, there are ways to bring those technology to the bedside or to the bed itself. There are beds, for example, that have the ability to continually create oxygen internally. By building a new hospital with equipment and technology built into the building, the hospital immediately becomes obsolete, he argues.
2. Building on the idea of a modular hospital, David argues that we should make our buildings flex around our patients rather than have the patients move around our fixed service lines. If you think about what hospitals do as either: 1. Short term care 2. Specialized Services such as OR or MRI 3. Long term care- you can structure your building and staff accordingly. The only area that needs a fixed space built around a patient, he argues, are the fixed services areas. In the short term and long term areas the services, staff and building should flex around the patient, rather than the opposite.
3. Disruptive technologies-derived mostly from experience from the military- will play a larger part in the hospital of the future. If a mobile laboratory, for example, can do 90% of what a separate lab can do why invest in the space for a separate laboratory? The same technologies that help save lives on the battlefield by bringing live saving technology closer to our soldiers, he argues, will improve our ability to meet our patients needs where they are without building bigger spaces to transfer them within.
Those are my takeaways from David’s talk, but you should check out his book to make your own. Even if you’re not building a new hospital it’s fun to have your idea of possible expanded.
posted by admin at 7:43 pm
Over the course of the past nine years implementing our Frontline Design programs in hospitals, the thing that has been most appealing to me about the job is improving the day-to-day working lives of caregivers. I’m always happy to help save a little money or improve a particular service line, but the thing that gets me out of bed in the morning is helping folks take control over their work life and helping empower improvement. So I was really excited to see this today. Check out number 18 on Modern Healthcare’s list of best places to work. We worked extensively at St. Joseph’s hospital in Kokomo, Indiana and I would like to think that we helped, in some small way, contribute to their success. Mostly, however, I’m just happy for the organization and the people that work there. Kudos.
posted by admin at 6:19 pm
Here’s a bit from an upcoming article in Executive Insight with our thoughts on the current state of IT in healthcare:
First, we should be aware of the reality of current IT products. In the current
phase of the IT adoption cycle the goal for vendors is market share. This means
that things like functionality, reliability, convenience, price and support take a
back seat to sales. As one former IT vendor told me recently-no doubt his new
job outside of the healthcare IT world allowed him unaccustomed candor-“we are
fully aware that we are shipping products with flaws, but the goal is market share.”
In addition to being at the front end of the adoption cycle there’s considerable
demand driving the adoption of IT in healthcare. First, there are folks in industry
that have had considerable success with IT and are pushing for adoption by
hospitals. Many of them see IT as a partial solution to their rising insurance costs,
and are shocked at just how far behind healthcare IT adoption seems to them. On
top of that the recent stimulus has added a heap of money from government to those who can show meaningful use. While I think prompting from outside of healthcare
is a good thing, there’s no doubt that the peer and industry pressure is pushing
demand for adoption ahead of the supply of a great product.
We’re in a position where the product isn’t yet great but we’re all rushing ahead
regardless because we see the opportunity and we’re being pushed by our peers.
It’s no surprise, then, that the results have been mixed with regards to the success
of implementing and effectively using these IT systems.
Despite that clip, the article is generally positive. Look for it and the new magazine in November.
posted by admin at 3:08 pm
Although our work continues to evolve, the initial kernel of our ideas came from what’s being called “lean healthcare,” which of course came from Toyota. So, we tend to keep an eye on the automotive industry. One of the more dramatic moments for the auto industry in recent history was the automotive bailout that was part of a host of measures implemented as the economic recovery package. One of the main participants in that drama was Steven Rattner, then head of the President’s auto industry taskforce. Rattner is promoting a new book which details his time with the Obama administration and in an interview with The New Republic he say’s something that should be reassuring for managers in any industry: they matter.
On the difference between GM and Ford:
Ford was playing with exactly the same deck of cards. They had effectively the same UAW contract. They had effectively the same manufacturing footprint, up in the upper Midwest area. They had the same kind of dealer network issues that GM and Chrysler had. And yet while Ford certainly struggled for a while, they got through this and have been making good money for some time now.
