1 00:00:00,000 --> 00:00:25,320 Azure Lamb 2 00:00:25,320 --> 00:00:32,800 Hi, and welcome to Be The Flagship with our podcast host, Jeff Parsons. 3 00:00:32,800 --> 00:00:37,080 This is where we tackle the day-to-day talent management challenges you face, particularly 4 00:00:37,080 --> 00:00:39,760 in hospice and small healthcare organizations. 5 00:00:39,760 --> 00:00:41,480 And now over to our host. 6 00:00:41,480 --> 00:00:43,600 Take it away, Jeff. 7 00:00:43,600 --> 00:00:48,000 Hello, happy new year and welcome to Be The Flagship. 8 00:00:48,000 --> 00:00:51,080 I'm your podcast host, Jeff Parsons. 9 00:00:51,080 --> 00:00:55,920 I hope you had a great holiday season and you're ready to get 2024 off to a great start. 10 00:00:55,920 --> 00:00:57,460 I know I am. 11 00:00:57,460 --> 00:01:03,960 So I've dedicated all of the episodes in January to topics related to process improvement and 12 00:01:03,960 --> 00:01:05,120 healthcare. 13 00:01:05,120 --> 00:01:09,820 So I hope we brought a notepad and a pen because you're really going to want to take notes. 14 00:01:09,820 --> 00:01:14,040 And we're starting off with an exceptional guest speaker. 15 00:01:14,040 --> 00:01:18,160 So let's take a quick break and I'll be back with the introduction. 16 00:01:18,160 --> 00:01:20,040 Is your team in need of alignment? 17 00:01:20,040 --> 00:01:23,480 Do you need to develop your team through a team building event? 18 00:01:23,480 --> 00:01:27,100 If so, contact a team building expert today. 19 00:01:27,100 --> 00:01:31,640 Contact Jeff at 1-800-530-4189. 20 00:01:31,640 --> 00:01:33,120 Extension 101. 21 00:01:33,120 --> 00:01:35,680 And take your team to the next level. 22 00:01:35,680 --> 00:01:36,960 Okay. 23 00:01:36,960 --> 00:01:39,600 Let's talk about our guest speaker. 24 00:01:39,600 --> 00:01:48,320 And his name is Terry Norris, MBA and a Lean Certified Master Black Belt. 25 00:01:48,320 --> 00:01:54,200 He is a full-time Lean Consultant, Speaker and author of the book, How to Make Lean Work 26 00:01:54,200 --> 00:01:55,880 in Your Hospital. 27 00:01:55,880 --> 00:02:03,840 He has trained over 1,800 hospital leaders and 150 plus hospitals on Lean concepts, principles 28 00:02:03,840 --> 00:02:08,980 and specifically on how to lead a Lean transformation. 29 00:02:08,980 --> 00:02:15,760 As a consultant, he's helped multiple hospitals develop a Lean strategic implementation plan. 30 00:02:15,760 --> 00:02:22,440 He's led dozens of frontline rapid improvement events in all major hospital departments, 31 00:02:22,440 --> 00:02:27,800 saving millions of dollars through efficiencies and significantly increasing revenue through 32 00:02:27,800 --> 00:02:31,280 new strategic options. 33 00:02:31,280 --> 00:02:35,040 Terry's Lean experience is diverse and extensive. 34 00:02:35,040 --> 00:02:40,720 He's provided Lean consulting services for the federal government, the military and multiple 35 00:02:40,720 --> 00:02:42,000 industries. 36 00:02:42,000 --> 00:02:47,960 Some of these industries include manufacturing, healthcare, pharmaceuticals, airlines, construction, 37 00:02:47,960 --> 00:02:54,160 public utilities, professional services and cellular services. 38 00:02:54,160 --> 00:02:58,600 Terry also served in the US Air Force for 25 plus years. 39 00:02:58,600 --> 00:03:00,400 Thank you for your service, Terry. 40 00:03:00,400 --> 00:03:06,320 In his last role, he was the Lean leader for a complex organization with 5,500 people at 41 00:03:06,320 --> 00:03:10,360 five locations in four European countries. 42 00:03:10,360 --> 00:03:15,400 Terry established the organization's Lean structure and developed a strategic and tactical 43 00:03:15,400 --> 00:03:23,600 plan that delivered 55 major improvement projects, saving millions of dollars through direct 44 00:03:23,600 --> 00:03:27,080 savings and cost avoidance. 45 00:03:27,080 --> 00:03:34,600 Terry has also taught graduate and undergraduate courses in Lean deployment, strategic management 46 00:03:34,600 --> 00:03:41,640 leadership, operations management and project management for 18 years. 47 00:03:41,640 --> 00:03:46,540 So again, we're privileged and honored to have with us today, Terry Norris. 48 00:03:46,540 --> 00:03:48,600 So Terry, thank you for joining us today. 49 00:03:48,600 --> 00:03:49,600 For sure. 50 00:03:49,600 --> 00:03:51,280 Thanks for the opportunity. 51 00:03:51,280 --> 00:03:57,600 So this episode is an introduction to Lean in healthcare. 