Friday, March 27, 2015

Evidence of an Improved Culture of Safety

A marvelous thing happened on Lean Daily Management rounds today. My LDM Team is “Team A.”  Deloris Tuggle and I are the senior leaders on this team. Deloris was away today, so Kevin Creaby, our Manager of Benefits, was standing in for Deloris and we were accompanied on the walk by Ishmel Fulton, our new Lean Facilitator. We were on our way to the PACU board, rounding the corner, passing the family waiting room desk for the General Operating Room, when we heard: “Gentlemen, stop! You must clean your hands before entering the PACU!” I turned to see that this message had been delivered by one of our superb volunteers. She and a colleague were looking at us with smiles on their faces, but, they were not kidding. We thanked them for the reminder, cleaned our hands, and proceeded into the PACU.

Readers of the blog may remember my posting: A Just Culture Fosters a Safer Culture (Dec. 11, 2013) http://ahealthydialogue.blogspot.com/2013/12/a-just-culture-fosters-safer-culture.html. In that blog post, I spoke about the Tenerife crash, the worst disaster in the history of commercial aviation, where the belief is that the two co-pilots could have prevented the event, but they were afraid to say anything that might upset the captain. The unwillingness of “subordinates,” people lower down in the organizational hierarchy, to speak up is a detriment to safety and a sign of a poor safety culture. So, as we were entering the PACU after having cleaned our hands, I was really delighted that volunteers felt comfortable speaking up to the President and CEO of the organization. I was very proud of them and happy that we are making progress towards our vision!

Continually Improving Lean Daily Management

Lean Daily Management (LDM) has been a huge success for GBMC HealthCare. But there is always room for improvement. The Senior Team has been studying the groups that make the most improvement to find ways to help others. When the local manager and his or her team understand that LDM is about problem solving, much more improvement happens as opposed to groups that act as if telling the story of “red” or “green” is the end. We on the Senior Team now see that in our zeal to “help” by asking questions about the specific problem, we may actually be slowing down the problem solving.

On the LDM walk, some teams are celebrating when a metric is “green” even though they have not changed anything since it was last “red” and they apologize when the performance is “red.” We frequently have to remind them that if something is “green” but nothing in the process was changed that it is likely to return to “red.”

I have written before in this blog (http://ahealthydialogue.blogspot.com/2014/04/red-is-not-badge-of-dishonor.html) about how “red” should not be looked upon as being bad – it is merely an opportunity to problem solve so there is no need to say that they are sorry or feel that they have to defend themselves.

The job of the Senior Team is to hold managers accountable and ask questions to generate problem solving, NOT to offer advice to fix the specific problem.  The Senior Team must make sure that the manager and the unit or department have what they need to get the job done and then say thank you.

So, we on the Senior Team have committed to ask questions like “What have you learned?” and “What are you going to try next and when?” and not get involved in suggesting fixes. This should help us get more out of a tool that has already been immensely helpful! What do you think? I would love to hear your thoughts.

8 comments:

  1. What a great reminder from our volunteers about hand hygiene! Infection prevention is everyone's responsibility and we are so proud of our volunteers for speaking up - Great Job!

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  2. I had the opportunity to see LDM in motion when my husband unfortunately was in GBMC for 32 days. Not because it was GBMC (that’s the great news!), but because he was so ill and dying that he needed to be here and for such a long stay.
    One thing I observed first hand that I would love to see addressed is, ”Don’t forget the personal touch” and thus, “Don’t forget the family”.
    I realize that is a hard thing to judge particularly in reds and greens, but let me explain and perhaps this can assist the teams to consider putting something in motion.
    One morning I walked into my husband’s room and due to the seriousness of his illness, his whole body had taken on a difference appearance. He was too ill to even realize it and I unfortunately was totally unprepared for it. Perhaps a phone call to me or a note on his door alerting me to see his nurse or doctor before entering would have better prepared me.

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    1. Thanks very much, Susann. We are working hard on the personal touch and in improving communication to our patients and their families.
      John

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  3. LDM has brought about some good work, but honestly? It's created MORE work for the frontline staff.

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    1. Anonymous, it is clearly new work to do the measurements. But...if the unit or department is doing problem-solving, the net can be much less work. Just look how much less time our nurses are now spending looking for missing medications because there are many fewer missing medications now. Please speak with your boss about your concerns.
      Thanks,
      John

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  4. Maneesha AhluwaliaMarch 31, 2015 at 6:54 AM

    It's my first day today. It's great to see the top-down, bottom-up approach in practice as you've cited in your example above. Kudos!

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    1. Thanks Maneesha and welcome to GBMC!
      John

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