Wednesday, September 29, 2010

LEAN Updates

Today, we had our first report outs from the 5 LEAN Six Sigma projects. I want to thank all the teams who pulled together to lead and develop these projects. Each one was driven by improving our quality (e.g., coordination of care, clinical outcomes, regulatory compliance, access to care, patient throughput, use of resources). This focus on quality creates more associate and physician engagement and participation. From there the improvement in financials will naturally happen but it starts with the drive to improve quality.

I enjoyed the dialogue on how hitting 97% would only get us to 2.6 sigma...and our goal is 6 sigma....97% is not good enough. These process changes are a true journey and need focus and discipline to stay on course and not get 'project creep', where you allow the project to get bigger and broader. The discipline to 'table' potential other projects is very important. This discipline and focus is one more way we will continue to build on a culture of safety and improvement.

I look forward to sharing the initial outcomes over the next few months.

Please share your Lean Six Sigma projects or process improvements you have made in your organization.

Monday, September 20, 2010

Root Cause Analysis - Workplace and Ironman Triathlons

Last Sunday, I had the opportunity to race in my first Ironman triathlon-technically 1/2 Ironman consisting of 1.2 mile swim (approximately 80 lengths of a 25 meter pool though you swim in a lake), followed by a 56 mile bike and 13.1 mile run. Essentially it is almost a full workday from arrival to race completion.

My blog tagline references training for life and I have spoken about many similarities to health & wellness and our workplaces. Both involve continual assessment and advancement. The vision for both are rooted in a journey and a constant pursuit of excellence related to your goals. So you work diligently, celebrate milestones, assess ways to improve and have fun and good humor along the journey.

At our hospital, we are committed to providing the safest hospital for everyone we serve. We have daily safety huddles where we review any potential safety concerns brought forward by our associates and physicians who are closest to the bedside. Through these efforts, we dig in and complete root causes on concerning trends or events. It allows us to not only learn from it but also re-evaluate and possibly change our processes for better outcomes.

So, I thought I would complete a deep dive on my performance last Sunday...
My goal was under 6 hours and my actual was 6:11. I started the swim and swallowed a lot of lake water-felt like stopping within first minute. Then was grabbed and slapped around by my fellow triathletes so I moved to the far outside and probably swam closer to 2 miles than 1.2! Then I fumbled around too long at the first transition though it was much more relaxing than the swim. The bike was in the Ozark mountains so I was either climbing hills or going too fast downhill. My legs were not made for biking hills. Then off to the run when it was 90 degrees. I stopped several times as my socks were soaked from dumping water over my head and getting sprayed by 2 guys with hoses (actually those
were more enjoyable moments). I finally stopped, dumped the socks and carried on to the finish. There is a lot that went well and many parts a comedy of errors. Certainly I will change some key things as it is all about training for life...and continuously improving along the way.

I look forward to hearing your stories in and outside of work when you apply the same deep dive review.

Congrats to all the race participants and thank you to the volunteers and Ryan Robinson, the Race Director, for keeping us safe.

And the race winners are...
Ironman 70.3 Branson
Branson, Missouri
September 19, 2010
S 1.2 mi. / B 56 mi. / R 13.1 mi.



1. Ben Hoffman (USA) 4:02:53
2. Tom Lowe (GBR) 4:05:38
3. Brian Fleischmann (USA) 4:08:25
4. Michael Lovato (USA) 4:11:04
5. James Cotter (USA) 4:14:36
6. Brent Poulsen (USA) 4:15:14
7. Gavin Anderson (USA) 4:21:40 * M30-34
8. TJ Tollakson (USA) 4:21:44
9. Jonathan Shearon (USA) 4:37:39 * M35-39
10. Scott Bredehoft (USA) 4:39:34 * M25-29