52 00:03:57,600 --> 00:04:00,580 So let's just start with Lean itself, Terry. 53 00:04:00,580 --> 00:04:06,400 So can you briefly tell us the origins of Lean, where it came from? 54 00:04:06,400 --> 00:04:13,200 Yes, and I will give you just that, a brief overview of it. 55 00:04:13,200 --> 00:04:16,880 Because it's quite detailed and it goes back for centuries, the little nuances and the 56 00:04:16,880 --> 00:04:18,320 tools and things like that. 57 00:04:18,320 --> 00:04:26,000 But Toyota originated or Toyota, Lean originated with Toyota from the Toyota production system. 58 00:04:26,000 --> 00:04:29,880 And that's really the origin of Lean as we know it today. 59 00:04:29,880 --> 00:04:36,000 You can say Toyota production system or Lean and you're essentially saying the same thing. 60 00:04:36,000 --> 00:04:42,600 There's been a few minor changes in America, especially with the Lean compared to that, 61 00:04:42,600 --> 00:04:44,000 but it's very, very close. 62 00:04:44,000 --> 00:04:46,160 It's again, almost the same. 63 00:04:46,160 --> 00:04:47,160 Okay. 64 00:04:47,160 --> 00:04:52,400 So again, with Toyota, so it sounds like a manufacturing concept. 65 00:04:52,400 --> 00:04:55,360 So can you define Lean healthcare? 66 00:04:55,360 --> 00:05:03,080 Yes, and I will say too, it definitely was a manufacturing concept. 67 00:05:03,080 --> 00:05:08,480 It was used there and the ideas and the concepts came from there. 68 00:05:08,480 --> 00:05:13,280 But the principles and the ability to solve problems and to make things better and all 69 00:05:13,280 --> 00:05:16,840 that, that's very universal. 70 00:05:16,840 --> 00:05:21,060 And I'd like to preface the definition of healthcare too by saying it this way. 71 00:05:21,060 --> 00:05:25,960 When I got into Lean kind of full time, especially when I was on my own as an independent Lean 72 00:05:25,960 --> 00:05:31,280 consultant and I'm talking to people about it, when I give the standard definition of 73 00:05:31,280 --> 00:05:36,160 Lean, talking about a management system to eliminate waste and all that, most people 74 00:05:36,160 --> 00:05:40,240 would, I could almost literally see them starting to yawn. 75 00:05:40,240 --> 00:05:46,840 So I realized early on that in order for people to understand really what Lean should be, 76 00:05:46,840 --> 00:05:48,760 I created a different description. 77 00:05:48,760 --> 00:05:53,440 So anyways, this is the description that I came up with to help people understand Lean 78 00:05:53,440 --> 00:05:56,640 healthcare and really Lean in general. 79 00:05:56,640 --> 00:06:01,520 But it goes like this, Lean is a function of leadership, a secret weapon that will significantly 80 00:06:01,520 --> 00:06:07,160 improve patient care and give your hospital an unfair competitive advantage. 81 00:06:07,160 --> 00:06:12,180 Lean healthcare is a system-wide strategy for achieving excellence. 82 00:06:12,180 --> 00:06:16,860 And then that's really the big part I want leadership to understand. 83 00:06:16,860 --> 00:06:20,960 And then I go on with a couple of bullets or three bullets by creating value from the 84 00:06:20,960 --> 00:06:26,200 customer's perspective, by creating a culture of continuous performance improvement and 85 00:06:26,200 --> 00:06:31,560 working to eliminate all waste of resources and time, by creating high quality stable 86 00:06:31,560 --> 00:06:36,720 processes and emphasizing respect for people throughout the organization. 87 00:06:36,720 --> 00:06:40,920 So that definition is really more of a description, although it includes what you would generally 88 00:06:40,920 --> 00:06:42,480 hear from the definition. 89 00:06:42,480 --> 00:06:48,880 But it helps people see that it's much bigger than just tools and eliminating waste, which 90 00:06:48,880 --> 00:06:52,360 is not really clear to a lot of people anyway when you first say that. 91 00:06:52,360 --> 00:06:56,360 So hopefully it helps people understand what you're getting into when you say you want 92 00:06:56,360 --> 00:06:57,760 to get into Lean healthcare. 93 00:06:57,760 --> 00:06:58,760 Okay. 94 00:06:58,760 --> 00:07:06,640 Yeah, I mean, I'm aware of healthcare professionals who have attended Lean in healthcare certification 95 00:07:06,640 --> 00:07:07,960 workshops. 96 00:07:07,960 --> 00:07:12,920 And one of their frustrations is that when they walk away, they're still in their mind 97 00:07:12,920 --> 00:07:19,300 is not that link in terms of knowledge versus application. 98 00:07:19,300 --> 00:07:22,460 So hopefully we can address that as we have our discussion. 