On our show this week Mark Graban, an internationally-recognized expert in the world of lean healthcare, in a discussion on lean hospitals and ways to reduce healthcare costs. Lean hospitals aim to reduce healthcare costs by eliminating wasted funds, increasing patient care, and keeping hospitals profitable.
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Carmela J: Hello and welcome! It’s now 5:06 and it’s time to get some good tips on The Conversation on News Talk WOKV where health and wellness are explained. I’m your host Carmela J. and of course I’m here with our weekend expert Dr. Ali Kasraeian. Hello sir, how are you doing this evening?
Dr. Ali Kasraeian: I am good!
Carmela J: Are you enjoying this dreary weather?
Dr. Ali Kasraeian: It is very rainy outside but I’ll tell you, I love rainy weather. I’ll tell you one thing that it does on Saturdays. It doesn’t make me feel guilty for prepping for the show.
Carmela J: Oh, there you go!
Dr. Ali Kasraeian: Because I’m sitting like a student reading. Thank you everyone! Thank you for joining us on The Conversation today. We have a lot of exciting things to talk about. We have a guest Mark Graban joining us from Texas to discuss this very interesting concept of lean hospitals. I’m very excited to talk about that and I’ll introduce him in a second. One very exciting thing I noticed today while I was opening up the paper – have you heard about the idea of bioengineering organs and kind of all that?
Carmela J: Yes.
Dr. Ali Kasraeian: So far to date, in actually a pediatric urologist in North Carolina bioengineered bladders that were implanted in children with dysfunctional bladders. They’ve done noses. They’ve bioengineered arteries to use in people.
Carmela J: Amazing.
Dr. Ali Kasraeian: They are close to what some call the Holy Grail of bioengineering, the human heart.
Carmela J: Wow.
Dr. Ali Kasraeian: A group out of Spain led by Dr. Fernandez Viaz has gone to the concept of a very elegant way of working towards hopefully in the near future creating a bio-engineered human heart, which will revolutionize the idea of transplant. For two factors, there’s a limit in terms of donors available. But two, when people have transplants they have to be on immunosuppressive medications for their life, and that is a challenging thing to do because it increases your risk of infection, it suppresses your immune system. With this idea, what they’ve done is take cadaver hearts and they put them in this potentially a bio-detergent, which washes away all the cells within three to four days. After that, you have this scaffolding of collagen. So basically this matrix that sits there and they expose it to the patient’s own stem cells.
Carmela J: Okay.
Dr. Ali Kasraeian: Stem cells are basically cells at the beginning of development. So these cells can become anything. When they place them on this collagen in the right environment, and they’re basically right now waiting for this thing called a bioreactor to finally become perfect for use, which recreates the environment of the human womb so it facilitates what’s called organogenesis or the creation of organs. So these stem cells now become the heart so you can transplant essentially a donation of the patient’s own heart cells formed in the heart to do that. The reason why this is so incredibly elegant is that the heart has multiple different types of cells. You need an electrical circuitry to create that pulse that you have and how it beats in a coordinated manner. And also the amount of blood that goes through the heart during a minute is incredible. This is for me at least mindboggling in terms of the amazing things science is doing.
Carmela J: Right.
Dr. Ali Kasraeian: Now that we spoke about that, we can get to our exciting show today everyone. Mark Graban is an internationally recognized expert in the field of lean healthcare. This idea of lean, which he will expand on hopefully for today it’s very elegant and it’s application to the healthcare field I think is very elegant. And he describes it in a number of different things. He blogs. You can go to markgraban.com to hear of some elegant discussions in terms of things that we can apply to individual healthcare from the office space, the hospitals. Kind of applying it to the global healthcare environment if you think a little bit through rose-colored lenses. He’s got an award-winning book that I tried to read through as fast as I could over the past couple days. Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement. The idea of being more efficient. He’s got a very interesting background of how he arrived at this and I will not delay the introduction anymore. So Mark, thank you for joining us today!
Mark Graban: Thank you!
Carmela J: Hello Mark! How are you?
Mark Graban: I’m doing great, thanks!
Carmela J: So great to have you. Thank you!
