A Guide for Your Transformation Journey

Camping Consultant.jpg

I'm going camping next week and I’m thinking about what I need to pack. The essentials always seem to add up so quickly even though the goal is to travel light. Unless, of course, you're going "glamping!" Anyway, it got me thinking about the settlers and their wagon trains that traveled west to start a new life. Five months is a really long camping trip and they didn't have the lightweight camping gear that we have today. Not to mention, they didn't even have a road to travel on most of the way. The goal was two miles per day and they endured oxen dying of thirst, dysentery, hunger, bad weather, and sometimes hostile American Indians. If they were fortunate, they would have a good guide to ensure their success.

Practices are much like those westward-bound settlers in that they are on a transformation journey and there are many obstacles along the way. Infinitum is that like that good guide that can help them succeed. The Infinitum Team has veteran consultants ready to share their knowledge to help you with the obstacles of health care changes. Happy trails to us all!

Imagine No Patients Waiting

Kayaking.jpg

It's officially summer and I am so grateful for sunshine and hot weather. It's my favorite season. One of my favorite things to do is to go kayaking. It's so peaceful with the quiet surroundings. The sun is warm and the water is cool. The rhythm of my paddle is meditative. The stresses of daily life just melt away. This relaxed state is also when I do my best creative thinking. As humans, our creative thinking, or imagination, for problem-solving is a gift that we don't always have the time to use in our busy lives. It's hard to slow down and unplug from distractions when we have deadlines, people counting on us, and in the medical profession: patients waiting.

Patients waiting, or demand and capacity balance, is a real problem for most health care organizations. One could even say that it takes the joy out of practicing medicine when you don't even have time to take care of yourself. The Infinitum Team has observed over and over again the unmanageable workload of the healthcare provider. We watch as the patients pile up while the provider works through lunch, stays late, and takes work home to complete their notes. So when do providers have time to use their creative energy to problem solve this situation and end the insanity? Their minds are thinking of one thing: there are sick people that must be seen. That's where the Infinitum Team comes in. We have answers to this problem. We can and want to help you get back to your joy: helping sick people get well.

The Pebble and the Patient Pathway

Pebble and Patient Pathway.jpg

Ah, summer and the great outdoors! Ever go hiking and get a pebble in your shoe? It forces you to stop your journey and find the pain causing pebble immediately. Why does such a small object create so much discomfort? So it is in life; it's the little things that seem to annoy us most. Perhaps because we feel it is unnecessary? Yes, I sign on for sore muscles after a hike, but I'm prepared to take on that discomfort for the gain of that beautiful view at the top of the mountain. I never, however, sign on nor am I prepared for that troublesome pebble in my shoe. I believe waiting is like that pebble for a patient. It is annoying to wait to be seen and every minute they wait they feel less respected. Or maybe they are waiting on test results that never get shared. Or needing to see a doctor and not being able to be seen within a reasonable time. Healthcare organizations want to address this but often do not know how.

At Infinitum, we ask what is ideal for the patient and we often hear:

  • Safe – avoiding injuries to patients from care that is intended to help them.

  • Effective – avoiding overuse and misuse of care.

  • Patient-Centered – providing care that is unique to a patient's needs.

  • Timely – reducing wait times and harmful delays for patients and providers.

  • Efficient – avoiding waste of equipment, supplies, ideas and energy.

  • Equitable – providing care that does not vary across intrinsic personal characteristics.

The above list is basically saying that the goal of care is to give patients what they need and when they need it. We have an acronym that we use called IDEALS:

Immediate response to problems or change

Demand planned for

Exactly what the patient needs

Adjust to each individual patient

Lean; no waste

Safe for patients, staff, and clinicians

If you'd like to talk about how to address the pebbles in your patient pathway, Infinitum can show you how to meet the ideals you are reaching for.

Are You Tending Your Garden?

People Plant.jpg

"Tend to the people, and they will tend to the business." --John Maxwell

It's gardening season. I'm not an expert gardener but I dabble enough to know that the soil needs the right amendments in order to provide the plant with the right amount of nutrients to grow effectively and produce the fruits or vegetables I hope to harvest. So it is with the people you lead. They need to have the right amendments to have what they need (nutrients) to grow. Whether growing plants or people it's work. The reward for all that hard work is capable employees that will work to the top of their abilities and credentialing with passion and dedication within a relationship of mutual respect and trust.

The difference between plants and people is that there are amendment formulas for soil based on the soil and the plant that you are growing, and there are not any formulas for the environment or the people you are growing. There are so many variables when it comes to human beings as they are complex, however, I have found the following list to be helpful as you figure out the right formula for each of the people you lead in any environment:

  1. Encourage professional development. Create a development plan with them, identify any gaps, and establish specific training objectives. While not all people need to grow into leaders they all influence one another.

  2. Discuss the organizational goals and how that is tied to their career goals. Goals should be based on their strengths, interests, and experience.

  3. Be a mentor to them as this fosters a positive and productive working relationship. Yes, this is where I say, "lead by example." It may also be appropriate to pair them with a work mentor that does a similar role as them so they will have support from an experienced peer in order to do their best. People who are coached with encouragement are better able to adapt to changes within any organization.

  4. Help them build their networks. If they are well connected, so will you be with important information. Recommend professional organizations that they can become members of and perhaps play a leadership role in.

  5. Challenge people with assignments. Most people don't want to do the same thing every day and enjoy a challenge. Professional growth happens when people leave their comfort zones.

  6. Show them you trust them by giving them autonomy. You can trust them to do the job they were hired for, but you have to get out of the way. Let them know what your expectations are, model the behavior you expect, and value credibility. This will provide greater ownership and accountability than micromanagement ever would.

  7. Show appreciation by acknowledging how hard they work, a job well done, or when they go above and beyond. Remember to say thank you. Everyone needs to feel appreciated.

