9 Points (continued)

J. Michael Rona
Principal, Rona Consulting Group
Mercer Island, Washington

This is the third in a series of posts about 9 Points that define the lean heatlh care enterprise:

1. A Compelling Vision
2. Enlightened and Fearless Leadership
3. Values Driven
4. Respect for the Customer and Customer Driven
5. Quality Driven
6. Obsessed with Safety
7. Respect for Staff
8. Continuous Improvement
9. Generate Higher Margins or Create Greater Capability

These nine points help characterize a lean health care organization. When implemented and fully engrained, the organization is transformed. Then it lives the principles of the Toyota Management System and produces perfect products, one at a time, in flow synchronized to the demand of the customer. This is what a lean health care organization looks like and how it behaves.

In the first two post in this series, I covered Points 1, 2, and 3. In this post, I cover Points 4, 5, and 6.

4. Respect for the Customer and Customer Driven

In all of its manifestations, such an organization would demonstrate the concept of “Customer First”. In every way, in the layout of facilities, the flow of healthcare processes, in communications, and in the behavior of providers and staff, one would see that there is a deep understanding of customer needs and wants. In every respect, the organization’s production processes would demonstrate a complete understanding of customer rate of demand by product family. In all of its written and verbal communications, the organization would demonstrate a deep respect for the customer. In every way, the presence of the customer would be felt within the organization and Toyota’s concept of “Customer In”, the idea that for the staff, the customer is always present, would be evident. We would call this for health care “Patient on shoulder”; the concept of the ever observant and present patient as customer.

5. Quality Driven

The lean health care enterprise is obsessed with quality. It has a deep understanding of the key quality characteristics, which its customers desire and of the products it delivers. It knows immediately when defects occur in the process and the process stops until the defect is fixed. It is uncompromising in its attack on defects as they occur. It has defect alert systems in place to allow the staff to know when defects occur and to stop the production process if defects cannot be resolved in the process. Quality is assured along the way, or what would be termed through “in-line inspection”, along the production process, so that essentially zero retrospective quality assurance is required. Each staff member is a front-line quality inspector and the role of management is to ensure that the staff can do perfect work.

6. Obsessed with Safety

Safety for the customer and the staff is paramount in a lean health care enterprise. As the organization understands the needs of the customer, it is constantly looking for ways to make the product safer. It not only looks at obvious areas for improving safety and what the customer tells it, but it looks ahead and simulates what could happen in the future and builds in safety for that possible eventuality before the potential safety issue even presents itself. This type of organization is obsessed with safety and cannot imagine that the customer would ever be the one to alert the organization about a defect that has occurred to them.

This kind of organization is similarly obsessed with safety for the staff. It addresses issues of physical safety and stress caused by the working environment to ensure the safety of its staff.