Dr. Ali Kasraeian: To start with, I guess ultimately we want to move towards an explanation of what this lean idea is and how it applies to the hospital, but how did you become involved and interested in this idea?
Mark Graban: My own career kind of shadowed the adoption of practices from engineering and manufacturing, called lean, into healthcare. I’m an industrial engineer. Started my career working; I grew up in the Detroit area. I started working right out of college at General Motors in the mid-90’s. We were very much trying to basically catch up to Toyota in terms of their quality and productivity. I worked in an engine plant. I learned very early on in my career, I was fortunate to work under a plant manager who had been one of the first GM people to work with Toyota in California at a plant that GM and Toyota ran together starting in the early 80’s. I learned that lean, as a quality improvement methodology and a management system, first off it’s about people. It’s not rocket science or brain surgery, it’s certainly not as complicated as creating an artificial heart that you were talking about. But it’s this distinctly different approach to managing organizations and managing people. I had the chance back in 2005 to join a consulting group that was part of a division of Johnson & Johnson that was doing consulting work with medical laboratories and hospitals and health systems, and that is really where I got my first start in applying these ideas in healthcare. I’m certainly not the first one to have done this. There are cases in Michigan, in Seattle, dating back the latest the late 1990’s of people learning from the auto industry, learning from companies like Boeing and bringing some of these kind of proven management and system improvement practices into healthcare.
Dr. Ali Kasraeian: What are some of the basic initial concepts of lean that you found intriguing not only as a general concept, basically with the Toyota concept from what I learned, they tried to be very efficient in minimizing what is, and I use this term all the time, but they specifically use the idea of waste which is any movement or effect or any kind of effort that you undertake that doesn’t provide any value to that effort is eliminated to make you more efficient. Through that, they’ve created this increased productivity by reducing costs and being more efficient. Is that seemingly accurate in terms of the general concept of the beginnings of the lean concept?
Mark Graban: Yeah, I think that’s a good start. We talk about, as you described it, waste is any work or time or activity that doesn’t provide value to the patient. In a healthcare setting, value would be things like diagnosis, treatment, education, being comforted in the emergency department before you’re diagnosed. Those really key steps that get us healthy or help keep us healthy as a patient. So lean is a very customer-driven philosophy and methodology, which is one reason it translates very well into healthcare. Physicians, nurses, other people working in healthcare are already incredibly patient-focused and compassionate and really concerned about their patients. Lean then gives them methodologies and a management system to help eliminate that waste so we that can focus more time on patients and more time on their care. A classic example of waste that a patient sees is time in a waiting room. There’s actually some very innovative work. There has been a lot of great lean work in Jacksonville out of Medtronic and some other really innovative companies. In fact, in Jacksonville I had the chance to visit his clinic, there’s a dentist named Sami Bahri who has essentially eliminated waiting room time for his patients. He’s improved his own efficiency, he’s improved his own outcomes for the patients and a really high level lean is really about both quality and efficiency. They go hand in hand as opposed to viewing those as some sort of trade off.
Dr. Ali Kasraeian: When you look at that in terms of the trade off concept with healthcare, one of the big things and a couple weeks ago we discussed the article out of Time Magazine, which talked about the excessive costs in the delivery of healthcare in the United States and how some of that may not have been necessarily essentially. I mean, it’s a vastly complicated discussion but in terms of looking at the concept of lean, it’s essentially trying to make more efficient and eliminate overhead.
Mark Graban: Well, you’re trying to eliminate unnecessary costs. And you’re right, the discussion in Time Magazine kind of goes to show healthcare is a very screwy market. It’s a very complicated market. Where in the lean philosophy we say value is something the customer is willing to pay for. Now if we put ourselves in the shoes of being let’s say a car buyer, it’s very easy for us to evaluate the cost of different cars. We don’t have to buy the car to then find out what they’re going to bill us for after we’ve taken that car home. There’s a lot of really great publicly available data on the quality of different cars and one thing that really hampers healthcare consumers or patients if somebody’s proposing that you should probably have surgery, it’s really hard to find data on infection rates at different hospitals to find out what the cost is going to be at different hospitals if you were to even try to call and find out I need to get a head and neck MRI, how much is that going to cost?