  8. Listen, listen, and listen. I love that old adage that we have two ears and one mouth so we need to listen twice as much as we talk. When you listen it gives you information about what people know and don't know, how they think and process, what type of learner they are, and where there may be a need for training. When you listen you create mutual respect because you are saying "I care" and "I respect your thoughts and ideas."

  9. Provide feedback frequently. People need both positive and corrective feedback to know if what they are doing is in the right direction. Providing specific examples of a person's work, behavior, or actions feel more like an observation than personal judgment.

  10. Know when the people are not a good fit for the position. It happens. Just like plants need to be moved so do people. You are creating a garden based on the harvest you want to collect.

  11. Ask questions. Whether leading, coaching, or mentoring it is best to put statements and requests in the form of a question. It opens up the conversation and feels less demanding to the people you are leading.

  12. Delegate and let people do things the way they think makes the most sense since they are the one doing the work. If you think there is a better way, ask them if it makes sense to do it differently, and do make them part of the decision-making process instead of demanding it be done in a specific way.

  13. Navigating organizational politics can be tricky in any organization. It's the way things get done and certain behaviors of others can be just as tricky. Allow them to job shadow or role-play with them to help educate them about these processes and people.

  14. Consistency is key. Like gardening, the people you manage need daily and weekly care. Neglecting them for weeks and months at a time is not relationship building. People like gardens need weeding, watering, and feeding. This consistent attention and support is needed for consistent growth.

  15. Celebrate with them and have fun together as a team! This, unfortunately, in my opinion, is the most missed opportunity to strengthen the leader-people bond. Take time to celebrate the successes. It can be a simple lunch or an afternoon activity like a game of bowling or a couple of hours at the lake.

Whether you are growing plants or people, both need you to provide the right amendments to grow to their full potential. When leaders take the time and energy to support people in their goals, listen to their ideas and provide challenging work that fits their growth curve a culture of productivity and engagement emerges as a harvest.

If you would be interested in a leadership workshop or a team building event, please contact us!

The Power of Change Agency

Whether you call it change, reform, or transformation we are all wanting to make a positive difference in the healthcare system. The School for Change Agents through the Horizons improvement organization of the National Health Service in the United Kingdom made the following distinction between change agency and change agent:

Change Agency.png

If the purpose of change is to make things better for everyone with the intended consequence being joy in work, then how does one activate people's agency, a team's ability to act with purpose, and reach their full potential within their job? Basically, how does one mobilize others?

At Infinitum we believe there are three key areas:

1. Safe Space:

The work environment needs to be a place where people not only feel heard, but are heard. They need to know that they can trust their team and leadership to respect and value their ideas. They need to be asked what matters to them to understand the intrinsic motivation of the team. This is the only way to truly engage everyone into the work design improvement process. Finally, processes and not people need to be judged.

2. Feedback:

There will be both positive and negative feedback that will be used to make adjustments, but the team focus should be on the positive. Most people have been trained to focus on what's broken and fix it, but a focus on what's working and how to expand on that is just as valuable. Between team members and the team and leadership there should be a conversation about what's the best way to communicate to get answers and ask questions; how will communications outside the team be gathered and analyzed such as surveys and unrequested feedback; and the creation of public appreciation such as a "Bright Spot" board to display positive actions and behavior of the frontline staff as encouragement.

3. Team Democracy:

A self-governing team will be more accountable and innovative than a traditional team. This is not to say that there will not be leadership, but rather everyone is involved in the decision-making and co-design changes. By giving team members a say in improvement ideas they are more engaged. Expectations and timelines are agreed upon as a team rather than being told what to do. The team agrees among themselves who will do what and when as they already know the why as the frontline staff or the people actually doing the work.

In the end, when a team is given change agency there is a change in culture where it is safe to communicate honestly, feedback is valued, and team democracy is built on mutual respect.

Please contact us if you'd like to hold a workshop on this topic!



The How Not the Who!

I recently read an article from Modern Medicine Network in their Medical Economics section that talked about how a manufacturing process can transform healthcare delivery. What surprises me is that the article is five years old and yet most healthcare organizations have not heard of this concept: lean healthcare. The Toyota Production System is a transferable lean methodology designed to remove waste from any system. Yes, people are not widgets and yes, everything a practice does is for the patient. However, it is not the who but the how that has waste. How things are done, the processes, and the way in which work is viewed as a system rather than an individual task. And my favorite part: the value of the people doing the work. Healthcare, after all, is a service for people and provided by people.

If you'd like to read the entire article: click here

If you'd like to contact the Transformation Team for a free quote on a practice assessment: click here

Value Stream Map.png

Transition from Individual Change Efforts to a System-wide Improvement Movement

When the Infinitum Team goes into a healthcare organization the first thing we ask is, "Where's your pain?" Everyone knows where they hurt, and when the hurt goes on for any length of time it begins to wear down a person's enthusiasm, work relationships, and the mission of the organization. Many individuals seek to make changes within their own work and soon discover it is not enough and become discouraged.

Boo Boo Bear.jpg

It is the Infinitum Team's practice to take that hurt and discouragement and turn it into an aim. The aim is the goal post or shared mission for a system-wide change by learning and implementing system thinking. This improvement science is data based. Measures are created to support the aim and evaluate countermeasures on a regular basis. These measures are like a measuring stick in that they not only show whether the implemented changes are the desired improvement, but also if they are sustainable.

Every clinician knows how to provide care and has some basic improvement skills. The key is to expand that skill from the patient to the system that serves the patient. Awareness and methodology needs to be learned to create system thinking and system problem solving across the healthcare system. The Infinitum Team enjoys seeing the faces of the people we work with light up when that awareness hits them. At that point system thinking cannot be unseen. When system thinking and system problem solving become shared knowledge as people speaking the same language a culture change takes place and patient safety, patient satisfaction, and optimal health outcomes are met with returned enthusiasm for the work that clinicians are passionate about.

