Staff Engagement in the Lean OR

One of the most important differences between an organization that is achieving great benefits from their process improvement efforts and an organization with so-so results is the level of employee engagement. In a truly Lean organization, everyone understands that it is not enough to simply do your job well, and that everyone is expected to participate in the improvement work in every process. This article documents this type of effort in a hospital OR department with an informal program they called Fix-it Friday.

A core concept in Lean Thinking is that of a Value Stream, and the technique of Value Stream Mapping is typically one of the first steps in launching a Lean effort. In order to measure the maturity of a value stream, we've developed the Value Stream Maturity Scale. This pyramid suggests that a value stream matures as it progresses though different levels.

The levels, leading to sustained performance, are:

Level 1: The Value Stream is identified and ownership is assigned. Think of a typical value stream in a hospital, Medication Management. It starts at the time when the MD places the order and ends when the meds are administered to the patient. All the processes in between those two points make up the value stream.

Level 2: Flow. The value (the med) progresses from process to process in an uninterrupted fashion. Achieving flow is not a one-time event, but a progression through a series of improvement iterations.

Level 3: Standardization. The processes within the value stream are standardized to the level of work instructions. Not all processes can be standardized in a clinical setting, but those that can be standardized must be.

Level 4: Engagement. This is the Holy Grail of Lean. Staff members participate in the identification of waste and engage in projects to seek the elimination of wasteful activities.

Just think of the power of every staff member in the OR focusing on eliminating waste. Here are several examples:

During a project to redesign a Sterile Processing Department, the entire team was coming at 6:00 a.m. every day, for a week, to bring live the area after the design was finished. On Wednesday, we all arrived to realize that the OR started late on Wednesdays, so we had nothing to do for three hours. Within 5 minutes, a team member said "Hey guys, why wait for instruments? Couldn't we do some of the 7S stuff we learned about in class?" BINGO! We split into three teams of 2 or 3 team members to work on different areas. By the time the first set arrived from the OT the team had completed three separate 7S projects, with the following results:

• We found two surgeon's stools that were scheduled to be re-purchased,

• We identified and re-located approximately $5,000 in "orphan" instruments that were stashed in a drawer to be dealt with at a later date. Nobody knew how long they had been there.

• We reorganized the unload area for the cart wash, saving ~1 minute per case cart.

Those are just the highlights. The real value was the sense of accomplishment that followed those mini-projects. This team became unstoppable after that.

Another person who took this idea of engagement to heart was Beth. Beth was the Manager for the Cardiovascular Services Department for a large city hospital.Fridays were usually very slow days for her department. Being an outstanding cook, she organized social lunches on Fridays for all her staff. After working with us for a few months, she realized that Fridays could be a great opportunity for something more than social time. She still provided lunch, but s Beth re-branded the day "Fix-it Friday".

Fix-it Friday meant to get together as a team, enjoy lunch, and then take one topic from the list of continuous improvement suggestions to fix it right then and there. The results were nothing short of remarkable. Beth was so successful that she was asked to tackle a very sore spot at the hospital: their overly-long Door-to-Balloon time. Under Beth's leadership, they reduced Door-to-Balloon time by more than 60%.

There is no magic in the cases above. There is engagement. There is respect for staff and their ideas. There is leadership in finding the time to do continuous improvement.

It is not that difficult. Go ahead, give it a try.

Gerard Leone, MSIE, MBA, is the Lean Hospital practice leader with the Leonardo Group Americas. The Leonardo Group is based in Munich, Germany and Denver, CO in the USA.
Gerard is has been a consultant to manufacturing companies for almost 20 years and to hospitals for 8 years. You can reach him at gleone@leonardo-group.com or visit the Lean Hospital Group website at http://www.leanhospitalgroup.com