Dr. Ali Kasraeian: The problem with that a lot of times comes up with like you mentioned in terms of systems and a process issue is that the cost is very much dependent on so many factors, like your coverage whether it’s Medicare, whether it’s Medicaid, whether it’s a private payer and things of that nature. And whether you’re in that work, whether or out. You’re very much right. The process itself inherently seems to create complicated conversations between patients and providers and patients and hospitals. The lean system, do they approach the concept of that aspect of healthcare in terms of the layers of complication that goes into even before you get to the bedside?
Mark Graban: Well, it’s hard to think of cases where people have used lean principles to help simply that interaction between the payer and the provider and the hospital and the patient. There are some organizations that are doing some really innovative work where they have the advantage of being both the health insurer and the health provider. There’s an organization in Washington State called Group Health Cooperative, which has done things to really break down some of the communication barriers between let’s say the insurance arm of their organization and the primary care groups. But they have the advantage of being part of the same non-profit corporate structure as opposed to the barriers and different incentives that a separate insurance company and the hospital and then let’s say the physician who’s part of a stand alone physician group, they’re part of different organizations with their own financial drivers. A lot of that is really inherent in our American system and lean is really more effective at the process level of somebody getting scheduled for a procedure. Using lean practices for example to make sure that all the insurance approvals have been done properly and all the lab testing is done properly before the patient arrives so you don’t have to cancel or delay or reschedule your procedure. Lean tends to be really affective at addressing some of those things that people might run into.
Dr. Ali Kasraeian: I tell you, one of the things from my reading over the past week over the lean concept was, and we mentioned it on the show where we discussed the Time article. One of the frustrations that physicians and healthcare providers have, I think that we through our training and our inherent beliefs of what we do, we expect that if we do the right thing at the bedside, everything else would kind of take care of itself. Some of the things that the lean concept and some of your writings bring up is those efficiencies in the delivery in that process in the system make that a big source of frustration, not just for the physicians and the people in the healthcare delivery side of things, but also for the patients. Some of the concepts here look towards making that interaction a little bit stressful for everyone involved, and in turn being more efficient with better outcomes and having a little bit better decrease in that cost that seems to plague our healthcare system.
Mark Graban: Yeah, there’s often times very mutual benefit to be had for, let’s say surgeons and patients. Doing everything we can to have good systems and processes, that sets things up so that the surgeon has everything they need when they need it in the OR to help minimize the length of time a patient is under anesthesia to improve the efficiency of the OR, not by working faster but by eliminating problems and eliminating delays. The hospital is providing better service to the surgeon for all the support departments and support staff. Everything that has to happen to line things up for the patient and surgeon to be there and ready to go. That’s also a great benefit for the patients in terms of not having to wait as long for surgeries or not have to wait as long in the waiting room or the pre-op area.
Dr. Ali Kasraeian: I’ll tell you, the importance of that concept is very understated because it sets up that whole process of that day for someone being in the operating room both in terms of the patient, their family, and the surgeon. We’re going to take a little break I hear?
Carmela J: Yep, that’s right. It’s 5:20. Today we will be talking about this concept of lean hospitals with our guest Mark Graban on The Conversation. Don’t forget to call us at 340-0690. Stick around on News Talk WOKV.
Carmela J: Welcome back! This is Carmela J. and you are listening to The Conversation on News Talk WOKV. Thank you for staying with us! Tonight we’ve been talking about the concept of lean hospitals, and remember we want to hear from you. You can call us at 340-0690.
Dr. Ali Kasraeian: Welcome everyone and thank you for joining us on The Conversation! We are here on a Sunday. It’s rainy outside and the lights are flickering in here. I feel like we’re on like a 1920’s radio show. We’re joined today by our guest Mark Graban, an international expert on the concept of lean hospitals. Thank you Mark for joining us! Again, we’re talking about this idea of lean and it comes from the way the Toyota Company looked at being more productive, more efficient, and thereby reducing costs. What Mark, what you have done with a number of different colleagues that you’ve worked with through the years has come up with the application of this concept and the understanding of that application to the healthcare system. On thing I was looking at that I think is very elegant in terms of running any kind of system, the lean concept is not really looking at fixing a big picture, but it’s looking within the system to find a number of problems that are discovered, and teaching people how to problem solve. By the accumulation of multiple small problems solved, you create a more profitable and efficient, and by profit I mean better outcomes for patient care. You get a system that is more successful in doing that and thereby having a decrease in costs of delivery of healthcare within that system.