System-wide improvement takes dedication and energy that not everyone has when they first start on the system thinking journey. The Infinitum Team can perform an assessment to address this very normal starting point and prepare people by helping them understand through education and implementation. The Infinitum Team has observed three key elements:

Everyone must be included; a multi-disciplinary team that has at least one person from every area of the system is essential to system thinking from the patient's view. Everyone knows something about the system and they have working knowledge of their area within the system.

Gather, analyze, and understand the system data to measure the desired changes and standardize those changes into sustainable improvements. Data from the EMR, safety data, patient satisfaction data, employee data, and quality data are all pieces in the data picture.

Not every employee has "quality" or "system thinker" or in their title, but everyone should have "quality" and "system thinker" in their job description. It should be a mindset that is shared by all through education, training, and transferable knowledge for system thinking to be cultural.

The Infinitum Healthcare Transformation System teaches people how to view their work from the lens of the patient within the whole system by showing them how their work affects patient safety, patient satisfaction, optimal health outcomes, and how their work is interconnected as a system of care. Consideration of the patient from the time they enter the system to the time they leave is a new cultural mindset. This mindset is transferable knowledge between individuals, teams, and the healthcare organization as a whole. If you're interested in a system-wide improvement movement and want to talk about an assessment to determine your starting point on this journey, contact the Infinitum Team.

Fostering Dignity

I learned about John Perry Barlow's "The 25 Principles of Adult Behavior" while attending the 2018 School for Change Agents through Horizons National Health Services in the United Kingdom. (If you haven't taken their classes, I highly recommend them. They are online and it was free!) We've all heard the term "lead by example," right? Well, "Change Starts with Me" was the School for Change Agents' first class. I wanted to share the 12 principles that the School for Change Agents shared because I couldn't help but think about how beneficial these principles are for creating and sustaining change initiatives:

John Perry Barlow School of Change.png

The Infinitum Healthcare Transformation System would add Barlow's #22, foster dignity, to the School for Change Agents list for "Change Starts with Me." If you look up the definition for dignity, you'll read that it is a sense of pride in oneself or self-respect, and knowing that you are worthy of honor or respect. One of the two pillars of lean is respect for people. Respect fosters dignity and creates intrinsic motivation to sustain the other pillar of lean: continuous improvement.

 

Note:  Here's the entire list of Barlow's "The 25 Principles Of Adult Behavior," if you're curious:

 1. Be patient. No matter what.

2. Don’t bad-mouth: Assign responsibility, not blame. Say nothing of another you wouldn’t say to him.

3. Never assume the motives of others are, to them, less noble than yours are to you.

4. Expand your sense of the possible.

5. Don’t trouble yourself with matters you truly cannot change.

6. Expect no more of anyone than you can deliver yourself.

7. Tolerate ambiguity.

8. Laugh at yourself frequently.

9. Concern yourself with what is right rather than who is right.

10. Never forget that, no matter how certain, you might be wrong.

11. Give up blood sports.

12. Remember that your life belongs to others as well. Don’t risk it frivolously.

13. Never lie to anyone for any reason. (Lies of omission are sometimes exempt.)

14. Learn the needs of those around you and respect them.

15. Avoid the pursuit of happiness. Seek to define your mission and pursue that.

16. Reduce your use of the first personal pronoun.

17. Praise at least as often as you disparage.

18. Admit your errors freely and soon.

19. Become less suspicious of joy.

20. Understand humility.

21. Remember that love forgives everything.

22. Foster dignity.

23. Live memorably.

24. Love yourself.

25. Endure.


Seize the morning, seize the day!

"The difference between ordinary and extraordinary is that little extra."

-Jimmy Johnson

Jimmy Johnson is one of the greatest football coaches in American football. He understood that giving a little extra, in the beginning, made all the difference in the end. Morning team huddles are like that. Initially, you might even think there isn't time, but in time you will realize that they make all the difference.

Standing Team Fist Bump.jpg

Morning Huddle Tips:

The morning huddle should be quick and lively with a bit of fun.

  • Timing is everything! Start and end on time. Be brief and concise in the sharing of information. Bigger issues that need brainstorming and planning should be scheduled for another time.

  • Although a quick stand-up meeting it is a time for everyone to connect just like a football huddle before each play.

  • Start and end the meeting the same way to create a shared ritual.

  • The team huddle will set the tone for the day, so be positive. Start with good news or something positive from the previous day.

  • Be prepared with an agenda that will relay information; don't wing it:

    • Game strategy: share figures of how you are doing against our target, status update.

    • Coverage: attendance and shared awareness of who needs help.

    • Goal: focus on the priorities of the day, organize the workload for the day, and plan for coverage for the day.

    • Heads up: where are the opportunities and issues. Intel: share the "ah-ha!" learning.

    • Touch down dance: celebrate the wins, give a compliment, ask team members to make an appreciation statement for another team member, or share a team cheer.

  • Consider a whiteboard as a Huddle Board to create Visual Management of metrics, issues, ideas, and wins that can be updated throughout the day.

  • Agree to talk about things that matter and unite the team, and not a place to chit-chat, whine, complain or have side conversations.

  • When bigger issues arise, schedule a meeting for just that issue.

  • Consider using a ball that is tossed from one person to the next so that each person has an opportunity to be heard.

  • The facilitator should communicate in a conversational style rather than a one-way conversation.

  • Eye contact is essential along with active listening.

  • Consider taking turns as the facilitator, if appropriate.


Morning Huddle Practice Benefits:

  • Improved communication between team members.

  • Better coverage of the practice.

  • Provides an opportunity to share concerns and receive feedback.

  • Improves workflow. When team members start the day together they have a common understanding of the priorities and plan to address any issues.

  • Teamwork mindset; morning huddles create awareness of what is going on in each other's work.