99 00:07:22,460 --> 00:07:26,720 So let's get into, I mean, Lean has numbers, right? 100 00:07:26,720 --> 00:07:31,160 Two Lean pillars, five principles of Lean, eight types of waste. 101 00:07:31,160 --> 00:07:33,620 So let's start with the two Lean pillars. 102 00:07:33,620 --> 00:07:35,500 What are they? 103 00:07:35,500 --> 00:07:40,160 The two Lean pillars are continuous improvement and respect for people. 104 00:07:40,160 --> 00:07:44,400 And this is from the Toyota Way model house. 105 00:07:44,400 --> 00:07:48,640 And within those two pillars, when I do Lean training, I tell folks, I say, listen, you 106 00:07:48,640 --> 00:07:54,000 know, I realize that some of you guys are never going to become Lean zealots, but there 107 00:07:54,000 --> 00:07:56,800 are things that you're going to listen to, you're going to hear, you're going to learn 108 00:07:56,800 --> 00:07:59,440 that can help you no matter what you ever do. 109 00:07:59,440 --> 00:08:02,280 And this is, these are a couple of those. 110 00:08:02,280 --> 00:08:07,420 So the idea of continuous improvement, when I think of that and I think of the fifth principle 111 00:08:07,420 --> 00:08:12,080 of Lean perfection, which we may get to, they're really interconnected. 112 00:08:12,080 --> 00:08:17,220 And so to say continuous improvement, just one, the idea of the words kind of give you 113 00:08:17,220 --> 00:08:23,180 what the idea is to continuously make things better and continue to do so over time. 114 00:08:23,180 --> 00:08:31,080 But unless that becomes part of your culture and the mindset of the people that work there, 115 00:08:31,080 --> 00:08:33,400 it's not, it's probably not going to happen. 116 00:08:33,400 --> 00:08:39,960 And that's more the general idea of continuous improvement is changing the culture and having 117 00:08:39,960 --> 00:08:42,800 a mindset where people think that way. 118 00:08:42,800 --> 00:08:45,200 So the second pillar is respect for people. 119 00:08:45,200 --> 00:08:50,120 And with that, it can make all the difference in the world with the first pillar, that the 120 00:08:50,120 --> 00:08:52,440 idea of changing the culture. 121 00:08:52,440 --> 00:08:57,040 But when you think of respect for people, people generally think of what's most common, 122 00:08:57,040 --> 00:09:01,120 that you treat people like you want to be treated, that you're kind, that you ask for 123 00:09:01,120 --> 00:09:02,720 people's opinion. 124 00:09:02,720 --> 00:09:04,000 And all of that is true. 125 00:09:04,000 --> 00:09:09,240 And things like schedule, work-life balance should all be taken into consideration. 126 00:09:09,240 --> 00:09:13,480 But with Lean, the idea of respect for people is a bit different. 127 00:09:13,480 --> 00:09:19,040 The idea of, it's more like, the best way I can describe it is think back in your life 128 00:09:19,040 --> 00:09:25,400 when somebody, whether it's a parent or coach or music teacher or professor, somebody, they 129 00:09:25,400 --> 00:09:30,480 pushed you to perform better than you are currently performing. 130 00:09:30,480 --> 00:09:34,880 They didn't allow the mediocre or even just the normal good. 131 00:09:34,880 --> 00:09:36,920 They pushed you. 132 00:09:36,920 --> 00:09:41,000 Those are the people that we generally think about, that we respect, that we admire, that 133 00:09:41,000 --> 00:09:44,280 they brought us along, that helped us become who we are now. 134 00:09:44,280 --> 00:09:46,620 And that's more the idea of respect for people. 135 00:09:46,620 --> 00:09:50,080 So when you have a culture where you're pushing people, you're challenging people, you're 136 00:09:50,080 --> 00:09:55,360 pushing in a good way, but you're challenging them to become better and better and better, 137 00:09:55,360 --> 00:09:59,640 those are, that's the type of organization, the culture with the continuous improvement 138 00:09:59,640 --> 00:10:03,200 and respect for people that can really make all the difference in the world. 139 00:10:03,200 --> 00:10:04,200 Okay. 140 00:10:04,200 --> 00:10:05,200 That's interesting. 141 00:10:05,200 --> 00:10:12,440 And it's certainly, when you describe it in that manner, it's certainly universal to all 142 00:10:12,440 --> 00:10:17,020 types of businesses and industries and organizations. 143 00:10:17,020 --> 00:10:20,360 It's a mindset and it's a cultural phenomenon. 