REVIEWED BY FRED SLUNECKA
Paradox and Imperatives in Health Care
By Jeffrey C. Bauer, Ph.D., & Mark Hagland
2007
192 pages, $39.95
Transformative Quality: The Emerging Revolution in Health Care Performance
By Mark Hagland
2008
174 pages, $49.95
Lean Hospitals: Improving Quality, Patient Safety, and Employee Satisfaction
By Mark Graban
2008
280 pages, $44.95
All books published by Productivity Press, www.productivitypress.com
Mr. Slunecka is regional president and chief executive, Avera McKennan Hospital & University Health Center, Sioux Falls, S.D.
Health care executives should always be seeking new ways to improve quality and efficiency in their facilities with the ultimate goals of patient satisfaction and saving money. With this in mind, three books — two released last year; the other in 2007 — offer practical information that can be implemented in Catholic health care facilities.
Let's say you are the CEO of a health care organization that is experiencing quality issues. You are generally committed to providing high quality care but the definition of quality is a bit variable in your mind. The board and medical staff want to do the right thing but a commitment to real quality improvement is expensive and can be politically exhausting. How can you frame the issues? How can you coalesce the various constituencies?
Well, you might buy everyone a copy of Paradox and Imperatives in Health Care and throw in the sequel Transformative Quality: The Emerging Revolution in Health Care Performance. The first book is co-authored by Jeffrey Bauer, Ph.D., a medical economist and health futurist, and Mark Hagland, a health care journalist, researcher, speaker and author. Hagland authors the second book with Bauer writing the book's foreword. In both books, the authors clearly make the case that quality improvement is the essential component of any successful health care organization.
In the two books, the authors provide numerous case studies that demonstrate the power of quality improvement tools like Lean, Six Sigma, and PDCA (Plan-Do-Check-Act). By describing a myriad of cases from a wide variety of organizations, Bauer and Hagland prove that any organization can be successful in improving the efficiency and the effectiveness of patient care. These books are just the ticket for getting the board and the senior executive team engaged in patient safety and clinical quality.
OK, let's now say you are the young vice president who was just informed that you would be leading the organization in implementing Lean across the enterprise. Being naïve about what all this entails, you eagerly accept the assignment and immediately begin the process of learning about Lean. You want to know about its history, the tools used, and some success stories from other organizations. You want some help in organizing the work. And you really, really need the support of co-workers and subordinates.
Lucky for you, Mark Graban has written just the book you need with Lean Hospitals: Improving Quality, Patient Safety, and Employee Satisfaction. Graban, a senior Lean consultant with ValuMetrix Services (part of Ortho Clinical Diagnostics and Johnson & Johnson), designed this well-written book to give health care leaders the tools needed to introduce the Toyota Production System or Lean to their hospital. Avoiding unnecessary jargon and using dozens of examples from some of the leading hospitals in the nation, Graban provides an excellent overview of the opportunities and challenges associated with the implementation of Lean. (In the interest of full disclosure, my organization, Avera McKennan Hospital and University Health Center, is one of the hospitals discussed in the book.)
Those executives who have been engaged in developing a Lean culture in their organization for more than five years know how badly this book is needed. I recall the first book on Lean that I ever attempted to read was about changing the manufacturing process in a Steelcase plant. Anyone who has attempted to "Lean" the surgical trays for neurosurgery will tell you that the cultural issues associated with hospitals are just a bit more complex.
And that is why I like Graban's approach. It focuses on the myriad of culture issues we face when implementing Lean in hospitals. Graban makes a considerable effort to impress the reader that Lean brings improved dignity to the workplace and to the worker. In Catholic health care, with its rich tradition of supporting employees, it is important to emphasize how incredibly empowering and energizing a Lean environment can be. Graban recounts success stories from across the country where the use of Lean methodology has resulted in lower costs, higher quality, greater patient safety and improved morale — all in the same project.
If I have a knock on the book, I wish Graban would have dramatically expanded Chapter 10 titled "Engaging and Leading Employees." It might have been better titled: "After the Consultants are Gone." Many organizations have successfully implemented a Lean project only to slip back into old habits, somewhat like losing weight only to gain it all back, and then some. Lean is still relatively new to health care and not everyone has found a way to hardwire the change.
In five years, the aforementioned young vice president will be older and wiser. Her or his organization will have dozens of wonderful examples of where the Lean teams have saved gobs of money and improved patient safety and morale. But, have they held the gains? Maybe Graban can make this the focus of his next book. In the meantime, if you are contemplating a Lean journey or have joined an organization that has recently begun one, this book will get you headed in the right direction.
Read Fred Slunecka's article (co-authored with Donna Farris) titled "Lean Principles Provide Opportunities for Catholic Health Care Organizations" in the July-August 2008 issue of Health Progress.