  • Creates a teamwork culture along with ownership and accountability that is proactive instead of reactive.

  • Supports organizational goals toward becoming a higher reliability organization in quality and safety.

  • Initiatives and safety concepts get distributed throughout the team for common understanding and reduced misconceptions.

  • In addition to reducing email traffic, it is more timely than an email as everyone receives the information together and has a chance to add any information they know.

Morning Huddle Patient Benefits:

  • Better care; with a review or "scrub" of the patient record there is less chance of a gap in care or awareness of specific needs of the patient.

  • Holistic care; the care team functions toward a specific patient goal together from all their areas of care.

  • Faster service; with preparedness the day runs smoother for the entire system.

  • Depending on the size of the practice, sometimes medical assistants and providers have a separate morning huddle to review the patient schedule it can look like this:

    • MA "scrubs the chart" looking for care gaps or high priority items such as preventative care, disease management, and identifying missing information.

    • Plan for continuity issues such as a special care tray in the exam room but avoid too many tasks as the point is to stay on schedule.

    • If there is a health team on staff such as dietitians, social workers, behavioral health; all who provide care attend. Avoid too many tasks - the point of the huddle is to provide the best care and to stay on schedule.

Team huddles can have a huge impact on patient care when the healthcare team functions with a team mindset and patient focus. The morning huddle provides a time and place for active listening, active communication with multiple participants, and shared knowing and learning. If you would be interested in a morning huddle workshop or online training, please contact us.

Standardization of Exam Rooms

In the last three weeks I've talked about cleaning out and organizing the practice storage room, implementing a 2-bin supply system for replenishing the supplies, and reorganizing the physical flow of the office. This week I'd like to talk about organizing the exam rooms. Most practices have multiple exam rooms which are in constant use as Patients are roomed, cared for and cleaned. Exam rooms can be a significant limiting constraint on Patient flow, as anyone who has waited excessively for a room to become available can tell you. Rooms are one of the main resources a Practice has, so maximizing their utilization is very important. When we look at the work flow in exam rooms, we tend to find themes:

  • Rooms are set up differently, with different equipment and layout. Sometimes this is personal preference for one provider, other times it is just how the layout has evolved. Many times the rooms are laid out in a legacy format, designed by people who have long since left the practice.

  • Signaling systems are missing or inadequate. One of the main contributing factors to delays while in the exam room is the inability of the provider to know exactly when the Nurse/MA has finished the rooming process and the Patient is available for the Provider Visit.

  • Equipment and Supplies are stored haphazardly with stock outs commonplace

Room with Bed Angled and Tape on Floor.jpg

Unless a room has a very specific purpose (and should only be used for that purpose), then there is a case to be made for standardizing room layout as much as possible. Every exam room should have the same supplies in the same place so no matter who is on duty items can be found quickly. If the gloves are on the third shelf in one room, then it should be the same in every room. This cuts down on people searching for supplies. And the same goes for equipment. Every exam room should have a blood pressure cuff instead of a shared one that has to be found every time there is a new patient being roomed. This will allow for better patient care as time will not be wasted looking for supplies and equipment. This is the beauty of standardization! Reduction in variability, easier learning curve for new employees, reduction in waste, and a baseline for improvement are just some of the benefits. Additionally, it adds discipline to the culture, and supports audits, and creates inclusion as it involves all healthcare team members.

 Standardization has received a bad rap in healthcare. There is still a pervasive thought process that insists everything about Medicine is an art, and shouldn't be tampered with. To this we say - Art is appropriate in some circles, but having the platform from which to create art be consistent can allow you to create that art with fewer distractions and delays. This is the philosophy behind standardization in the medical practice. The removal of reasons to divert thought away from the Patient and how the Physician interacts with them. 

 Standardized work is a powerful lean tool in which the sequence of job elements have been efficiently organized and repeatedly followed by the healthcare team. Standardization can maximize quality, repeatability, safety, interoperability, and compatibility. The goal is not only consistency but continuous improvement as changes take place. Some say (wrongly) that standardization makes us all operate like robots. This is not the intent. Standardization provides the commonly agreed best practices to the entire team, and helps them all perform to that best practice consistently. From that platform of excellence, innovation is encouraged, ideas tested through PDSA cycles and deliberate changes made to continually improve the underlying processes.

 Standardization is a core principle of Infinitum. We have extensive experience in designing standardized systems in medical environments. If you would be interested in holding a Standardization Workshop, please contact the Infinitum Transformation Team.

The Spaghetti Map

I have to confess that I love rearranging the furniture in my home. It's part of my spring cleaning routine to consider reorganizing a room that will make the most sense for the changes that have taken place over the last year. For example, maybe I added a new piece of furniture or bought a new TV and the layout needs to change. Part of the cleaning and organizing process for a practice is to look at where everything and everyone "sits" and determine if those placements make the most sense for the workflow of the practice.

Have you ever stopped to consider how many times in a day you walk from here to there in the physical layout of the practice? Unnecessary movement or motion is one of the eight waste categories in lean healthcare. If you were to draw a line for every place you walk to and fro, what would it look like? Spaghetti? Would it reveal that the scale over in the corner of the office creates a lot of extra steps? Unnecessary steps that take time away from doing something with more value for the patient?

Spaghetti Map.PNG

The Transformation Team was at the IHI San Francisco Conference last week discussing lean methodologies including the above spaghetti map which is one of many countermeasure projects to reduce waste in the patient pathway. In this particular project there was an 87% reduction in unnecessary movement. If you'd like to learn more about saving time to create time, please contact us.



Two-bin Systems are Better Than One!

