Undercover Hospital Sensei’s Diagnosis

First, the introduction. This post was earnestly written by my friend, Jeff Fuchs. He’s the director of the Maryland World Class Consortia, a lean nonprofit assistance organization in the mid-Atlantic. He’s also president of Neovista Consulting, which works with large and small organizations on lean, leadership, and organizational change. Jeff has participated in the development and expansion of SME/AME/Shingo Prize/ASQ Lean Certification. He is Lean Bronze Certified and serves as co-chairman of the Lean Certification Oversight Committee. Jeff received his bachelor of science in aerospace engineering from West Point. He is a veteran, and a member of the Shingo Prize Board of Examiners. His current projects are in lean for personal time management, job shops, and lean government.

Now for some background. At the moment, Jeff is the instructor for three lean training programs. Recently, a trip to the emergency room interrupted one of his training sessions. Subsequent to the “interruption,” Jeff sent out an apologetic and—ever the sensei—instructive e-mail to his session participants. He also shared the e-mail with some other folks. Unfortunately for him, I was one of them. Jeff has graciously agreed to let me post his e-mail (with some slight editing) on my Gemba Tales blog. I think his entertaining letter drives home some of the not insignificant opportunities within health care, the importance of customer focus, and the power of direct observation (even when wearing something lent to you by a hospital). Jeff also managed to read a great book about lean during his “incarceration” and give it a plug.

The subject line of Jeff’s e-mail? “I’m just fine! Wish I could say the same for health care in this country.” Here’s the text:

Dear Class,
“Rumors of my demise are greatly exaggerated.” Please accept my sincere apologies for throwing your day off last Thursday. Unfortunately, I had to bring my body into the shop for some unscheduled maintenance.

As we all heard Sir Ken Robinson observe on Wednesday’s video, some of us just view our bodies “as a way of getting our heads to meetings.” Proper upkeep falls by the wayside from time to time, and that is what happened with me. A bit of detail is in order. I was up to answer nature’s call at 4:15 a.m. on Thursday, and instead of the usual heartbeat, thumpita-thump, thumpita-thump, thumpita-thump, what I felt was more like thumpita-thump, eeerrk! thumpita-eeerrk! thumpita-thump, errkk!

I grabbed my keys, wallet, cell phone, and a good book, and drove to the emergency room. You may have missed your day of training, but let me tell you that class was in session at the Baltimore Washington Medical Center ER when I showed up for school at 5 a.m. Four hours later (let me say that again: four hours later), we were still monkeying around with forgotten paperwork, twice redone blood draws, shift-change meetings over my bed, and staff that was making three trips to my room to restock inventory. I was rolled through a series of three “move, wait, process, wait, move, wait” patient-inventory transactions between some lab and my ER bay for X-ray, sonogram, and ECG, respectively. 

I told you folks. I told you to your face: “When I am through with you, if I am successful, I will make you as miserable a human being as I am,” I said. “You will see broken processes all around you.” Welcome to my world. Behold, the sad customer/piece-of-meat inventory:

Now seriously, doesn’t he look sad? Pity the poor victim of the broken process.

Naturally, in a case like this I couldn’t resist going into consultant mode. Even though I was hooked up to the monitor, IV, and oxygen like a marionette, the monitor kept losing my continuing thumpita-errk heartbeat, so the nurses had to keep walking back to the main desk an average of every 11.3 minutes (but who’s counting) to see if I was dead yet and to reset the monitor. How thoughtful of them to give me an ER bay where I could see their goings-on, their wasted motion, their absence of mistake-proofing or visual controls, their failed attempts to communicate with each other, failed service opportunities, excessive patient transportation, and more. How very thoughtful.

After three hours of the fear, boredom, and frustration cocktail, I used a pen left behind by one of the nurses and began sketching out a nurse/patient spaghetti map of my morning, along with a crude value-stream map, on the back of an IV wrapper I found on the floor. (There are a few things wrong in that last sentence. Please use a black or blue ink pen to circle them. We’ll review your answers next session.) The ER staff found my doodles and efficiency ravings… amusing. I’m sure they did not have much time to be interested in the “bored consultant in room six” while they were dealing with the cut-up guy the cop brought in handcuffed, the construction worker who just fell off a scaffold, the guy sleeping on a gurney in the hall who nobody knew where he came from, or the other poor folks who needed their full attention.

The attending physician diagnosed me with atrial fibrillation, an eminently treatable condition. We’ll see in a couple of weeks what the follow-up says. They admitted me for observation, where I was subjected to other process design and systems management horrors that I shall not relate to you at this time. Suffice to say I got an education in those 14 hours. The lesson for me: Health care is broke. It’s broke bad. I mean, if I had a clone army of a thousand lean Jedi Knights, we’d be swinging our lean light sabers for decades trying to unhose health care in this country. Lean Facilitator Certification Program students, your future in this industry is secure.

One final note on my lean health care field trip: The good book I mentioned that I snagged on my way out the door was Toyota Kata, by Mike Rother (McGraw-Hill 2009), the one I described with such admiration on Tuesday morning, lamenting that I had not had the time to read it. Well, there you go. I plowed through half of it. Would have gotten further, but I had to watch a really good Jerry Springer and eat my tasteless hospital food (overcooked mac and cheese, gray asparagus, canned pears, and a drink that arrived frozen solid).

So, remember what I said: “A true lean leader is a lifelong learner.”

Put your left hand on the computer screen, raise your right hand, and repeat after me: “A-true-lean-leader-is-a-lifelong-learner.”

Here’s me “enjoying” my incarceration:

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