1. Kelly Williamson (USA) 4:25:47
2. Angela Naeth (CAN) 4:33:47
3. Pip Taylor (AUS) 4:41:57
4. Nina Kraft (GER) 4:42:41
5. Marisa Asplund (USA) 4:59:16
6. Tami Ritchie (USA) 5:02:30 *W25-29
7. Ali Rutledge (USA) 5:22:00 *F35-39
8. Betsy Mercer (USA) 5:22:52 *W30-34
9. Kari Fritchie (USA) 5:26:03 *W18-24
10. Jessica Imm (USA) 5:26:09 * W25-29

How you Feeling...In Your Shoes on 4 East

Last week I had another great In Your Shoes on 4E where I worked for Becky B. As always, it is eye opening for me. The amount of effort it takes with each patient encounter is really amazing. It is sometimes difficult to imagine until you are 'In the Shoes' of someone else.

Becky and the team provided great direction for me. They showed such a great team effort with each other among the nurses, PCAs and other support staff. Their handoffs at change of shift were like watching a well-orchestrated play or musical. After each patient handoff, the nurse leaving would find their next nurse partner and 'handoff' their next patient. Becky said the nurse leaving usually takes the lead to find the next nurse. I understand that this coordination of care is key in any healthcare system but it does not always play out that way.

Of course I once again found myself using the insulation gowns which are always very heat intensifying. I walked into one patent's room and asked how she was doing. She responded, 'how do you think I'm doing...terrible! That's why I am her in the hospital.' Then she immediately followed with, 'but I am comfortable, thank you for asking'. She gave me a huge grin and it made my day. Of course it should be obvious that people are not in the hospital because they want to be in a hospital. They are there to get the care and treatment they need. And that is why we are here.

I had dinner with some of our executive team members the other day. Bob F. said our physicians are great, our nurses are wonderful, we have a great support team at the hospital and pretty good facilities and equipment. But our patients, our staff, volunteers and our associates will see our greatest difference by the way we care for one another. That's what will always make us shine. And I saw that true focus on caring when I worked on 4 East. Thank you Becky, Angela and the 4East team. It was a great experience.

Thank you to those of you who would like me to do In Your Shoes with you. I have upcoming sessions with our PBX Operators, one of our surgeons (no, I will not be performing surgery) and our nurse navigators. I look forward to hearing your In Your Shoes stories. The experience will certainly give you a greater perspective.

Friday, September 17, 2010

Computer Cake Anyone

We have a new and improved Information Technology support group. Check out this computer...100% cake!

Thursday, September 16, 2010

Jayhawks in the House

Last night I had the opportunity to present to graduate students with The University Of Kansas. We discussed the challenges I face as CEO of SJMC.

It is interesting to reflect back on the many challenges faced over the past couple years and also a time to reflect on all the good... This morning, while driving into work 810 radio was discussing the Kansas City Chiefs game as they beat the San Diego Chargers. One of the comments brought up was the fact that the team is not perfect and has lots of things they could continue to build on this year and over the next few years. However, the city needs to 'allow ourselves to celebrate'. It is easy to beat up on all the bad or all the potential opportunities but we need to allow ourselves to celebrate the good. The same need to celebrate the good exists in all of our organizations along with the need to evaluate the ways to continually improve.

This brings me back to last night's presentation with the students. We have seen many changes st SJMC over the past few years and I am so proud to be a part of this organization and the great care we provide to those we serve. One of the students mentioned that she had worked at the hospital 5 years back and realized some of those similar challenges existed back then. SJMC has seen strong growth in our volumes and improvements in quality and satisfaction. Certainly cause for celebration.

The students asked great questions which certainly kept me on my toes. We discussed key skill sets needed for the healthcare field. I think the needs are critical thinking/analytics, process improvement, writing and relationships.

I am interested in hearing your recommended skill sets for our future and current leaders?

Sunday, September 12, 2010

I'm Sorry, I Forgot to Pay Attention - Information Overload

A few weeks ago, my daughter Sydney asked me to tell her a story from when I was a little kid. It was late and the story was less than 30 seconds. When I finished the story, she looked at me for a moment and said, 'Dad, could you repeat the story?...I'm sorry, I forgot to pay attention.' It just cracked me up because we have all been there.