When staff can't find the supplies that they need healthcare organizations end up with delayed patient care, frustrated staff, hording which can create over ordering of items which adds cost to the system, as well as interruptions to the workflow of the purchaser having to deal with a rush order. Most healthcare organizations usually use the par system whereby each item has a set par level based on historical usage. The purchaser or material handler would have to manually count how many of each item was in inventory, enter the amount into the system, and deliver the exact amount needed to bring the item up to par in the storage space. In addition to this process being inefficient, it has a lengthy learning curve for any new material handler.

A two-bin inventory control system is aimed at reducing inventory and optimizing the reordering process. The system monitors the quantity of how many items remain by a visual process. When the first bin is emptied the Kanban or visual card on the front of the bin is flipped to signal that it is time to reorder. The clinical team uses the items in the second bin until more items arrive. The person doing the reordering can quickly tell what needs to be reordered by the color of the visual card.

Bin Use.PNG
Bin Card.PNG

The advantage of a two-bin inventory control system;

  • Items never run out for reduced waiting time (no stock-outs);

  • Items are always reordered when needed for minimized lead time ( no overstock);

  • Optimized inventory volume for the need of less storage.

The two-bin inventory control system has four factors that must be balanced:

  • C - the number of visual cards must equal the number of bins in use;

  • S - the size of the bin or how many items can fit in it;

  • L - the lead time to replenish the inventory or how long from sending the signal until the team receives new inventory;

  • D - the daily demand for the particular item.

The formula for the optimal two-bin system is (C-1)*S = L*D. Of course, this basic approach does not factor in fluctuating demand, minimum orders, or other variables as these are the customization calculations that would need to be included. This may not be an issue if you partner with a supplier that fills the bins as needed on a regularly scheduled delivery.

Check out this short training video!

The Infinitum Transformation Team can assist you in implementing a two-bin inventory control system. Contact us if you'd like to train your staff.

Spring into 5S!

Spring has sprung and the sun feels warm and the days are getting longer. Time to open the windows and let in all that sunshine and fresh air. I have the urge to spring clean and I'm ready to hoe out all the things I forgot I had and organize! I have a rule that if I haven't used it or worn it in a year, then it must find a new home. As I dig through my closets I am reminded of the lean 5S methodology that has been proven to be an effective way to identify and eliminate waste while organizing and standardizing the workplace. The list below describes the steps to organize a work space so that it functions with efficiency in mind and is effective at eliminating unnecessary motion, maintaining a clean and tidy area, making inventory easy to manage, and sustaining the new order.

You'll notice this 5S list is now 6S because the Transformation Team at Infinitum has added "safety:"

  • Sort -

    Goal: Reduce the number of items and reduce the amount of needed storage. If more people wear medium gloves than small then the amount of each size of glove should represent the office population. Everything has a "home." You do not waste time looking for items as you know exactly where items are stored so they are easily available and inventoried.

    Implementation: Evaluate whether or not an item should be stored in this space. Evaluate the number of each item. Remove unnecessary items, and "red tag" all the items you are not sure about and place in a "red tag" area until you know.

  • Set in order -

    Goal: Reduce inconvenience. Reduce unnecessary movement and over reaching.

    Implementation: Put the items that are used most in the most convenient or optimal place. Items should be in a logical order as to use or size. Make it easy to find items by using visual labels (color code, number, alphabetical order) Put tape on the floor to show where equipment "lives."

  • Shine -

    Goal: Keep area clean so it is pleasant to work in. Keep area picked up so it is safe. Keep equipment well maintained to prevent time loss during an equipment breakdown.

    Implementation: Sweep and dust regularly. Inspect area and equipment within the area regularly.

  • Standardize -

    Goal: Standardize the sort, set in order, and shine processes. Procedures and schedules are within the standardized 5S policy.

    Implementation: Make sure it is part of everyone's daily routine. Provide visual reminders such as photos and diagrams. Ensure that everyone knows their responsibility. Create an audit checklist.

  • Sustain -

    Goal: Sustain the developed and sometimes co-created processes. Staff will follow the processes without being told.

    Implementation: Organize training sessions. Audit the entire procedure regularly as things change. What made sense a year ago may not be true anymore. Staff feedback is valuable for ongoing improvements. When issues arrive, address them by identifying the cause to avoid them happening again.

  • Safety -

    Goal: Increase safety.

    Implementation: Eliminate hazards that can cause trips, slips, and falls on the floor. Eliminate falling object hazards. Eliminate injury by putting heavy and often reached for items closer to the person.

6S.PNG

Feeling ready to do some spring cleaning in your work spaces? Contact the Infinitum Transformation Team and we'll be happy to help!

Becoming a Data-driven Healthcare Organization

Becoming a data-driven healthcare organization takes more than deciding to become one. It takes commitment and planning:

  • The commitment of leadership and an implementation plan with a shared mission.

  • The right technology architecture in place.

  • Selecting the best analytical tools to derive insights from data.

  • Realigning an organization’s culture to make sure that everyone is involved in understanding the value of the data, how to obtain good data, and how to translate data into decisions.

  • While the transformation takes commitment and planning the formula is simple : (Executive Commitment + Shared Mission) x (Data Analytics + Employee Involvement) = Data-driven Decision Making Culture

Transforming the culture of an organization from one of "this is how we've always done it" to "this is how we know we're doing it the best way" has to come from the top and be of constant support to the change leaders. The four steps to transforming culture:

  1. Executive Commitment -Executives need to be shown how analytics will bring value to the organization. Metrics must be clearly defined. Managing expectations with small changes, such as a pilot program, to prove the return on investment. Knowledge costs money, data is knowledge; what is its value to the organization and qualify it to the mission of the organization and quantify it to the cost of care.

  2. Shared Mission - It is essential that the Data-driven Culture Change Implementation Plan be connected to the mission, vision, and value statements of the organization. These three statements serve as a constant reminder of "who we are," "where we are going," and "how we will get there."

  3. Data analytics - What, why, and how need to be planned out. What data will you collect to answer the "why" and how will you collect it? Employee training on how to collect and input data is vital to the success of clean data. It is often said that what comes out is only as good as what goes in.

