Tuesday, July 26, 2011

I'm just fine! Wish I Could Say the Same for Health Care in this Country.

This morning, I read the following email sent to me by my good friend, Jeff Fuchs written to his lean students after a recent medical visit to his local emergency room. Jeff is the Director at The Maryland World Class Consortia and a great lean thinker!

I have copied it below with permission and some edits to remove classroom specific instructions to his students. Please read his story about his patient experience. As Jeff and I both hope, may it help stimulate some healthy and thoughtful commentary as we look to improving not only outcomes but the entire patient-family experience.

From: Jeff Fuchs
Sent: Monday, July 25, 2011
To: (All his Lean Students)
Subject: "I'm just fine!" Wish I could say the same for health care in this country.

I am getting back in control of my in-box after my unfortunate absence on the last of our three days together week. My sincere apologies. As the message header indicates, “rumors of my demise are greatly exaggerated.” Just a reminder: You still have your homework. You still have your capstone projects. And now you have your make-up training on cellular production. More on all that in a while.

I am sorry for throwing your day off last Thursday, but I had to bring my body into the shop for some unscheduled maintenance. As we all heard Sir Ken Robinson observe on Wednesday’s video, some of us just view our bodies “as a way of getting our heads to meetings.” Proper upkeep falls by the wayside from time to time, and this is what happens. A bit of detail is in order. I was up to answer nature’s call at 4:15 a.m. on Thursday, and instead of the usual heartbeat, “thumpita-thump, thumpita-thump, thumpita-thump…,” what I felt was more like “thumpita-thump, eeerrk! thumpita-eeerrk! thumpita-thump…errkk!...”

I grabbed my keys, wallet, cell phone, and a good book and drove to the Emergency Room. You may have missed your day of training, but let me tell you that “class was in session” at the Baltimore Washington Medical Center ER when I showed up for school at 5 a.m. Four hours later, (Let me say that again, “FOUR HOURS LATER”) we were still monkeying around with forgotten paperwork, twice redone blood draws, shift change meetings over my bed, staff that was making three trips to my room to restock inventory, and rolling me through a series of three “patient inventory” transactions between some lab and back to my ER bay of “move, wait, process, wait, move, wait” for X-ray, sonogram, and ECG, respectively.

I told you folks. I TOLD you to your face! “When I am through with you, if I am successful, I will make you as miserable a human being as I am. You will see broken processes all around you.” Welcome to my world. Behold, the sad customer/piece of meat-inventory:

Now seriously, don’t he look sad? Pity the poor victim of broken process.

Naturally, in a case like this I couldn’t resist going into Consultant Mode. In spite of being hooked up to the monitor, IV, oxygen, etc. like a marionette, the monitor kept losing my continuing thumpita-errk heartbeat, so the nurses had to keep walking back to the main desk an average of every 11.3 minutes (but who’s counting) to see if I was dead yet and to reset the monitor. How thoughtful of them to give me an ER bay where I could see their goings on. Their wasted motion, their absence of mistake-proofing or visual controls, their failed attempts to communicate with each other, failed service opportunities, excessive patient transportation, and more. How very thoughtful.

After three hours of fear, boredom, and frustration cocktail, I used a pen left behind by one of the nurses and began sketching out a nurse/patient spaghetti map of my morning on the back of an IV wrapper I found on the floor, along with a crude value stream map. (There are a few things wrong in that last sentence. Please use a black or blue ink pen to circle them. We’ll review your answers next session.) The ER staff found my doodles and efficiency ravings…amusing. I’m sure they did not have much time to be interested in the “bored consultant in room six” at the same time they had to deal with the cut up guy the cop brought in handcuffs, the construction worker who just fell off a scaffold, the guy sleeping on a gurney in the hall who nobody knows where he came from, or the other poor folk who needed their full attention.

The attending physician diagnosed me with “atrial fibrillation”, an eminently treatable condition. We’ll see in a couple weeks what the follow up says. They admitted me for observation, where I was subjected to other process design and systems management horrors which I shall not relate to you with at this time. Suffice it to say, I got an education in that fourteen hours. The lesson for me: Healthcare is broke. It’s broke bad. I mean, if I had a clone army of a thousand Lean Jedi Knights, we’d be swinging our Lean Lightsabers for decades trying to unhose healthcare in this country. Lean Facilitator Certification Program students, your future in this industry is secure.

By the way, one final note on my lean healthcare field trip. The “good book” I mentioned that I snagged on my way out the door was Toyota Kata, the one I described with such admiration on Tuesday morning, lamenting that I had not had the time to read it. Well, there you go. I plowed through half of it. Would have gotten further, but had to watch a really good Jerry Springer and eat my tasteless hospital food (Overcooked mac and cheese, gray asparagus, canned pears, and a drink that arrived completely frozen solid.). So, remember what I said: “A true lean leader is a lifelong learner.”

Put your left hand on the computer screen, raise your right hand, and repeat after me: “A-true-lean-leader-is-a-lifelong-learner.”

Here’s me “enjoying” my incarceration:

Pick up a copy of Toyota Kata. Will change your life. It’s an easy and interesting read. You can finish it in a weekend. Or two bad Emergency Room visits. Whichever.
Thanks, all. I look forward to seeing you again soon!

Very best,

Jeff Fuchs
The Maryland World Class Consortia
401 East Pratt Street, 17th Floor
Baltimore, MD 21202

Thank you Jeff for sharing your story. Despite your scare, you maintained your wit and humor. I wish you a speedy recovery and may God bless you! My prayers are with you.

Friday, July 01, 2011

Masaaki Imai on Gemba Walks in Seattle

Last week I had the wonderful opportunity to go Gemba Walking with Masaaki Imai to several Seattle Companies. I will talk about that experience in a follow up post but thought you might like to see Mr. Imai in action in this slideshow.