144 00:10:20,360 --> 00:10:21,360 Yes. 145 00:10:21,360 --> 00:10:22,840 Absolutely true. 146 00:10:22,840 --> 00:10:27,240 Most of the things that we will talk about, they work in the same way. 147 00:10:27,240 --> 00:10:30,720 They would be applicable across industry. 148 00:10:30,720 --> 00:10:35,720 So let's talk about the five principles of lean, Terry. 149 00:10:35,720 --> 00:10:36,860 Okay. 150 00:10:36,860 --> 00:10:43,000 With a quick summary, the five principles are value, value stream, flow, full, and perfection. 151 00:10:43,000 --> 00:10:45,080 And I'll talk just a little bit about each. 152 00:10:45,080 --> 00:10:49,280 So for me, value and value stream are easier to explain together. 153 00:10:49,280 --> 00:10:55,720 But the idea of value is what's considered value from the perspective of the customer. 154 00:10:55,720 --> 00:11:01,400 And we all think that sort of, you know, intuitively, well, that's kind of a norm. 155 00:11:01,400 --> 00:11:06,960 However, when you look at it from a lean perspective, we go just a little bit deeper. 156 00:11:06,960 --> 00:11:12,760 The idea of lean and the value, it's an emphatic about what's the customer understanding and 157 00:11:12,760 --> 00:11:13,920 what the customer wants. 158 00:11:13,920 --> 00:11:18,440 And then the value streams are all the steps in the process. 159 00:11:18,440 --> 00:11:23,280 And because of that, it forces us, even if we have 150 steps, we look at each one and 160 00:11:23,280 --> 00:11:24,720 say, does that add value? 161 00:11:24,720 --> 00:11:27,120 Does that add value all the way through? 162 00:11:27,120 --> 00:11:31,840 And then we have a much better picture of what adds value from the customer's perspective. 163 00:11:31,840 --> 00:11:35,320 So value stream is simply all the steps in the process. 164 00:11:35,320 --> 00:11:38,940 And the third principle is flow. 165 00:11:38,940 --> 00:11:44,320 And the idea that that value flows perfectly without stop, without rework, it just flows 166 00:11:44,320 --> 00:11:45,320 nicely. 167 00:11:45,320 --> 00:11:48,880 And a matter of fact, all the tools that we use and everything that we do generally is 168 00:11:48,880 --> 00:11:54,520 to help things flow, help processes flow by eliminating waste and all of that. 169 00:11:54,520 --> 00:11:59,840 Then you have pull, which is probably one of the least understood, I would suppose, 170 00:11:59,840 --> 00:12:01,320 especially outside of manufacturing. 171 00:12:01,320 --> 00:12:06,000 But I'll give you a quick healthcare example. 172 00:12:06,000 --> 00:12:10,360 And I will try to not get into the great level of details, but this actually happened and 173 00:12:10,360 --> 00:12:12,880 the story isn't exaggerated to make a point. 174 00:12:12,880 --> 00:12:18,240 But I was doing observations and surgery one morning, had a mid-size hospital. 175 00:12:18,240 --> 00:12:21,240 And at eight o'clock in the morning, all the people that were having surgeries for the 176 00:12:21,240 --> 00:12:24,840 whole day were already checked in. 177 00:12:24,840 --> 00:12:30,160 And I asked the registration director there, the patient access director, I said, so where's 178 00:12:30,160 --> 00:12:31,160 everybody at? 179 00:12:31,160 --> 00:12:35,720 You know, and they were, they're like, they've all been checked in and the individual was 180 00:12:35,720 --> 00:12:36,720 serious. 181 00:12:36,720 --> 00:12:37,720 So I said, okay. 182 00:12:37,720 --> 00:12:40,900 And even if they had a surgeon at 2.30, like, yes. 183 00:12:40,900 --> 00:12:45,120 I went to the pre-op area and of course there was a lot of people there. 184 00:12:45,120 --> 00:12:48,440 You know, I saw, I asked the people that worked there, I said, so what does your patients 185 00:12:48,440 --> 00:12:49,440 think of this? 186 00:12:49,440 --> 00:12:51,320 You know, and they were very nice people. 187 00:12:51,320 --> 00:12:54,360 They're like, just smile and said, they hate it, you know, especially the one that have 188 00:12:54,360 --> 00:12:55,360 later surgeries. 189 00:12:55,360 --> 00:12:59,480 And then I went to the holding area, which where they repeated the same thing that happened 190 00:12:59,480 --> 00:13:04,600 in pre-op and it was near surgery on another floor. 191 00:13:04,600 --> 00:13:07,080 And there was a lot of people there, a lot of people there, people that were going to 192 00:13:07,080 --> 00:13:10,020 be having surgery several hours later. 193 00:13:10,020 --> 00:13:12,480 So there's much more to that story. 194 00:13:12,480 --> 00:13:17,460 But the idea is that they, they pushed people through the system. 