  4. Include everyone - All those working within the culture need to be part of the change for the change to stick. Additionally, their work knowledge and ideas are important to the success of creating the best processes and innovations. As an organization begins applying those insights directly to the healthcare system, using them in the decision-making process will start to become embedded within the organization and the culture will change organically.

Fist Bump over Technology.jpg

Forging a stronger connection between analytics and healthcare outcomes is accomplished by combining executive commitment, shared mission, data analytics, and the people doing the work to become a data-driven making culture. Infinitum recognizes the need for culture change and can provide a cultural assessment of where a healthcare organization is currently at, where it needs to go, and co-create a plan with leadership on how to get there. If your healthcare organization is ready to make data-driven decisions through process change, please contact us and we'll show you how to implement a culture transformation.

References

Kralla, Preston. Providing the business value of big data. 10 December 2015. Web address: https://www.cio.com/article/3013831/proving-the-business-value-of-big-data.html

Know your numbers, know your world!

World as Binary Numbers.png

"All known things have number."

--Pythagoras, Greek mathematician and philosopher


If all the known world is a number, do you know your healthcare world; specifically your patient and operation numbers and how they correlate? Do you know the numbers of other healthcare organizations in comparison to your numbers?

As I write this post the Worldometers.info has reached almost 7.7 billion people. Every one of those people needs healthcare. It blows my mind. What is the healthcare data on 7.7 billion people?

According to Our World in Data, Americans have a life expectancy of 79.2 years. They estimate that the last 11.6 of those 79.2 years are spent living with disability and disease. With the new value-based payment structure and the population aging, how will healthcare organizations manage these populations and keep healthcare organizations fiscally sound?

While we may never know the healthcare data of 7.7 billion people, a healthcare organization could and should know their healthcare world numbers by creating and monitoring its patient and operations data and correlating it to know with 98% accuracy it's demand and capacity at any given time. These collected numbers are called data analytics and are used to manage the world from which the numbers were collected. There are three type of data analytics:

Descriptive Analytics: Uses data aggregation and data mining to provide hind sight into the past to answer the question, “What has happened?”

Predictive Analytics: Uses statistical models and forecast techniques to provide foresight into the future to answer the question, “What could happen?”

Prescriptive Analytics: Uses optimization and simulation algorithms to provide insight into the present and answer the question, “What should we do?”

The Infinitum Healthcare Transformation System looks at a healthcare organization's numbers and applies data analytics to understand what has happened in the past, what could happen in the future, and what is the best practice for the present based on the patient and operations data. Would you like to know the numbers of your healthcare world? Contact Infinitum to learn more.

References

Our World in Data. 14 March 2019. Website address: https://ourworldindata.org/#entries

Pythagoras, Greek mathematician and philosopher. 11 March 2019. Website address: https://www.google.com Searched: All Known Things have Number

Wikipedia. 14 March 2019. Website address: https://en.wikipedia.org Searched: Descriptive, Predictive, Prescriptive Analytics

World Population. 13 March 2019. Website address: http://www.worldometers.info/world-population/

Data Goes with the Flow!

In healthcare organizations, the data goes with the flow of the patient. Every step a patient takes creates a data footprint. Data literally follows the patient through the patient pathway within the healthcare organization like bread crumbs in the forest. When data is collected over a length of time, predictive data exists that can actually predict where the bread crumbs will fall with 98% accuracy within a given day, month, and season!

The first question is: are you collecting this data? It is important to collect this data in order to optimize patient flow throughout the healthcare organization as it is essential to ensuring safe, high-quality, patient-centered care.

The second question is: do you know what to do with the data? When this data is applied, for example, to a current state value stream map clinicians can see where waste exists by assessing the problem areas and identifying major areas of opportunity for change. Or maybe you'd like to balance demand and capacity through load leveling?

The Infinitum Healthcare Transformation System is based on the lean Toyota Production System that provides the right care at the right place and at the right time. Waste is removed from the patient pathway by the people doing the work as lean methodologies are learned such as visual management. Employees learn to work as a collaborative team and individual QI experts resulting in innovative problem-solving. When data is collected, monitored, and analyzed through the lens of system thinking the healthcare organization can ensure that capacity can meet the demands for services, prevent overcrowding, create predictable scheduling, and calculate the return on investment.

Last question: would you like to go with the flow of your patient data? Contact Infinitum! We will customize a learning package that fits your healthcare organization size and implement actionable strategies, transferable knowledge, and ensure a data-driven work culture.

Blog Index

You don't know what you don't know!

Up Arrow Over Time.png

It's true, you really don't know what you don't know until you become aware of it. This is more than an amusing adage as it speaks to the need for information. Information that reveals factual data to create awareness. According to Google, awareness is the "knowledge or perception of a situation or fact." Ever wonder if something is really true? Your mind tells you one thing and your gut tells you another. Somehow the human heart negotiates between the two to make a decision. But how do you know if it's the right decision until you have all the information?

When data is collected and analyzed, it reveals truth and provides knowledge. What is something you'd like know? How about the demand and capacity of your healthcare organization? Would you like to know how many people in the population you serve need to be seen and how often? Would you like to know if these patients are being scheduled correctly? Would you like to know if your demand and capacity line up? Even if your gut had a crystal ball you would never be able to guess that information. What do you need? Data! And lots of it. Preferably a year's worth, and it can be pulled from your EMR. A year's worth of data to show the fluctuations from day to day, month to month, and season to season. For example, in the fall you know you're going to have a lot of flu vaccine appointments and sport physicals before school starts. Or maybe your data will show that Mondays are consistently over scheduled.