Mark Graban: Right, and what we tend to see are better results in terms of patient’s safety and quality. We see reductions in waiting times. We see reductions in costs. Now a lot of times that doesn’t directly translate to lower costs for the patient, but that results in lower costs for that might be captured by the hospital or health system, or the payer, the insurance company, or Medicare, Medicaid because even non-profit hospital systems still need to have a positive financial line so they can continue investing in new technologies and by improving processes. There are huge opportunities to reduce costs and improve quality. For example, looking at all of the little things that lead to patients acquiring what we call bedsores or pressure ulcers in a hospital. A lot of times this happens because nurses and other staff are just stretched really thin. Again, it comes back to waste. There’s too much waste in the process. They’re running around searching for medications. They’re trying to find IV poles when they need them. When you start fixing all of those little things, it’s not just one big fix but it’s all of these little things that contribute to the waste. You can be more attentive to the patients at the bedside and reducing those pressure ulcers can be worth millions and millions of dollars to a hospital because Medicare, Medicaid, and insurance companies are basically not wanting to reimburse the hospital for problems that are increasingly proven preventable, like certain types of infections, patient falls, things that are really egregious. Let’s say wrong side surgery, operating on the right knee instead of the left knee. There’s some of those financial drivers that are leading hospitals to pay even closer attention to quality and improvement.
Dr. Ali Kasraeian: That’s a great place to stop and we’ll come back in the next half hour and we’ll invest a little bit more of that discussion.
Carmela J: That’s right! Stay with us on News Talk WOKV.
Carmela J: Welcome back! You’re listening to the second half hour of The Conversation on News Talk WOKV. I’m your host Carmela J. I’m here with our weekend expert Dr. Ali Kasraeian and our special guest Mark Graban is on the phone with us. Thank you for staying with us as we continue our discussion. Remember you can call us at 340-0690.
Dr. Ali Kasraeian: So everyone, thank you for joining us again! Hopefully everyone is safe in the weather out there. Mark, thank you for joining us. We’ve been talking about the concept of lean hospitals and making our healthcare system a little bit more efficient at the ground level where we’re delivering care in the clinics and the hospital system. One question I had for you Mark, looking at the concept of lean vs. what seems to be going on with our healthcare system. Our healthcare system is kind of looking at decreasing this dilemma of high costs in healthcare by trying to decrease and cut reimbursements, which in turn puts the hospitals in a difficult place in terms of their profit margin to, like you said invest in growth and invest in technology and things of that nature. Also, it creates a fairly low morale within the people delivering healthcare as we saw approaching January. When people were worried about the fiscal cliff and the 30% decrease in Medicare, about 30% of physicians opted out of covering patients with Medicare in an AMA study. What lean tries to do is look at reducing the costs of delivery of healthcare thereby sustaining that profit margin for the hospitals by doing that. One question I have is if there a finite limit to where you can decrease that cost of spending, where do you negotiate the rest of the costs to be more efficient in the delivery of healthcare for everyone?
Mark Graban: Right. I share your concern with the pretty dramatic slashing of reimbursement. We’re trying to I think as a country give more people access to care. Then when the government does things that leads physicians to not want to take new Medicare and Medicaid patients, it goes against that goal. I think the lean management philosophy gives us a really clear comparison between just slashing price and actually improving the system that truly takes cost out of the system. I’ll go back to the auto industry again on a comparison of the way Detroit automakers treated their suppliers as opposed to the way Toyota partners to their suppliers. General Motors, and Ford, and Chrysler were notorious for just basically bullying their suppliers and slashing the price that they paid every year, which lead to really combative relationships. It led to people having to cut corners on quality. It was a really dysfunctional relationship. Toyota has always had a much more cooperative approach with their suppliers. To work together to collaboratively find ways to reduce costs and then share that savings. So I don’t like seeing in the healthcare where we have one large party kind of bullying another. Reducing the price we pay doesn’t mean cost is actually getting taken out. We see dysfunctions in a number of countries. In the UK, the NHS has had some fairly recent scandals where, even though they don’t spend as much on healthcare as the US, their costs have been increasing. No country has unlimited budget for healthcare so there’s been a lot of cost cutting pressure. So you’ve had hospitals that are short staffed, and there’s been a lot of quality problems and patient harm that has resulted from just slashing what’s paid. That’s why we need to work together to actually improve processes, to improve efficiency, reduce costs in a way that improves quality rather than harming quality.
