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How to Ace Your Joint Commission Survey With Lean
The Mid-Eastern Medical Center passed its Joint Commission inspection in December 2010 with flying colors. The research manager said this when asked: “There are few people who have found out from an organization your size is amazing and unbelievable”. First consider the amount of work and stress in the weeks and months before the visit from the Joint Commission investigators. Now think about the prospect you are looking forward to visiting, and your opportunity to present yourself to the research team. This is an achievable goal. Mind your steps and the Joint Commission investigation will take care of itself.
The best way to establish and improve processes and improve processes in your hospital is to adopt the philosophy and principles of Lean. The Joint Commission itself has adopted Lean as its process of improvement. For example, see the article “Don’t Just Talk the Talk: The Joint Commission examines its processes with Lean and Six Sigma, Quality Progress, July 2009” on the Joint Commission website.
Below are five key areas that the Joint Commission identified in their study, along with recommendations from the hospital’s assigned Lean teacher.
Tip 1: Start a Strong Visual Workspace with the 7S Program
7S is a standard approach to home improvement and maintenance, and is the cornerstone of a lean approach. The researchers spoke highly of the 7S clinical program. They openly stated that this is one of the best workplaces they have seen in a long time. For this to happen, discipline and vision are needed from the leadership. At this hospital, the CEO created one 7S departmental project, including a well-organized office, as part of an annual evaluation of the entire hospital’s leadership.
You also need to look beyond the traditional 5S program that many books cover. The hospital adopted 7S, including Safety and Security for every operation.
Here’s how to do your research in this category. Train at least one or two 7S Mentors per department and unit. These people do not have to do all the work, but to be available to the workers when they start the 7S activities.
Divide the hospital plan into groups and allocate space to each senior to circle the 7S. Make sure each supervisor knows what tasks have been completed, so they can put their heads in those areas and give them a check. Note to moderators: If you pass through a disturbed area and do not say anything, you are condoning this behavior. If you really want to change, put on some scrubs, roll up your sleeves and support the 7S mess. Now you are in a good position to point out the mess and ask for it to be fixed.
Tip 2: Implement Tight Supplies Management with Kanban
The Administrator of Perioperative Services had the opportunity to shine by explaining a new and very effective way to improve the hospital’s resources, the Kanban system. The hospital adopted Kanban as a way to change the PAR system. The PAR phase plan is a confusing process that you should avoid as soon as you finish reading this article. The researchers were also interested in the organization of the products, guided by Kanban management.
Here’s how to do your research in this category. This is easy, just use a Kanban replenishment system for all your deliveries. This is one of the things you have to deal with with your Materials Management department. Request that items be returned to your section using Kanban. You might think that as long as the goods are there you don’t need to care how they get there. Stop and ask the staff how many times they have to call equipment management, yelling to get the items that need to be there. Then ask yourself how appropriate it is to calculate each item every daywhich of course, no one does.
If you can’t get your device manager to log in 20th century, do a small experiment with things that are not in their hands. Then show the results and try again until they see the light.
Tip 3: Reach a High Performance Level
One of the questions that seemed to be “tricky” to the Director of Process Excellence was “and who does the actual project and implements all the Kaizens written by your department?” Their eyes lit up when the answer came back “good enough staff. RNs, Techs, and all relevant stakeholders.”
Successful Lean businesses are not about a “select few” but a culture of continuous improvement that affects everyone. Employees are the hallmark of a mature Lean business that will see sustainability in its efforts.
Here’s how to do your research in this category. Train everyone, and constantly remind every employee of the importance of continuous improvement. Some hospitals hear about Lean and want to rush to hire some engineers to create their “Process Excellence” department. We recommend that you do NOT do this. Don’t even think about starting a “Leaning Kingdom”.
Set up department management and manage studies and projects from each department and each division. This department should not to do the works, as they should be done by the workers in the sectors that got the opportunity to renovate.
Tip 4: Understand and Deploy the Lean Management System
The Joint Commission’s investigators were more interested in tracking the results of Lean projects and the metrics the hospital used to manage their operations, rather than innovating. It is very important that the fruits of your Lean work are reflected in measures such as patient satisfaction, patient satisfaction, physician satisfaction, and employee satisfaction. This does not mean that you should not follow other measures such as patient room changes, daily reductions, and OR Suite changes but these should make hospitals run better.
Here’s how to do your research in this category. If you haven’t already, link your Lean efforts to existing metrics. Every hospital we know has a management dashboard. We recommend that you do not create a new one. Keep the dashboard up to date and have a way to deal with deviations.
Set up local dashboards and use the site to hold daily 15-minute feedback meetings with department managers. Local dashboards may or may not have the same dimensions as the control dashboard.
Establish a formal leadership role. The closer you get to delivering value, the more sustainable your work should be. If you are a member of the management team, it does not mean that you do not have a permanent job. One example is a late check by the SPD Manager to see how the department is doing each day before he goes home.
Tip 5: Insist on Leaders’ Commitment
How do you expect a member of hospital leadership to understand and commit to your Lean hospital if they do not understand the principles and tools? They will not. The best case scenario is that some do their own research by reading other books (or maybe Wikipedia), while the worst case scenario is that many pay lip service and just ask for anything to get the job done and advance the process.
Here’s how to do your research in this category. Each member of the leadership team should attend training where they will have the opportunity to learn the principles and tools and use them in their own practice.
Prepare this lesson as follows:
Day 1 AM: Lesson: Lean Basics and Kaizen. Make teams and get 5 chances per team. One of these will be the PM project.
Day 1 PM: Each group completes a project and prepares for 10 minutes the next morning.
Day 2 AM: All teams report on the previous days activities. Lessons: Kanban and 7S. Select a PM project based on Kanban and/or 7S.
Day 2 PM: Each group completes a project and prepares a 10-minute presentation the following morning.
Day 3 AM: All teams report on the previous days activities. Case Study: Permanent Work. Choose a PM project for Standard Work.
Day 3 PM: Each group completes a project and prepares a 10-minute presentation the next morning.
Day 4 AM: All teams report on the previous days activities. Lesson: Value Model Mapping (VSM). The class sits together and chooses a place to map.
Day 4 PM: The class completes the VSM of the selected area.
Day 5 AM: Complete the VSM preparation by adding all the opportunities identified during the mapping process to the progress database. Close the morning by creating a Value Stream plan using simple Goal Deployment (Hoshin Kanri) tools such as the A3-T Team Charter and the A3-X Chart.
Day 5 PM: Group exhibition and celebration.
The comments, articles, suggestions above are not meant to be solutions to all problems. These are the lessons learned from the highly successful Joint Commission Survey and the work done in the months leading up to the survey. When considering implementing Lean as a process improvement strategy, there are many other tools that are just as important as the ones listed here. Some of these materials were also taken by the hospital.
Now, it’s your turn to take action. A Joint Commission investigation should not be a stressful event. Researchers are looking for stronger ways. Focus on your experience with Lean thinking, and you can look forward to your next research.
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