Healthcare – Agile/Lean principles and Kanban practices in a hospital ward

Well its been a week since I last reported, with the family member admitted to the ward and the use of a Scrum board, this was a white board by Nurses station on the floor and it indicated assigned stories that a team of Nurses were working on.

Week 2, things have moved along. They have just today started using the electronic board, more along the lines of the Kanban board that ER. There appeared no fuss in with this change. Didn’t see anyone having kittens about this change, a far cry from what I had observed with some software engineering and/or tech operations teams teams. Clearly the mission of saving or mending lives is a greater leveler in the relative mundane changes with use of new tools and presentation of information. It was late this evening so I didn’t get the opportunity to ask the Nurses what they made of the changes. I will get to this during my next visit and may be even ask the patient coordinator if they have been on any training relating to Lean principles.

I also came across interesting sites/articles relating to Lean in Healthcare

The blog on standardized work is by a CEO of a large Boston hospital.When I first read this I wasn’t convinced that there is a call for standardized work. You see the work performed by Health care workers is one that touches people when they are most fragile and really some variability is desired by both the care giver and the patient alike. In software engineering there are standards that the coding and testing practices are measured to, but the standards adopted by an organization are used as a framework within which teams are expected to deliver their product. So no two people, though equally trained, will approach laying down the track of code the same way. Within this there is great deal of variability due mainly to style and level of experience.

Besides this standardized work as seen on a Toyota production line is not a comparison one wants to make when addressing Healthcare. For one machines have no cognition nor expectations. My biggest objection with a call for standardized work in health care is that this will replace the rational thinking that is needed, you know the act of doing as it is in the standards. I am sure there is fine balance between standardized work and what may be micro-management.

However, having said this and seeing at first hand the investment in information technology that has been made, I do see the opportunity of standardized process and work flow, as an example the nurses Kanban board. This no doubt can help with better coordination in services the patient receives, such that there is an order in which a particular set of services are best received. This last point is critical idea of standardized work that is addressed in the article. In fact, I realize the article does talk about benefits that can be achieved through standardized process by which work is gated and within which learning occurs. It also points out how visual cues/flags can help signal and thus avoid errors.

…… returning to my original thoughts – I still wonder if they routinely have retrospective meetings that promote Kaizen – continuous improvement.

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