195 00:13:17,460 --> 00:13:20,760 Registration wasn't ready to have all that, that many people come in at 5.30 or six in 196 00:13:20,760 --> 00:13:22,160 the morning. 197 00:13:22,160 --> 00:13:24,400 Pre-op wasn't ready to handle that many people in surgery. 198 00:13:24,400 --> 00:13:25,400 It definitely wasn't. 199 00:13:25,400 --> 00:13:27,480 So they pushed them through the system. 200 00:13:27,480 --> 00:13:31,340 So if it was pulled, they would have scheduled the surgeries an hour and a half or whatever 201 00:13:31,340 --> 00:13:35,360 the workup time was prior to surgery throughout the day. 202 00:13:35,360 --> 00:13:38,760 Have people come in, do pre-op and go straight into surgery. 203 00:13:38,760 --> 00:13:40,360 Straight into surgery throughout the day. 204 00:13:40,360 --> 00:13:42,840 And that's more the idea of pull. 205 00:13:42,840 --> 00:13:46,680 And then the last one is perfection that I've hit on a little bit already. 206 00:13:46,680 --> 00:13:51,560 And that's the idea where your people, they start, they start thinking that idea of continuous 207 00:13:51,560 --> 00:13:56,560 improvement and they're trained, they're taught, they understand how to do it and they're rewarded 208 00:13:56,560 --> 00:13:57,560 for doing it. 209 00:13:57,560 --> 00:13:59,360 And they're always looking and thinking that way. 210 00:13:59,360 --> 00:14:02,080 How can I make something better? 211 00:14:02,080 --> 00:14:06,160 And the technical definition is, you know, to continuously work, to eliminate all waste 212 00:14:06,160 --> 00:14:07,840 of resources and time. 213 00:14:07,840 --> 00:14:08,840 And that is correct. 214 00:14:08,840 --> 00:14:12,720 But if you can't get that in the minds of the people, they won't go very far. 215 00:14:12,720 --> 00:14:16,960 So in summary, it's value, value stream, flow, pull and perfection. 216 00:14:16,960 --> 00:14:17,960 Thank you, Terry. 217 00:14:17,960 --> 00:14:20,680 And that's a, that's a great example, by the way. 218 00:14:20,680 --> 00:14:28,200 So you know, lean really focuses on waste elimination. 219 00:14:28,200 --> 00:14:31,020 That's my understanding, at least correct me if I'm wrong. 220 00:14:31,020 --> 00:14:34,720 So can you walk us through the various types of waste? 221 00:14:34,720 --> 00:14:35,720 Yes. 222 00:14:35,720 --> 00:14:36,720 And it's funny. 223 00:14:36,720 --> 00:14:40,240 I feel like lean, one of the most well-known things, I suppose, even if you just take a 224 00:14:40,240 --> 00:14:45,320 course on lean or whatever, you're going to say, well, lean is about eliminating waste. 225 00:14:45,320 --> 00:14:50,400 Which is true, but I feel like waste gets all of the notoriety when it's really flow. 226 00:14:50,400 --> 00:14:53,480 You know, why do we even bother eliminating waste and all that stuff? 227 00:14:53,480 --> 00:14:56,000 It's because we want things to flow. 228 00:14:56,000 --> 00:14:59,480 Victoria came up with something they refer to as seven deadly waste. 229 00:14:59,480 --> 00:15:05,720 And one of the things that made them so successful is because they relentlessly go after these 230 00:15:05,720 --> 00:15:07,440 seven deadly waste. 231 00:15:07,440 --> 00:15:13,080 Now over time, there has been one added and I'll mention that when I get to that. 232 00:15:13,080 --> 00:15:22,240 But of the eight types of waste are emotion, transportation, weighting, defects, inventory, 233 00:15:22,240 --> 00:15:27,640 and it's really excess inventory, overproduction, over-processing. 234 00:15:27,640 --> 00:15:33,800 And then the eighth one is underutilization of your staff, of your folks. 235 00:15:33,800 --> 00:15:38,080 And I can give you just one or two examples that ease in a healthcare environment, like 236 00:15:38,080 --> 00:15:43,840 for defects, it could be incorrect or missing information on forms, repeat visits, things 237 00:15:43,840 --> 00:15:45,560 like anything that goes wrong. 238 00:15:45,560 --> 00:15:48,840 Defects is probably the easiest one to explain. 239 00:15:48,840 --> 00:15:51,280 For weighting, okay, I'll take it back. 240 00:15:51,280 --> 00:15:52,280 Weighting is the easiest one. 241 00:15:52,280 --> 00:15:55,560 We've all done that in all aspects of our life. 242 00:15:55,560 --> 00:15:59,920 But weighting for results, weighting to see a doctor, weighting for transportation. 