Undercover Hospital Sensei's Diagnosis - "Healthcare is Broke" [guest post]

Normally, I introduce the guest post author at the conclusion of the post. However, this one needs a little pre-post explanation. Believe me.

First the introduction. This post was earnestly written by my friend, Jeff Fuchs. He is Director of the Maryland World Class Consortia, a lean non-profit assistance organization in the mid-Atlantic. He is also president of Neovista Consulting, working with large and small organizations on lean, leadership, and organizational change. Jeff has participated in the development and expansion of SME/AME/Shingo Prize/ASQ Lean Certification.  He is Lean Bronze Certified and serves as Co-Chairman of the Lean Certification Oversight Committee.  Jeff received his B.S. in aerospace engineering from West Point.  He is a veteran, and a member of the Shingo Prize Board of Examiners.  His current projects are in lean for personal time management, job shops, and lean government.

Now the explanation/background. At the moment, Jeff is the instructor for three lean training programs.  Recently, a trip to the emergency room interrupted one of his training sessions. Subsequent to the “interruption,” Jeff sent out an apologetic and, ever the sensei, instructive email to his session participants. He also shared the email with some other folks. Unfortunately for him, I was one of those folks. Jeff has graciously agreed to let me post his email (with some slight editing) within Gemba Tales. I think his entertaining letter drives home some of the not insignificant opportunities within health care, the importance of customer focus, and the power of direct observation (even when wearing something lent to you by the hospital). That, and Jeff managed to read a great lean book during his "incarceration" and then give it a plug.

The subject line of Jeff's email -"I'm just fine!" Wish I could say the same for health care in this country.


Dear Class,

“Rumors of my demise are greatly exaggerated.” Please accept my sincere apologies for throwing your day off last Thursday. Unfortunately, I had to bring my body into the shop for some unscheduled maintenance.

As we all heard Sir Ken Robinson observe on Wednesday’s video, some of us just view our bodies “as a way of getting our heads to meetings.”  Proper upkeep falls by the wayside from time to time, and this is what happens.  A bit of detail is in order.  I was up to answer nature’s call at 4:15 a.m. on Thursday, and instead of the usual heartbeat, “thumpita-thump, thumpita-thump, thumpita-thump…,” what I felt was more like “thumpita-thump, eeerrk! thumpita-eeerrk! thumpita-thump…errkk!...”

I grabbed my keys, wallet, cell phone, and a good book and drove to the emergency room.  You may have missed your day of training, but let me tell you that “class was in session” at the Baltimore Washington Medical Center ER when I showed up for school at 5 a.m.  Four hours later, (Let me say that again, “FOUR HOURS LATER”) we were still monkeying around with forgotten paperwork, twice redone blood draws, shift change meetings over my bed, staff that was making three trips to my room to restock inventory, and rolling me through a series of three “patient inventory” transactions between some lab and back to my ER bay of “move, wait, process, wait, move, wait” for X-ray, sonogram, and ECG, respectively.

I told you folks.  I TOLD you to your face!  “When I am through with you, if I am successful, I will make you as miserable a human being as I am.  You will see broken processes all around you.”  Welcome to my world.  Behold, the sad customer/piece of meat-inventory:

Now seriously, don’t he look sad?  Pity the poor victim of broken process.

Naturally, in a case like this I couldn’t resist going into Consultant Mode.  In spite of being hooked up to the monitor, IV, oxygen, etc. like a marionette, the monitor kept losing my continuing thumpita-errk heartbeat, so the nurses had to keep walking back to the main desk an average of every 11.3 minutes (but who’s counting) to see if I was dead yet and to reset the monitor.  How thoughtful of them to give me an ER bay where I could see their goings on.  Their wasted motion, their absence of mistake-proofing or visual controls, their failed attempts to communicate with each other, failed service opportunities, excessive patient transportation, and more.  How very thoughtful.

After three hours of fear, boredom, and frustration cocktail, I used a pen left behind by one of the nurses and began sketching out a nurse/patient spaghetti map of my morning on the back of an IV wrapper I found on the floor, along with a crude value stream map.  (There are a few things wrong in that last sentence.  Please use a black or blue ink pen to circle them.  We’ll review your answers next session.)  The ER staff found my doodles and efficiency ravings…amusing.  I’m sure they did not have much time to be interested in the “bored consultant in room six” at the same time they had to deal with the cut up guy the cop brought in handcuffs, the construction worker who just fell off a scaffold, the guy sleeping on a gurney in the hall who nobody knows where he came from, or the other poor folk who needed their full attention.