Upper & Lower Control Limits.PNG

Now that you have the data, what are you going to do with it? Here are some basic steps:

  • Sort the patient data by provider and appointment to create upper and lower control limits. You quite literally can see the demand over time; days, weeks, months, and seasons. (There is so much you can do with this information including the takt time of the practice. We will discuss this more later, but for now, let's stay focused on demand and capacity.)

  • Pull your EMR procedure list and sort them by time to create service families.

  • Perform a patient time study on procedure time.

  • Compare the appointment times against the actual visit time.

  • Perform a root cause analysis to determine why the appointment times and actual visit time do not match.

  • Create a countermeasure plan to address the service family deltas.

  • Complete another patient time study to confirm that procedures are now correctly organized within the service family.

  • Analyze how many clinical hours and compare against demand.

  • Perform a root cause analysis to determine why the schedule does not accommodate the population.

  • Create a countermeasure plan to address the demand and capacity deltas to adjust the work load and alleviate burnout.

We've all heard the term "data-driven decision making." Why has this become so popular in system thinking? Because without data you do not have the information you need to become aware of the situation and make the most informed decision. Data will back up any decision reliably. The numbers don't lie, but your gut can. Would you like to know what you don't know using data? Contact Infinitum, the healthcare transformation system that relies on data!

balancing_capacity_demand.jpg

References

Awareness, defined by Google. 26 February 2019. Web address: https://www.google.com/search?q=definition+of+awareness&rlz=1C1CHBD_en&oq=definition+of+awareness&aqs=chrome..69i57j0l5.4398j1j7&sourceid=chrome&ie=UTF-8#dobs=awareness

Love my work!

Have you heard yourself tell other people those three little words? If you haven't, have you taken the time to ask yourself why? Obviously, you're passionate about your patients, the work that you do, and the people you affect or you wouldn't be where you are. Right? So what are the items that fall under the "con" column in your work life?

Lack of joy at work affects everyone in healthcare, but let's look at what a physician might have in their "con" column. According to Medscape's National Physicians Burnout, Depression & Suicide 2019 Report, 44% of the physicians surveyed in October 2018 reported that they felt burned out. And what were the top three biggest contributors? Too many bureaucratic tasks, spending too many hours at work, and "increasing computerization of practice." According to the Advisory Board's 2019 survey report, 21% of a physician's work hours are spent on non-clinical paperwork, and 54% stated they were emotionally exhausted. Sadly, this data confirms what you already know: we have a national crisis in American healthcare.

So, how is this crisis being addressed? Physicians were also asked how they cope with burnout and the top three answers were: exercise, talk with family members and close friends, and "isolate myself from others." Can you see how the root cause of the problem is not being addressed and the coping tactics are just a bandage for the real problems? There are people working together across the healthcare industry to try and find a solution for the future, but what about right now?

Infinitum can offer you a "right now" solution: assessment, transference of lean knowledge, root cause analysis, countermeasure projects, and implementation. The Infinitum Healthcare Transformation System begins with an assessment by an Infinitum Consultant, a lean healthcare expert, who will evaluate the healthcare organization for:

  • Current improvement methodology.

  • Strategic alignment of the board of directors, executives, management and frontline staff with respect to the organization's goals.

  • Alignment of overall priorities in the adoption of a lean management system.

  • Behaviors and policies that demonstrate implicit or explicit principles and expectations of leaders and staff that can accelerate or impede the adoption of a lean healthcare management system.

  • The consistency of the day-to-day approach of implementing process improvements that will provide sustainable growth and benefits to future growth strategies.

  • Enable a multidisciplinary group of stakeholders as participants to envision, simulate and co-create a future-state vision for implementation.

After the assessment, the Infinitum Consultant will customize a learning and training package for the healthcare organization based on the desired level of implementation. Infinitum offers lean healthcare methodology through the Infinitum University online education modules; on-site or virtual workshops, training, and certification for your quality improvement people or the organization as a whole; and consultant support at every level of the chosen learning and training package. Infinitum consultants are experienced multidisciplinary transformation experts who will assist a healthcare organization to design and promote a consistent day-to-day approach to implementing process improvement across the healthcare organization; achieving a sustainable culture of change and collaboration, and operations fine-tuned to deliver value to your patients while improving work relationships and reducing the mental load.

At Infinitum we help people address their "con" column by addressing the root causes within a given healthcare organization. Would you like to hear yourself say, "Love my work?!" What are you doing "right now" to improve your joy at work? Contact Infinitum!

Graphs provided by Medscape's National Physicians Burnout, Depression & Suicide 2019 Report:

Burnout Cause Picture.PNG
Physicians Cope.png


References

Hasan, Hamza Hasan. Research Division Practice Manager of The Advisory Board Company. 18 January 2019. Web address: https://www.advisory.com/daily-briefing/2019/01/18/burnout-report

Kane, Leslie. "Lifestyle Burnout and Depression. Medscape. 16 January 2019. Web address: https://www.medscape.com/slideshow/2019-lifestyle-burnout-depression-6011056

Love My Work

For the love of Lean!

Organizations love lean because it works when properly implemented. This implementation requires that the whole team be willing to look at healthcare through the lens of data and become reliant on data-driven decisions. Yes, this process improvement methodology came from car manufacturing, however, it is transferable when it comes to reducing inefficiencies and improving patient value with their healthcare being the end product. Lean has three key goals:

  1. Eliminate waste

  2. Value employees

  3. Continually improve

What is interesting about the three goals is that they work synergistically. You cannot meet one goal without meeting the other goals. Through the inclusive process of eliminating waste by focusing on non-value added activity; keeping inventory low by only storing what is needed when it is needed; embracing technology to provide data and reduce manual labor, valuing employees by developing people, and continuously improving by focusing on the root causes the synergy happens. Healthcare organizations across the country are learning to love lean as their awareness of the transformation in the way they look at the patient flow via data grows.