243 00:15:59,920 --> 00:16:04,200 And inventory, again, excess inventory having more than what you need and there's a lot 244 00:16:04,200 --> 00:16:07,600 can be said about that, but I'll leave it at that. 245 00:16:07,600 --> 00:16:11,880 Overproduction is a little bit less understood, but it's really doing more than you're required 246 00:16:11,880 --> 00:16:15,080 to do and doing it sooner than required to do. 247 00:16:15,080 --> 00:16:17,880 And that one can be confusing, especially in a competitive environment. 248 00:16:17,880 --> 00:16:20,320 So don't you want us to do more? 249 00:16:20,320 --> 00:16:23,320 And the answer is we want to give the customer more than they expect. 250 00:16:23,320 --> 00:16:26,360 Yes, but do we want to do more in our processes? 251 00:16:26,360 --> 00:16:27,360 No. 252 00:16:27,360 --> 00:16:32,080 For example, mixing 10 doses of medication when you only need seven, making multiple 253 00:16:32,080 --> 00:16:34,600 copies of forms that are rarely used. 254 00:16:34,600 --> 00:16:37,600 That's overproduction. 255 00:16:37,600 --> 00:16:40,320 Overprocessing is doing more to something than required. 256 00:16:40,320 --> 00:16:46,240 So let's say you need three signatures for something, but you really only need two, but 257 00:16:46,240 --> 00:16:47,680 you have to get three. 258 00:16:47,680 --> 00:16:50,040 That would be overprocessing. 259 00:16:50,040 --> 00:16:54,120 Multiple reviews, approval, things like that. 260 00:16:54,120 --> 00:16:56,080 Transportation is moving things. 261 00:16:56,080 --> 00:17:01,920 Moving things are people unnecessarily so excessively doing more than required. 262 00:17:01,920 --> 00:17:06,720 Moving patients, specimens, supplies, equipment, long distances, multiple bed assignments, 263 00:17:06,720 --> 00:17:09,920 moving patients, things like that. 264 00:17:09,920 --> 00:17:15,000 Motion is moving yourself, basically searching for patients, looking for supplies, reaching 265 00:17:15,000 --> 00:17:16,840 across things in an unsafe way. 266 00:17:16,840 --> 00:17:17,840 It's movement. 267 00:17:17,840 --> 00:17:20,280 It's human movement. 268 00:17:20,280 --> 00:17:24,200 And the underutilization of people is the one that's been added over time. 269 00:17:24,200 --> 00:17:29,680 When Toyota was asked, well, why don't you include that, it was more like, well, that's 270 00:17:29,680 --> 00:17:30,680 a given. 271 00:17:30,680 --> 00:17:31,680 We're going to do that. 272 00:17:31,680 --> 00:17:32,680 We're going to utilize our people. 273 00:17:32,680 --> 00:17:34,120 So they think just a little bit differently. 274 00:17:34,120 --> 00:17:41,440 So if you have people and there's no cross-training, there's no capturing best practices, no considering 275 00:17:41,440 --> 00:17:46,280 suggestions, ideas, things like that, that would be considered some examples of underutilizing 276 00:17:46,280 --> 00:17:47,360 people. 277 00:17:47,360 --> 00:17:51,920 So let's talk about the standard work. 278 00:17:51,920 --> 00:17:56,200 You refer to it as the heart of lane, so can you tell us more about that? 279 00:17:56,200 --> 00:17:57,400 Yes. 280 00:17:57,400 --> 00:18:01,680 So for standard work, in order to be lean at all or to even pretend to be lean, you 281 00:18:01,680 --> 00:18:03,740 have to have standard work. 282 00:18:03,740 --> 00:18:09,680 And I have over the years became, it's became one of my, I don't know, you hate to say passion, 283 00:18:09,680 --> 00:18:12,560 but it's one of the things that I understand that if you don't do it, you're not going 284 00:18:12,560 --> 00:18:13,560 to be able to be lean. 285 00:18:13,560 --> 00:18:18,040 You're not going to have the highest level of consistent quality and things like that. 286 00:18:18,040 --> 00:18:22,680 So the idea of standard work is simply everyone doing the same job the best known way. 287 00:18:22,680 --> 00:18:27,280 And then when somebody makes it better, everybody makes an adjustment and makes it better as 288 00:18:27,280 --> 00:18:28,640 well. 289 00:18:28,640 --> 00:18:32,760 And that's really the most basic definition, but it's the one that I found that people 290 00:18:32,760 --> 00:18:34,800 understand the most. 291 00:18:34,800 --> 00:18:39,080 And it's funny too, as we just talk about standard work, people sometimes resist it. 292 00:18:39,080 --> 00:18:41,000 They're like, you know, I'm not a robot. 293 00:18:41,000 --> 00:18:45,760 You know, I have, you know, I'm a human, so I make different decisions and things like 294 00:18:45,760 --> 00:18:46,760 that. 295 00:18:46,760 --> 00:18:48,440 I don't want to do it this way. 296 00:18:48,440 --> 00:18:50,240 And I understand that. 297 00:18:50,240 --> 00:18:55,120 And honestly, I felt that way before in my lifetime, early in my life, in my career. 