Dr. Ali Kasraeian: I’ll tell you, one of the parts of the delivery of healthcare for all of us who are the physicians and nurses, the people that run our clinics, the people that work in our clinics, and the hospital; everyone wants to do a good job of delivering the best care for their patients. What the processes that you’re talking about in terms of decreasing the nurse to patient ratio and delay in delivery of things, that puts an undue stress on everyone at every aspect of the process, which makes those outcome measures which are becoming ever more important in the US healthcare system and the reimbursement picture that will emerge in the next few years, it’s making that very challenging if we don’t pay attention to it now proactively.
Mark Graban: Yeah, I agree and I would certainly agree with the statement that individuals in healthcare are incredibly committed and well educated. There’s a growing number of people I think in the healthcare quality movements and healthcare patient safety movements that realize you can have a lot of really talented, wonderful individuals and still have a really broken system. I think one of the other ways that comes up is I think unfortunate things that occur when there’s a medication error or some sort of harm that is done to a patient. These are more often than not very system related issues and healthcare is still trying to get away from the traditional culture of blaming an individual instead of looking more systemically at how and why that problem occurred. Punishing an individual leaves a lot of dysfunctions. Instead of preventing future problems, it leads people to cover up and hide problems. That’s a core part of that Toyota kind of lean-based management system. Instead of having people hide and cover up problems, we need to be open about risks and things that could go wrong. So that we can fix the system before somebody is harmed instead of just punishing somebody after the fact.
Dr. Ali Kasraeian: You know it’s a very interesting thing. Of the things in one of your books I was looking at, there was a quote that you mentioned hospitals do many wonderful things but if we have world-class doctors, we have world-class treatments, and a completely broken process. That’s really not going to translate well for maximizing, optimizing those world-class doctors and world-class treatments to maximize their efficiency of delivering world-class outcomes. That’s an important thing for us to consider as we proactively think of ways to increase and improve our outcomes by decreasing, and decreasing costs in the long run. One thing that in a lot of the writings you mentioned in one place that we have to decrease cost and add value to our services so as the market increases, it will increase what it’s willing to pay for those optimized and better outcomes. Do you think that’s something we can see in the foreseeable future?
Mark Graban: Well, I think in terms of the idea of increasing value and people being willing to pay more, I think there’s an interesting dynamic. If you look at the types of healthcare that people tend to pay for out of pocket. For example, laser eye surgery. The cost has gone down and the quality has improved over the last 20 years. There’s different market dynamics than there are for other types of less elective procedures that are covered by insurance. I think that’s one thing that makes healthcare very, very different than the car business is that this connects between what I want as a customer vs. what I’m willing to pay for. In a lot of cases, personally speaking, I have health insurance through my wife, through her employment. I pay something but I’m certainly not having to do, there’s nothing driving me to do any sort of cost comparisons. Like I mentioned earlier, there’s very little data available and this varies state by state, to find out which healthcare organizations are less likely to give me an infection or give me a medication error. You’re kind of taking your chances based on the reputation of an organization. There’s been a lot of quality studies and as this data comes out, some of the really big brand name high profile healthcare organizations don’t always deliver the best quality to patients, and I think that’s going to be a real wake up call for a lot of the really nationally known medical centers. They can do amazing things like developing new types of transplants, back to your discussion again of these artificial hearts, but if you go in for a relatively knee replacement surgery, are they really the best at making sure you don’t get an infection?