So, what’s the difference between Ford and GM? I would argue the difference between Ford and GM is management. I don’t know what else to attribute it to. It’s one of the few cases where you actually have two examples that you can put side-by-side and it would be a very valid comparison.
Alternatively, management can also have a profoundly negative effect:
..GM and Chrysler—both companies—had dramatically improved their manufacturing efficiency. When you looked at how long it took them to make a car versus how long it took Honda or Toyota, they were on par. They had dramatically increased their quality. GM was now receiving complaints at a similar level—or even a lower level—than the Japanese companies. And this was before the Toyota recalls, of course. GM had made significant improvements in its product line. So the whole process of actually building a car was in far better shape than I would’ve imagined.
What was in worse shape was the management and the finances—they just had no handle over their finances or their financial needs. [So] they got themselves to a point where they just literally ran out of money. They had a very insular culture with no real accountability, no real consequences of failure. It was all very collegial, but a kind of ‘get-along-go-along’ culture. It was shocking beyond anything I would’ve guessed.
Lastly, on why he feel’s more optimistic about Chrystler than GM:
And so, why do I feel better about Chrysler? First, because it turns out that even though we thought Chrysler was better managed than GM, particularly in terms of controlling costs and things like that, it turns out that the new management team from Fiat has been able to find even more cost savings and generally improve the efficiency of the operations.
So there you have it: management matters. The way you carry yourself, the way you solve problems in your organization, the way you teach (or don’t) your staff, the way you care for the bottom line (or don’t) all matter whether it’s for making cars or caring for patients.
posted by admin at 2:29 pm
“An expert is an ordinary fellow from another town.” – Mark Twain.
I had the pleasure of meeting with a hospital CEO recently who paraphrased Mark Twain’s quote above while introducing myself and my colleague to his executive team. I’ve heard versions of this before but usually by people who were bemoaning the idea of consultants. This gentleman, however, seemed to have a great grasp on how to use us to accomplish goals that he has for his organization and recognized that he couldn’t accomplish these things on his own. Not because any lack of knowledge or skills on his part, but because sometimes you need an outsider’s perspective even if we are just ordinary fellows from another town. I have no problem being ordinary, in fact, I’m pleased to be working with someone with such a clear idea of what they want done in their organization.
posted by admin at 7:28 pm
This graphic is from BP’s report on the recent oil spill in the Gulf. It’s a nice visual of the Swiss Cheese concept in action. We use this framework a lot when thinking about harmful events. If you’re someone who teaches this concept to health care folks, this might be the perfect teaching aide as I find that people have a hard time abstracting in areas that they know too well.
Full report here:
Hat tip: TPM
posted by admin at 7:12 pm
Somebody has to right? Seriously though, over at The Health Care Blog there’s a post that I read as insinuating that all health care CEO’s are idiots and links to a video that essentially says the same. Here was my response:
Is the larger narrative here really, “CEOs may often not be the best people to be running their institutions?” Even more to the point, is there really a larger narrative? Or is this just a matter of having thousands of people running thousands of organizations and occasionally one of them is bound to do something stupid. I’ve worked with a lot of these folks over the years and all of them are smart and self-aware enough, for example, to tell the difference between an event that is interesting because it confirms their own bias and one that actually tells a larger story. I’m not sure I would say the same about the author of this story.
That last sentence was probably a little much but see how you feel after reading the column, and feel free to chime in.
posted by admin at 4:42 pm
Busy last week with traveling but I did have a chance to snap these photos. You see a lot of visual signals that aren’t helpful, but I liked these and found them helpful.
posted by admin at 2:47 pm
This made the rounds last week but I didn’t see it on any healthcare blogs. It’s definitely public-health related, but that’s not why I recommend it. It’s a great example of a solution that seems counter intuitive to people…until it doesn’t. Much of our work is like this-in particular, our approach to inventory-some idea seems crazy until it’s implemented and then it seems like common sense. This video gives you a look at people experiencing that shift.
posted by admin at 1:46 pm
Dave gives a nice summary in an interview with the Leanblog’s Mark Graban of how the scientific method underlies the tools and practices that have come to be called Lean.
Click Here to listen to the interview.
Enjoy.