298 00:18:55,120 --> 00:18:59,920 But when you think about it from a broader perspective, you want people to do things 299 00:18:59,920 --> 00:19:00,960 the same way, right? 300 00:19:00,960 --> 00:19:02,840 It reduces variation. 301 00:19:02,840 --> 00:19:05,760 So if you show up for an appointment today, it doesn't matter who's working, you're going 302 00:19:05,760 --> 00:19:08,200 to get the same level of service. 303 00:19:08,200 --> 00:19:11,480 But if you don't have standard work, you're just hoping and praying that this other person's 304 00:19:11,480 --> 00:19:15,660 working and not that one, because you know, they do things quite differently. 305 00:19:15,660 --> 00:19:17,640 So we want people to do things standardized. 306 00:19:17,640 --> 00:19:19,000 It makes it easier to train. 307 00:19:19,000 --> 00:19:23,280 It makes you, it helps your quality go up, your safety is much better. 308 00:19:23,280 --> 00:19:26,960 So standard work is a big, big deal when it comes to lean. 309 00:19:26,960 --> 00:19:28,720 Gotcha. 310 00:19:28,720 --> 00:19:37,000 So, Terry, let's talk about how lean applies to small healthcare. 311 00:19:37,000 --> 00:19:45,640 When I say small healthcare, I'm referring to, you know, hospice and home health and, 312 00:19:45,640 --> 00:19:49,860 you know, smaller hospitals and things of that nature. 313 00:19:49,860 --> 00:19:54,280 So talk to me about how it applies to small healthcare. 314 00:19:54,280 --> 00:19:56,840 In general, it applies the same in general. 315 00:19:56,840 --> 00:20:00,820 And then we can talk about specifics as we think about what are some of the issues and 316 00:20:00,820 --> 00:20:05,700 problems that people in small healthcare come up against, especially when you think of one 317 00:20:05,700 --> 00:20:11,160 person going into someone's home or in the case of hospice or home healthcare, either 318 00:20:11,160 --> 00:20:12,160 one. 319 00:20:12,160 --> 00:20:16,280 So it helps people, you know, go back to those most famous words, eliminates waste in their 320 00:20:16,280 --> 00:20:18,160 processes and things like that. 321 00:20:18,160 --> 00:20:22,560 But again, that generally doesn't mean anything to people unless you look at what the process 322 00:20:22,560 --> 00:20:24,660 is and what does that really mean? 323 00:20:24,660 --> 00:20:29,080 Can I spend less time doing something that I do now, but actually make it safer and higher 324 00:20:29,080 --> 00:20:31,020 level of quality? 325 00:20:31,020 --> 00:20:35,840 So that elimination of waste, that looking at your processes like that is, you know, 326 00:20:35,840 --> 00:20:36,840 is a way. 327 00:20:36,840 --> 00:20:39,500 Again, very general. 328 00:20:39,500 --> 00:20:42,560 Communication is improved in a lean organization. 329 00:20:42,560 --> 00:20:47,760 So whether it's a small or large, how you communicate and how you communicate results 330 00:20:47,760 --> 00:20:52,400 and things like that are looked at and that is improved. 331 00:20:52,400 --> 00:20:57,800 Safety and quality, as I mentioned, is a big part of the improvement because of the standardization. 332 00:20:57,800 --> 00:21:01,460 So I've worked in organizations where, and I've surveyed organizations where they've 333 00:21:01,460 --> 00:21:05,240 had let's say 15 people go out in the home care. 334 00:21:05,240 --> 00:21:08,240 They have 15 different nurses goes out. 335 00:21:08,240 --> 00:21:12,680 And I'm pretty sure that the 15 different nurses did things 15 different ways, you know, 336 00:21:12,680 --> 00:21:15,040 because that's just sort of human nature anyway. 337 00:21:15,040 --> 00:21:16,960 There was no emphasis on standard work. 338 00:21:16,960 --> 00:21:20,360 But if you train people in a certain way, and of course there were certain protocols 339 00:21:20,360 --> 00:21:26,120 for each, but that basic type of training with all of the different nurses, that means 340 00:21:26,120 --> 00:21:30,680 that that particular company would deliver the same level of care, ideally, throughout, 341 00:21:30,680 --> 00:21:35,560 you know, with all the different people, 15 different folks, no matter who went out. 342 00:21:35,560 --> 00:21:40,720 So standard work is pretty important in a small or large organization. 343 00:21:40,720 --> 00:21:44,960 And when you start looking at things like metrics and a couple of things that say, okay, 344 00:21:44,960 --> 00:21:45,960 did we do good today? 