Dr. Ali Kasraeian: It’s very interesting, the last two points you bring up. The American College of Surgeons is trying to be very preemptive and proactive in trying to create transparency and then creating that no blame look at outcomes within hospital systems to compare outcomes within their peers. If something seems to be an outlier within any of those systems within the region, they in a non-blame fashion are trying to set up systems where people can discuss what may be going on. For example, if one hospital has a high risk of blood clots, deep vein thrombosis, or pulmonary emboli, or things of that nature, or infections, they all work together to see what that challenge may be to see if they can improve that. They’ve got a number of studies that look by doing that preemptively, that they can improve outcomes all across the board. That’s one thing that the American College of Surgeons is trying to do. A lot of it is driven by the fact that a lot of the payers, whether it’s the government or private insurance payers, are being to look at better reimbursement for better outcomes.
Mark Graban: Yeah, and I think that’s a very important trend. Some of the best lean healthcare organizations are participating in experiments. There’s another new approach called the Accountable Care Organizations, or ACOs, where again you have these different organizations but let’s say a hospital system and the surgeons and the medical device maker are trying to figure out different ways of sharing the reimbursement that gets people aligned to work together on efficiency improvement and quality improvement. Some of these experiments are taking place through the Affordable Care Act. I think some of it’s encouraging but it’s sometimes easier to say at a real high level conceptually, we’re going to pay for quality and better outcomes. The devil is in the details of, well how do you really precisely and scientifically determine how we should be reimbursing exactly how many dollars for X? How do we pay doctors and health organizations to keep patients healthy instead of treating them once their chronic condition has gotten to a point where they have to be hospitalized? There’s so much change going on in healthcare right now. It’s both I think really scary and really promising.
Dr. Ali Kasraeian: I’ll tell you the scary thing about the outcomes measure reimbursement concept that I brought up at conferences and we don’t really have much of an idea how it’s going to play out is that are these types of changes going to keep physicians and hospitals and departments from taking care really sick patients? That’s something that we’ve seen before. The cardiothoracic group up north, which was very well known for taking care of the sickest of cardiac patients and doing the most complex redo bypass graphs and things of that nature, but they also had a high mortality rate. Thereby whenever they got kind of dinged for reimbursement and people were looking at them, hey your rates are too high. They’re like you know, we’ll just do what everyone else does. And they went back to doing the regular stuff and the regular operations that had less risk, and their outcomes became fantastic and their reimbursements went up. That’s one thing that I look at and I worry that if it isn’t done smartly, and asking the right questions you may set up a situation where people are going to take care of healthy people and then the sick people are going to be out on the ledge and we’re going to recreate the same problem in a different formulation.
Mark Graban: I very much share that concern and I think there’s a general management principle of having to be careful with incentives and measures. When we try to impose I think overly simplistic incentives in really complex systems, you get a lot of dysfunction and unintended consequences. I think that’s true. I saw a lot of that back when I worked in manufacturing, and I certainly see that in healthcare. We have to be really careful about that. I think that’s where lean, the promise of lean is improving the system very locally. Each doctor. Each nurse. Each health system. Rather than trying to come up with a single solution out of Washington D.C. and even Dr. Don Berwick who was running Medicare and Medicaid services said that the solutions for healthcare problems are not going to come from D.C., we need everybody working together on quality and efficiency improvement.
Dr. Ali Kasraeian: And that’s a tall undertaking. That’s one of those things that we don’t understand. The people that are trying to do these things it’s kind of like an everyday education in terms of trying to recreate something and also change something that’s been going on for decades. That’s quite a challenge. Especially since you bring up the car industry. The car industry, people go do comparisons. You look at and you have a price that you pay for something, and you get what you pay for. I’m not going to go out and buy a Bentley because I can’t afford it. But with healthcare, everyone wants to have Bentley level service, and all of us that are practicing medicine want to deliver that. However, the cost constraints of the system make that very challenging to do.