Recently the Infinitum Transformation Team was conducting a Value Stream Map Workshop, also known as the Transformation Acceleration Program or TAP Workshop. At the table was a representative from each work area discussing delay area 2 on their current state value stream map. One of the delays was that the "providers were running late." Through the 5-why root cause analysis it came down to the providers being late because the previous appointment took longer than expected. This happens, but upon further investigation, it was discovered that this happens frequently as in more than 50% of the time. The Infinitum Transformation Team walked them through the data mining process of figuring out their demand and capacity so that they are now scheduling patients within the appropriate time slots by creating service families; processes were reconfigured to meet the time limitations; and they learned how to create a demand chart from their data showing upper and lower control limits to address the patient demand variations with 98% accuracy.

Lean on lean; it's reliable! Contact us to learn how your organization can transform for the love of lean.

References

Dunn, Lindsey. "5 Key Principles for Hospitals from Toyota's Lean Production System." Becker's Hospital Review. 17 Sept, 2009. Web address: https://www.beckershospitalreview.com/news-analysis/5-key-principles-for-hospitals-from-toyotas-lean-production-system.html

The Heart of the Matter!

The heart of lean healthcare is to create value by eliminating waste. It's hard to imagine that there is any waste when all efforts are for the patient. After all, where would the human race be without medicine and the professionals that care for us? So let's define waste within the framework of patient flow. Waste is the non-value added activities or the inefficiencies within a given process or workflow of a system; in this case, healthcare. Gain or value-added services are what the patient is willing to pay for. Every step in a process is either value added or it non-value added. Non-value added activities fall within these eight categories:

  • Defects: Poor labeling of tests, incomplete referral instructions or missing information in patient charts.

  • Excess Inventory: The cost to store, manage, and maintain (e.g., monitor expiration dates) is greater than the savings of buying in bulk (e.g., latex gloves).

  • Excess Transportation: Moving patients back and forth, moving information, and moving lab tests.

  • Excess Motion or Movement: Lifting, bending, and reaching more than is necessary. Not having the things that are used most often closest to your work; this includes equipment.

  • Overproduction: By producing in excess, faster, or earlier than needed (e.g., producing “just in case” IV solutions, or batching lab samples).

  • Over Processing: Re-testing, extra labels on charts, multiple insurance claim forms.

  • Unused Talent or Creativity: Sharing of knowledge and ideas, working to the top of a license or skill level, and a safe culture that respects creativity.

  • Waiting or Reoccurring Delays: Waiting to be roomed, waiting to see the provider, or waiting for an x-ray are a few examples.

According to Maureen Bisognano, President Emerita of the Institute for Healthcare Improvement and a Senior Fellow, the top reason to improve patient flow is to reduce patient that feels disrespectful to patients and families. This stress on the patient is also stressful on the clinicians and staff because it negatively affects them and creates burn out. Lean provides a way to create a more effectively designed and managed process that supports clinicians and staff morale resulting in increased joy at work, reduced stress, and increased productivity and job satisfaction.

There are opportunities to remove non-value added activities within the interconnected processes in any and all healthcare systems. Lean is a multi-faceted methodology that requires a simultaneous application within a healthcare organization in the micro, meso, and macro work levels. The Infinitum Healthcare Transformation System is designed to work with and integrate all three levels:

Level Picture.PNG

Some lessons from the field have taught the Infinitum Transformation Team:

  • It starts with leadership. Employees look to leadership for permission to be innovative, autonomous, and collaborative within a team.

  • Purpose (sets the direction), Process (how people do it), and People (organizational values that drive action). A shared vision is a co-created story that everyone plays a part in. Sustainable change happens when everyone moves in the same direction while aligning their actions to a shared vision.

  • The vital few must be identified. A system-wide transformation requires representation from each work area. It was Italian economist Vilfredo Pareto that reported in 1906 that 80% of the land was held by 20% of the people. He also noticed that 20% of the pea pods in his garden produced 80% of the peas. This principle of factor sparsity or the law of the vital few is known as the Pareto Principle. This statistical distribution of data states that 80% of a specific event can be explained by 20% of the total observation, or 20 percent of an activity will account for 80 percent of the results. Therefore, the 80-20 rule is a very helpful concept for life, time management, and work. A modern day example, Microsoft observed that 80% of the operating system crashes were eliminated by fixing 20% of the most reported bugs.

  • Identify issues through learning rather than blame. Learning is a curiosity rather than an assumption. The Infinitum Transformation Team asks "why" rather than "who."

  • Customer satisfaction through patient flow is the patient's perspective on how they move through a healthcare system.

  • Methods matter as much as results.

  • Back to the data; always back to the data. Not only the average, minimum, and maximum, but how often and within what control limits?

Healthcare organizations are businesses providing a service, and like all businesses, they need to focus on achieving a positive ROI (return on investment) to stay in business. The lean process can give you between 20%-60% cost savings and more work capacity which equals more profit. Lean methodology provides evidence that quality improvements are sustainable in the long term and are culture changing. The Infinitum Healthcare Transformation Team can help you get at the heart of the matter!


References

Bisognano, Maureen. "Flow Failures are Disrespectful to Patients." Institute for Healthcare Improvement. 25 Aug, 2016. Web Address: http://www.ihi.org/communities/blogs/flow-failures-are-disrespectful-to-patients

Teich, Sorin T and Fady F Faddoul. “Lean Management-the Journey from Toyota to Healthcare” Rambam Maimonides medical journal vol. 4,2 e0007. 30 Apr. 2013, doi:10.5041/RMMJ.10107. Web Address: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678835/

Tracy, Brian. "The 80-20 Rule Explained." No date. Web Address: https://www.briantracy.com/blog/personal-success/how-to-use-the-80-20-rule-pareto-principle/

Kenton, Will. Reviewed 80-20 Rule. 29 May, 2018. Web Address: https://www.investopedia.com/terms/1/80-20-rule.asp