Thursday, February 18, 2010

The Breakfast Club

Twenty-five years ago, The Breakfast Club was released in theaters. The tagline read, "They only met once, but it changed their lives forever."

Today, I held our first "Breakfast Club" meeting with approximately 20 employees and volunteers. We met from 7a-8:30 and it was really a very open and direct conversation. The feedback was great to hear and it gave us a chance to learn more about each other and our respective issues and concerns.

I will hold these Breakfast Club meetings at least every other month with a group of 15-20 so everyone has an opportunity to participate. The common themes and recommendations will be shared with our management team and each hospital department. It was very helpful to hear the exchange of ideas.

The discussion focused around 5 questions to get the dialogue started:

1. What would make St. Joseph Medical Center a better hospital?
2. What is the one thing you want to do but have not been able to do at the hospital?
3. What should we stop doing?
4. What do we do really well?
5. What are your other questions, concerns and suggestions?

Essentially some themes and recommendations from today's meeting included:

- People are seeing an increased workload per patient or situation, in part because of all the additional stress our communities are feeling in this economy. For example, our Public Safety Officer indicated that our incidence were up 20-30% over prior year though the census and volumes have not increased by that percentage.

- We need to become more comfortable reporting the "bad" things so we can work on ways to improve or change how we do things. I will share an A3 Board (see A3 reference below by Jamie Flinchbaugh, founder and partner of the Lean Learning Center in Novi, Michigan)

- I love this one...STOP sending out emails by individual departments to say they are closed on a holiday. Send one with all the departments closed. This will give people a chance to read the critical emails for better patient care. We are targeting Memorial Day as a time to own up to this improvement.

- Take an hour some day to "Walk in the Shoes" of another department. This will help us get to know each other better, improve patient placement and overall coordination of care.

- Review the amount of contract help and see if it would be better to hire people to fill these roles more effectively.

- Review our own department's inventory to look for waste. Utilize a central area to share supplies when appropriate (e.g., paperclips, pumps, etc). Steve F. in Purchasing sent out a note a few weeks back asking people to let him know what overstocked items we had so we could share across departments.


- Communicate why changes are made and the expected benefits for the organization.

- Communicate issues to specific people rather than as a "global problem." Those doing what they need to do should not have to get the same message as those not following our protocols.

- Enforce our existing policy rather than create a new one just because people do not follow the current policy.

- Stop saying someone is too busy to help. We are here to support one another so make sure to speak up if you need help.

- Share key data about the hospital and department so everyone can provide support on achieving the overall goals of the organization.

- Our volunteers are great. SJMC is a very friendly place. There is a lot of cooperation among units.

This breakfast was just one more thing which makes it so enjoyable for me to serve the employees, volunteers and physicians at and Carondelet Health.

Please let me know if you have similar get togethers in your organizations and the benefits realized.

A3 Reports:
A3 Reports are simply a waste free way for report writing and communication. But the basic building blocks of the A3 report provide a nice little template for good thinking. Here are frequent failure modes in using A3s:

The Problem Statement. There are few things both more fundamental and more frequently fouled than the problem statement. How you structure the problem statement determines your focus. Make sure your problem statement is actually about the current observable condition, not about a perceived solution, cause, or what you want.

The Current Reality. This is not a sit-down exercise; it is an activity. Go observe. See what is actually happening. You want the as-is, not the supposed-to-be or the my-belief-is version of reality.

The Target Condition. This is not the result you would achieve; this is how you will change the work in order to get the result. We don't just want to uncover solutions to problems, we want to design the work to create a new and better reality. Bad systems beat good people, and our job is to change the system.

Work in Pencil. Two things happen when we work in pencil. First, we are much more likely to draw pictures than on a computer. When we draw a picture, we are more likely to capture the system view, not just the results view. Second, we should be willing to backtrack as we learn. At least half of problem statements should change based on what you learn going through the exploration.

Don't grab A3s as the next lean tool. If you do that, you will have the same result as any time you grab a tool. Use it to help you understand and change the thinking of the organization. A3 does not change the thinking, but it makes the thinking that we hold visible. And you cannot change what you cannot see.


  1. A great idea. Having a repeatable pattern allows people to start to come prepared and get some momentum built. My one recommendation: most of the discussion focuses on the organization, and that means that it is likely that you "own" all of the output from such a discussion. Allowing just one more question: "what one thing can you personally do (to everyone in the room) to improve before the next meeting?" Improvement is most effective when rapid and owned at many levels.

    And thank you for the mention of my A3 description. I will have an ebook available for free soon on my blog.

    And let me know if you ever need any help. I love helping hospitals, because the underlying spirit is so right.

    Jamie Flinchbaugh

  2. Jamie
    Great recommendation. Our next Breakfast Club meeting is in 2 weeks. I will add the discussion point on one thing everyone could personally do by the next meeting. Let me know when you have the ebook available.

    Thank you