Mark Graban: I think some of this comes back to the different definitions of quality. Bringing it back to more practical cars maybe, the difference between a Lexus and Toyota. There’s one aspect of quality that says the Lexus has maybe nicer seats and certain features and better engine. But then there’s a different definition of quality that says basically the absence of problems. Whether I buy a $12,000 Toyota or a $80,000 Lexus, I still have a similar expectation that engine is not going to break down and stop working in the first year. I think when we look in healthcare, the parallel I would draw is that there may be some aspects of healthcare quality, certain exotic types of procedures or medications that some people are going to have access to that some people won’t. But then there’s that other definition of quality that says regardless of what’s happening, don’t harm me in the process. I think that’s one of the main things that people are really working on today that’s really important.
Dr. Ali Kasraeian: And it’s interesting to find out who is going define those outcomes, and we’ll talk about that a little bit more. Are we up for our next break?
Carmela J: Yes, we have to take another break, but we still have a few minutes left to finish our discussion on the concept on lean hospitals. Stay with us on News Talk WOKV.
Male: You’re listening to The Conversation with Dr. Ali Kasraeian and Carmela J. on News Talk WOKV. To join The Conversation call 340-0690.
Carmela J: We’re wrapping up on The Conversation on News Talk WOKV. Thank you again for listening. Dr. Kasraeian, what are we closing with tonight?
Dr. Ali Kasraeian: Today we’ve been talking about the concept of lean hospitals, which I find very intriguing and I’m going to look at our own clinic and try to apply some of these principles. I think we’re already starting to do some of this stuff, but may bug Mark to help me. Mark, anything to leave our audience with? Both with physicians listening, patients listening, anyone that isn’t seeing doctors right now, what are some closing thoughts for them to leave with this concept of lean healthcare as it’s applying to us here in the United States?
Mark Graban: Well, one of the things I always like to emphasize with the lean improvement methodology, whether it’s for you and your clinic or people working in a hospital, or even patients who might be able to apply this in their own workplaces. Lean improvement doesn’t come from an expert coming in and telling people what the answers are. Lean is being taught a methodology that you can use to identify problems and frustrations and opportunities in your own work, and then have ways of learning how to do problem solving, how to do continuous improvements. That’s the focus of my most recent book called Healthcare Kaizen. It’s really about how do you engage everybody in improvement, lots of small improvements adding up to a big difference. Making things better for your customers and your patients. Having it be a more rewarding and enriching workplace and then leading to better results for the organization that you work for. It doesn’t require a lot of complicated methodologies and lots of Japanese terms, even though kaizen is a Japanese word. It’s pretty simple, it just takes a different style of leadership that’s willing to listen to people, to engage people, and work together in improvement.
Dr. Ali Kasraeian: I think that’s the key of this concept and I think that’s, in my opinion, the key of leadership is engaging people into what they’re doing. If people are engaged, I think they will go above and beyond their own expectations of what they want to do. One of the goals of this show is to engage people in their own healthcare. To think about and ask questions that they might not otherwise think of because it’s not something that we readily walk around thinking about. That engagement concept of the lean concept for me is the most, for the lack of a better word, engaging. Because I think that’s the way we get things done. If people don’t want to do something or if people are being told to do something, and they’re negatively reinforced to do something, I think we lose them somewhere along the line. I think the positive reinforcement in engaging people to do better or seeing things and identifying things they can do better is the way that this would make us all do better I think.
Mark Graban: Yeah, and I think lean at it’s core is a very positive, optimistic methodology that assumes things can always be better instead of feeling shamed that we have problems, it focuses instead on the positive. Let’s look at how to make things better and how to do so often in creative ways. One example even for a patient, if somebody has a lot of medications that they have to take on a certain schedule, maybe they forget, maybe they missed some meds, or if they forget if they’ve taken them. That problem could be solved through technology or a simple plastic pillbox and I encourage people to look for simple, elegant solutions to the problems that they’re facing in managing their own health rather than looking for big expensive technology.
Dr. Ali Kasraeian: Thank you very much, Mark!
Carmela J: Okay. Thank you so much, Mark! Thank you for being with us. Thank you everyone for listening. Please join us again next week on The Conversation on News Talk WOKV. I’m Carmela J. We’ll see you next Saturday at 5pm for more talk on your health and wellness.[End of Audio 0:53:38]