Knowledge Worker 2.0

I continue to fret that the dominant model for understanding healthcare organisations and in defining methods to improve them, comes from an old fashioned industrial process methodology (Lean). I think this continues to hold the stage because it is easy to understand a process and to make charts that count things. It makes us feel better.

But healthcare is not only a service industry it is one based on relationships. The workers are predominantly knowledge workers.  And the role, the use of and the ways in which knowledge workers connect is changing rapidly.

If the whole concept of the knowledge work is an unfamiliar one then have a look at the presentation below. And if you role is one of making improvements in a system then think about how you might go about such changes when you conceive of staff - and patients - as knowledge workers.

Knowledge Worker 2.0 - Power to the people from Stephen Collins

Book Review: Sustaining lean healthcare programme; a practical survival guide - Eaton & Phillip

Different book styles appeal differently, to different people. This one appealed to me because it is relatively short (94 pages plus appendices), well organised, uses bullet points and lists, checklists, diagrams and has some short examples to illustrate points.

Contents include:

1. Where are you on your journey
2. Why do only 24% succeed?
3. Going Lean
4. The top ten signs of a failing programme
5. Creating a lean healthcare organisation
6. Four key checklists
7. The next eight things to do...

So do only 25% succeed? The authors suggest there are 8 critical success categories Communications. resources, involvement, training, implementation, compass, achievement and leadership (yes, these do spell "critical"). If you like wordplay then read the book and discover PRISM, CAD, VSE, RIE, RPE, FIT, FMEA etc. Not as bad as it looks in a list here. I found them a good description, and sometimes reminder, of basic principles.

The chapter on the top 10 signs of a failing program is easily read. For each reason there is an explanation of what you may experience, why it happens and then what you can do about it.

The four checklists you need? One each on people, success, tools and culture. Nothing really new to me, just nicely organised.

I particularly liked the Appendices which included key lean phrases and concepts (worth the price of the book for its organisation and simplicity), audit form, guide to common saying (fabulous!), and then a number of "how to" guides.

I know Mark Eaton has actually implemented lean in healthcare. This book is a demonstration that when written by someone who has got their hands dirty it turns into valuable desktop reference.

Productivity 3: Productivity is more than a process

This the the third in a series of Productivity notes by Sarah Fraser. Productivity is more than a process.

New and improved policies can impact the design and implementation of efficiencies. For example, new recruitment, pension, appraisal and similar policy changes can impact processes not only in the short term but also long term. I do think that policy improvements are a necessary condition for many other efficiencies to be put into place.

Clinical productivity is often conceived as as "how hard are we sweating out clinical assets". Another way of looking at this is to see clinical productivity as the most up to date and best practice clinical methods being used. For example, continuing to carry our surgical procedures that are no longer proven to be effective is not productive.

Process productivity is the most familiar aspect of efficiency chasing in healthcare. Largely based on the principles of Lean (or reduced and less focused use of Lean) it is helpful but not enough to meet the healthcare challenges for the next 2 - 5 years.

Books on Lean for Healthcare

I am sometimes asked to recommend a book on Lean. On my book blog I have given one a short review this month. Others on my shelf include:

The Elegant Solution; Toyota's formula for mastering innovation, by Matthew May

Has some good hints, tips and checklists in it. I particularly like the IDEA (Investigate, Design, Execute, Adjust) process and form. For me this has more applicability to many projects I work with in healthcare than they way PDSA's are used (probably inappropriately) to write up projects and action.

Journey to Lean; making operational change stick, by John Drew, Blair McCallum, Stefan Roggenhofer

I like this book because it sets out the hard work involved. The authors also do the full set - namely, they include and emphasise the behavioural and mindset changes required. The use of stories and examples is helpful in putting the change processes into context.

Lean Hospitals; improving quality, patient safety and employee satisfaction, by Mark Graban

Very much a lean theorist book. Lots of Japanese terms. I liked the way the book is framed specifically for healthcare and this may make it easier to grasp some of the technical language and methods. I was a bit disappointed that the focus is so much on the technical and less on the social / cultural / behavioural aspects.

Sustaining Lean healthcare programmes; a practical survival guide, by Mark Eaton and Simon Phillips.

I reviewed this book this month. Short, sweet and worth it for the glossary of definitions! Simple and most useful for beginners or for sharing with other staff who need to know a bit about Lean but don't need to be overwhelmed by too much detail.

Lean for Practitioners; an introduction to Lean for healthcare organisations, by Mark Eaton

Another short and sweet book. If you only have 45 minutes on the train to get up to speed with some Lean Thinking - then this book will work for you. Mark's style includes bullet points, short paragraphs and checklist - worked for me.

Lean for Dummies, by Natalie Sayer and Bruce Williams

Probably the most useful Lean book I have but I am too scared to walk around carrying it! Rich in detail and an excellent reference.