Posted by: Knightbird | December 15, 2011

Lots of Waste

I read a regular CEO newsletter from a large health organization that does not use lean as its management system and has been concerned about how its patients from out of town are handled. It has been a huge controversy for a long time and I have written about it before. As with many organizations, if the funds are available to throw at the problem, that’s what happens. And, surprise , surprise, that’s what is happening. More employees are being added regularly to accommodate the problem, not necessarily improve it. There is no standard work, no training to standard work or continuous improvement. I blogged about a meeting I attended a couple of weeks ago to talk about this very same topic. It was clear from the meeting that all of the parts of the organization are siloed, coordination is non-existent and there is no buy in for improvement.

The message to employees involved with that patient is that you will drop what you are doing in order to accommodate that patient. So, bad processes not only impact the value stream that caused the problem, it impacts many other value streams by allowing work arounds to happen. There are sure a lot of Capes waiting to be awarded with this action. (Capes are those workers who know all of the work arounds and people flock to in order to have their problem solved. I learned this from Virginia Mason, you know, “Here I come to save the day.” That’s a reference to Mighty Mouse.)

So what is the consequence of this action? It is actually greater cost for our health care system. And since we have no more funds than what we already have, some services will have to diminish as a consequence. Crutch positions, and crutch actions, increase the cost of doing business. That’s a given.

Because I have been trying to recruit original thinkers to improve the process that cause this problem since 2007 with little success, I get frustrated. That’s why I blog about it. My Sensei and my many friends in the world of Lean have given me a great education on different thinking. Different thinking is what this problem requires. Instead, we are getting an Executive Coordination team, a new care coordination division with a significant number of employees and orders to accommodate patients by all means available. I am pretty sure that there will be a bit of blame and share spread around by this method as well.

So what’s the solution? A new Executive? They are getting one. Another consultant? They have gone through a lot of them already and I am sure others are being looked at. The CEO letter tells me that they have run out of ideas. WHY NOT TRY LEAN. We have a number of people here who can define the problem through a problem statement in a few hours. We have the same people who can map the current state in a day. The same people can lead a future state mapping event in another day, then do a problem solving and brain storming session in a couple of hours. After that, it’s just project management along with motivating and inspiring the employees involved. In my experience, results are certain in far fewer than the 5 years I have been working on the problem.

Thanks for letting me vent.



  1. Knightbird, you say “The message to employees involved with that patient is that you will drop what you are doing in order to accommodate that patient.” I know a mental health worker that was written up for being late to one of those infernal wasteful meetings becaues she worked over time with a patient in crisis. So I don’t understand that it is wrong to accommodate the patient.
    The problem is the clients are not being accommodated, the mission is being forgotten as the monster of an entitiy grows to feed itself. All over the US entitys are gobbling up money from feds and states. Everyday they hire more people have more meetings all in order to grow bigger to get more money to grow bigger etc etc. There is so much waste of time on meetings about meetings about projects.
    I recently heard of a program called Sheilds in California. I have done some research and they have good numbers of folks who are sucessful and graduate from there program. They have alot of programs, don’t work in fancy highdollar buildings and stick to the mission.
    I also hear there is a chance something like them may happen in Alaska if someone gets the RFP that can make a buisness plan.

    Why don’t you do it?? You could design it to be lean. Maybe finally in Alaska there would be help for people instead of alot of talk about health for the people.

  2. I was not real clear about my point and I apologize. The part of the value stream I am referring to is after the patient arrives in Anchorage and before they see a provider. Because of substantial variance among patients and their referral to Alaska Native Medical Center, many patients show up without housing and no appointments or appointments that are far apart. What management is saying is that all employees must step in to correct the problem (defect). This is a problem that can go away with good application of the lean culture. These employees are being asked to abandon their standard work to attend to a defect thus creating waste in their own value stream. This explanation will be clear to lean practitioners, but not to most other managers. Thanks for the observations and the information. I do appreciate thoughtful comments. 🙂

  3. So are you saying instead of all employee’s tackling the defect to ask one employee to schedule appointments and housing for incoming patients and family?
    That does seem like a simple fix that one employee could cover.

    I had not realized so many people come to town without planing on a place to stay. To bad the designers of the hospital didn’t also build housing in a village style. But no sense worrying what might have been.

    I am not trying to be disrespectful just wondering. You have a place of power in the community and write a blog. I do not have the learning that you have so just curious.
    What do you need to help you do more? Is there a way to “fix” what exists or is it to late for existing corporations to learn to run lean.

    One last question. Do you ever hold workshops on the lean theory and methods? I would be very interested in attending.

    Respectfully Alatkaqtuq

  4. Actually, no I am not offended nor do I feel disrespected. Our method of improvement is team directed. If one employee notices the defect, they can fix it if they are capable. if not, they are to write a problem statement with a team, go see the problem, analyze the current state, visualize the future state, and work together to find solutions. The problem is quite complex and it’s not like people are coming to town without planning on a place to stay. They should have one, and it is likely a lack of communication and planning that is the problem.
    It is never to late to learn to run Lean, but it is not an easy path. We don’t currently hold training sessions, but you are more than welcome to come visit and see how we work.

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