It is so easy to go on information overload these days - between texts, emails, podcasts, standard reports, blogs, tweets, get my point. The question is determining what information to review and what decisions do you make with this information. What true value does it add?

Of course, in your personal life, there are some basics like looking at your gas tank gauge to determine if you need to fill up the tank, reviewing what is in the pantry or refrigerator to determine what food you need in the house, looking at the overflow of laundry to determine how many sets 'necessities' do you have before you run out and need to was a load.

Earlier today, I was speaking with a Chief Financial Officer, Chuck, who works with an outdoor retailer. He discussed how he focuses on the vital few in his business and only reviews key reports he will use to make decisions. Sure this seems basic but many people and business overload themselves with data they will not use to make decisions. There is certainly data that may need to be tracked for compliance or trend purposes. Even this information needs to be reviewed to make decisions even if not reviewed daily. Chuck said he reviews staff productivity per unit of service, lead time to get a product and back orders. These were 3 things valued by his employer and the customers he served. In one case he found, he could increase his lead time and his customers were still okay as long as they knew when to expect the item and that it would be there when he said it would arrive. This reduced his inventory and cost and he could pass on the savings to his company and his customers.

I enjoyed reading an article by Herb Meyer entitled, How to Analyze Information - which spelled out some focused ways to review and analyze information.

I look forward to hearing what information you review and how it adds value.

Sunday, September 5, 2010

Strange Today...The Expectation of Tomorrow

Happy Labor Day Weekend. I am in Milwaukee for a couple of days to surprise a friend for his birthday. I'll fill you in on the birthday weekend in a later blog entry.

With 2 weeks left until my first Half Ironman triathlon, I headed out this morning for my last brutal workout before the taper phase. I went out for a 15 mile run and 1.3 mile swim and it provided me some time to think about service (actually that is what popped into my head - one never knows what will come to mind during a long stretch of time). Along the route, I came across a golf course where my 'birthday' friend was playing. I saw the 'cart person' come around and stopped her. I asked her to relay a message to my friend when she saw him...within 15 minutes, I received a call from him that the message was received. I was very impressed that the message was provided so quickly. She was truly wired for service.

Then, I made a stop for some water at a restaurant and the people working there were so nice even though I technically wasn't buying anything. They treated me well knowing I may be back after the workout or another day for lunch - a potential future customer.

After the run, I went to swim and tried out a gym where I had a pass. Wow, there was essentially a full spread continental breakfast in the locker room. It was clear to me why people spent just as much time in the locker room as they did working out. Again, taking note that organizations are continuously elevating the bar to ensure customers stay loyal to them.

After the swim (and a bagel and coffee to go), I headed to Bayshore Mall. If you haven't been to Milwaukee recently, or ever, this is a totally new look than 5 years back. There were many shops and restaurants. I was really impressed with the Apple Store. I walked into the store a saw a huge crowd of people. Halfway into the store, I thought this was going to take too long so I almost turned around to leave. Just then, one of the sales people, asked me if he could help, found what I needed and went to ring me up. I asked if I had to wait in the long line at the front. He indicated they now could check me out from his 'office' located anywhere in the store. With his hand device, he scanned the product and my credit card and emailed my receipt within a couple of minutes. He said, 'what seems strange now, will be the expectation in the future.' He is right...think about the start of credit cards at the gas station pumps, the increased use of ATMs instead of walking into the bank, self check-out at the grocery stores...obviously, these are just a few basics but the world has changed what we expect from the time we thought 'this seems strange'.

This is how we will have to change how we do things in our healthcare system. Yes, things have evolved and technology has helped. However, we do still have a ways to go to ensure we provide the experience our patients, physicians and associates expect every time they are in the hospital. We also need to look at ways to make things more forward thinking and intuitive based on where we expect the next set of expectations.

I look forward to hearing the forward thinking changes your organizations are making towards those next set of expectations.