Daily Kaizen

Hi everyone, I’m still around, admiring the great work of Lee and colleagues at Group Health, and also applying my knowledge at a different level, working with the California Healthcare Foundation, based in Oakland, California. What I’m experiencing in this work is a very different view of health and health care – a societal one, as opposed to one that is based at the level of a health plan / delivery system.

The specific medical issue we’re looking at is the control of blood pressure, which has been really interesting to look at from a societal perspective. Why? Because the health system sees a slice of the impact – expenditures on drugs, office visits, and eventually the devastating outcomes of cardiovascular disease. It does not see the other impacts, on patients’ time, their costs, or the time and costs of their employers and families, which frames how a society might look at managing this condition (which right now is done poorly, with only 35 % of Americans with adequate control, and a third unaware that they are at risk).

This is very tied into LEAN for me, because it’s taught me to look at every problem as one impacting society, whether I am seeing it in an exam room or a board room. I am also using everything I’ve learned to date to help make an impact with this organization and its partners. This includes visibility – I asked if it would be okay for me to publish the plan “in the making” on the public Internet, and the answer was “yes.” I have never done that before.

With that in mind, feel free, if you’re curious, to take a look on my other blog and offer myself, and Californians, some advice on improving a plan that will make a difference for patients managing chronic conditions.

Also feel free to answer this question – why doesn’t every health care organization post its A3′s in progress for community comment? Should patients and their families be part of the nemawashi process? Should we create a forum where that happens?

(I’ve been spending a lot of time studying patient and family involvement in the care system, also thanks to LEAN..)

Finally, something to energize us about all that we have left to do:

A guest in my home who is from Germany told me today, “Ted, I saw that book (“Overtreated,” by Shannon Brownlee) on your table, and it brought a smile to my face that you were reading it. Why is health care here all about money? When I compare health care to Europe to health care in America, it’s like first class compared to tenth class.” I told her I was doing my best along with others to make a difference, but I felt as disappointed as I ever have at what we’re accomplishing with the $2 trillion we spend each year.

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A year or so ago the organization decided to make a commitment to using A3′s to support planning and improvement in the organization. At that time I was a big proponent of this change. I was fully convinced that if we only had a standard tool for planning we could be far more effective in not only developing the plan, but also executing to the plan. Like most organizations our’s had a high level of variation in our planning and deployment tools and formats. Primarily, long and boring PowerPoint’s were the primary tool of choice. Far from compelling.

Now it is a year later and A3′s are being used widely across the organization, but I would say that the change has led to moderate improvement at best. Yes, we have cut down on the over production of long status reports and planning PowerPoint’s. Yes, there are some teams that have embraced the A3 process and it has led to improvement. But overall the change has fallen short.

Why? The answer is simple, the A3 is a tool and without the process and thinking behind it nothing really changes. In our organization in most cases leaders and more often staff took the plans they had already developed and translated them into a new A3 format. As you can imagine, there are a lot of A3′s floating around with size 8 font in order to fit all of the content into a single page. In most cases PDCA was not applied, nor was the basic root cause and Pareto analysis.

Please don’t get me wrong, I am not trying to be critical. We learned the tool, but were not yet ready to learn and embrace the the thinking. Now that the organization has made an enterprise wide commitment to implementing a Lean Management system things have changed. Leadership is very vested in learning the foundational thinking that underlies Lean and the A3 process. We are developing a standards and a process around how the A3′s should be used and more importantly we are now capable of coaching leadership in the thinking. Just this Friday I spent a couple hours with one of our physician leaders as he worked to develop an A3. He was very excited by the process and how close the thinking is to how physicians approach their work every day through the scientific method.

I guess sometimes its okay to learn the tool, but like everything, its all about the thinking!

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