345 00:21:45,960 --> 00:21:47,680 How do we know if we did good? 346 00:21:47,680 --> 00:21:51,520 We look at those metrics and it helps us, it really starts uncovering problems and things 347 00:21:51,520 --> 00:21:52,980 that we don't really talk about much. 348 00:21:52,980 --> 00:21:58,160 We just kind of live with or do workarounds or whatever we need to do. 349 00:21:58,160 --> 00:22:03,560 And when you can eliminate some of the things that waste time, it helps the nurses in particular, 350 00:22:03,560 --> 00:22:06,880 people that are dealing with people, spend more time with the people, whether a nurse 351 00:22:06,880 --> 00:22:09,520 or a staff. 352 00:22:09,520 --> 00:22:15,120 It helps eliminate those, I don't know, things that frustrate throughout the day that just, 353 00:22:15,120 --> 00:22:19,280 I'll share this, one of the things I've done survey work and some of it, you ask questions 354 00:22:19,280 --> 00:22:22,600 like something that happens poorly. 355 00:22:22,600 --> 00:22:24,800 How often does that happen? 356 00:22:24,800 --> 00:22:27,920 People will say, I don't know, I never really tracked it. 357 00:22:27,920 --> 00:22:28,920 What does it happen weekly? 358 00:22:28,920 --> 00:22:29,920 Oh yeah, yeah. 359 00:22:29,920 --> 00:22:30,920 Three or four times? 360 00:22:30,920 --> 00:22:32,960 Yes, yes, for sure. 361 00:22:32,960 --> 00:22:37,000 So you have something happen three or four times a week at least, every week, and it's 362 00:22:37,000 --> 00:22:38,800 never dealt with. 363 00:22:38,800 --> 00:22:41,840 In a lean environment, you would look at that and you'd say, that's a problem. 364 00:22:41,840 --> 00:22:45,440 You would identify it and then you would take some action to make it better, make it go 365 00:22:45,440 --> 00:22:47,400 away, make an improvement. 366 00:22:47,400 --> 00:22:49,820 So you're not dealing with the same thing. 367 00:22:49,820 --> 00:22:54,380 So just like in a big organization, you can use the same ideas, the concepts, the principles 368 00:22:54,380 --> 00:23:01,280 to make things better, smoother, safer, higher quality for everybody that's involved. 369 00:23:01,280 --> 00:23:03,620 Thank you, Terry. 370 00:23:03,620 --> 00:23:09,360 So let's wrap up our discussion today, Terry, and we'll pick it back up next week on why 371 00:23:09,360 --> 00:23:15,000 lean fails and what we can do about it in healthcare. 372 00:23:15,000 --> 00:23:17,040 Let's go to a commercial, then let's come back. 373 00:23:17,040 --> 00:23:21,200 I'll end this episode with a quote and we'll go from there. 374 00:23:21,200 --> 00:23:25,520 Do you need to schedule a strategic planning session, but don't want it to waste your team's 375 00:23:25,520 --> 00:23:26,520 time? 376 00:23:26,520 --> 00:23:30,760 If so, you need an expert facilitator who knows how to make the most of your session 377 00:23:30,760 --> 00:23:33,600 and give you the deliverables you need. 378 00:23:33,600 --> 00:23:38,640 Contact Jeff today at 1-800-530-4189. 379 00:23:38,640 --> 00:23:39,820 Extension 101. 380 00:23:39,820 --> 00:23:44,440 Get your new year off to a great start with a great strategic planning session. 381 00:23:44,440 --> 00:23:46,160 Okay. 382 00:23:46,160 --> 00:23:51,080 I hope you enjoyed this episode and I would like to end it with a quote from a legendary 383 00:23:51,080 --> 00:23:57,640 NFL coach by the name of Vince Lombardi. 384 00:23:57,640 --> 00:24:07,200 The quote is, perfection is not attainable, but if we chase perfection, we can catch excellence. 385 00:24:07,200 --> 00:24:10,480 And again, that's by the great legendary Vince Lombardi. 386 00:24:10,480 --> 00:24:14,400 I hope that gives you some encouragement to move forward with your process improvement 387 00:24:14,400 --> 00:24:15,400 initiatives. 388 00:24:15,400 --> 00:24:19,680 I look forward to you joining us again next week when we continue our discussion with 389 00:24:19,680 --> 00:24:22,440 Terry on lean and healthcare. 390 00:24:22,440 --> 00:24:23,800 Goodbye, everyone. 391 00:24:23,800 --> 00:24:24,800 Take care. 392 00:24:24,800 --> 00:24:29,800 Thank you for listening to this episode of Be the Flagship with Jeff Parsons. 393 00:24:29,800 --> 00:24:30,800 We hope you enjoyed it. 394 00:24:30,800 --> 00:24:34,320 If you did like it, please subscribe and share with others. 395 00:24:34,320 --> 00:24:54,560 Until next time, take the step to become the flagship in your marketplace.