Something Interesting Happened
How did I get myself into this and, more importantly, how could I get out of it?
I could act like I had inadvertently shown up at the wrong room, “so sorry to barge in, I’ll be on my way now.” Or, I could fake an important page that would require me to attend to an “emergency.” Or, I could just tell the group, “look, as much as I’d love to meet with you all for two straight days, I really have more important things to do with my time.”
Problem was I had been part of the decision to call this meeting in the first place. What was I thinking?
For years I’ve sat on a capacity management committee that met frequently and tackled various projects, such as reducing length of stay, discharging patients earlier in the day, and improving the discharge process—all of which fell under the rubric of efficiently moving patients through the system so we could create space for more patients. This not only makes good business, sense but also is good for our patients who benefit from getting out of the hospital earlier and back to the recuperative comfort of their homes.
The committee had met for hours on end, discussing new methods to tackle old problems. What if…we developed a follow-up clinic that could see patients back shortly after discharge, had a discharge nurse whose only responsibility was to discharge patients, had a lounge that could hold discharged patients waiting for a ride, and so on.
Hour after hour, meeting after meeting, we searched for the elusive Rosetta stone that would unlock the mystery of the timely discharge. We often implemented a large intervention, then met again only to find that our glorious idea came up short. We’d scratch our heads, find someone to pin the blame on for these shortcomings and move on to the next doomed project. Ideas were waning, patience was frayed and morale was at an all-time low.
At our wits end we decided to get thinner, reduce waste, make cars.
Ok, not literally make cars but to use the methodology of the Toyota Production System (TPS) to remove waste, to get lean. Sounded like a good idea until I settled into my hardback chair for the meeting that first morning. I quickly was filled with the ominous dread that only results from mixing consultants, a trough full of meeting-issue scrambled eggs congealing over a Sterno flame, and a roomful of sleepy-eyed participants. Sprinkle in a two-day agenda and we had all the ingredients for a scalding caldron of tedium, bubbling over with boredom.
Then something interesting happened.
I became interested.
Our consultants initiated our journey by discussing the basis of lean Toyota production—the theory of Kaizen, or “change (Kai) for the good (Zen).” The essence of the process included multi-day continuous sessions (yikes) utilizing a cross-functional team consisting of leadership and front-line staff from all hospital disciplines—from doctors to nurses to transport to janitorial staff. It also focused on fast, continuous, experimental change.
Then something interesting happened.
We left the room.
A meeting that didn’t meet? What was this strange Japanese system? Well it turns out that another key tenet of the TPS is “gemba,” meaning “shop floor.” The idea is to spend as much time as possible observing the actual processes, out on the shop floor, not in the board room. So, rather than wallowing away in a meeting discussing what we thought the problem was, we actually went to see what the problem was.