The attending physician diagnosed me with “atrial fibrillation,” an eminently treatable condition.  We’ll see in a couple weeks what the follow up says.  They admitted me for observation, where I was subjected to other process design and systems management horrors which I shall not relate to you with at this time.  Suffice it to say, I got an education in that fourteen hours.  The lesson for me: Healthcare is broke.  It’s broke bad.  I mean, if I had a clone army of a thousand Lean Jedi Knights, we’d be swinging our Lean Lightsabers for decades trying to unhose healthcare in this country.  Lean Facilitator Certification Program students, your future in this industry is secure.

By the way, one final note on my lean healthcare field trip.  The “good book” I mentioned that I snagged on my way out the door was Toyota Kata, the one I described with such admiration on Tuesday morning, lamenting that I had not had the time to read it.  Well, there you go.  I plowed through half of it.  Would have gotten further, but had to watch a really good Jerry Springer and eat my tasteless hospital food (Overcooked mac and cheese, gray asparagus, canned pears, and a drink that arrived completely frozen solid.).  So, remember what I said: “A true lean leader is a lifelong learner.”

Put your left hand on the computer screen, raise your right hand, and repeat after me: “A-true-lean-leader-is-a-lifelong-learner.”

Here’s me “enjoying” my incarceration:

Pick up a copy of Toyota Kata.  Will change your life.  It’s an easy and interesting read.  You can finish it in a weekend.  Or two bad Emergency Room visits.  Whichever.

Related posts: Beyond Toast Kaizen – Lean Breakfast Concepts, Circa 1937, Lean Management Systems and Actionable Empathy…or, “How Was Your Day?”

There are 6 Comments

Jeff Fuchs's picture


I like your Sixth Sense analogy! "I see dead resources!" In a way, lean transformation requires looking at things that everyone looks at and seeing something nobody does. But seeing the possible comes at a price, doesn't it. There's your next movie, M. Night Shyamalan!

I saw sooo many things there that were so familiar in other industries, and so typical. Most of it was good people working hard to overcome obstacles, believing that all the hassle is "part of the work", when it is really very removable. If only they have the experience of every so often stepping out of broken process and fixing it, rather than being a perpetual slave to it.

Regarding your final sentence, we really don't need that kind of partisan grenade-throwing on this forum.

And "Beat Navy!" : )

David's picture

Mark (and Jeff),

Like that Bruce Willis move in which the little kid sees dead people, those of us who have been involved in Lean jouneys see waste. I was hoping we would have seen the maps on the backs of the wrappers.

The shocking part is that those involved in the process probably don't appreciate the wait time or excess motion. Some book I read commented that the workers sees all motion as work and all work as value adding.

Thanks for sharing the story...oh, and since Jeff is from West Point and I went to Navy, I will close with "Beat Army!"

Carol's picture

Fortunately (or unfortunately) I work in a hospital in Process Improvement and have the opportunity to sit on the other side of the business as the family of the patient multiple times over the past year and can agree whole-heartedly with your observations. We are just trying to roll out Lean in our organization and it is very difficult for staff to see/believe it can be done better, more efficiently, less costly, etc. based on their suggestions (obviously we have some culture issues as well). Thank you for allowing your experience to be shared. It is another reminder and incentive for me to keep charging forward to make our organization a better place for all!

Jeff Fuchs's picture

I want to thank you for your efforts in applying lean in your hospital. There are a mountain of opportunities in healthcare in general, as I noted, and I'm sure you see many in your facility. I believe the way forward in healthcare is the same as in any large organization, and that is with more and more people pulling in the right direction. Best wishes on your lean journey!


Andrew Bishop's picture

Whoo boy, this business of practicing what our teachers show us has got to stop! ...meaning, I just spent a weekend in E.R., too, and, feeling fine, finally took the time to finish Rother's Toyota Kata. Jeff Fuchs-Sensei, this is a great book indeed, but a bad way to read it! I recommend the book but not the reading room!

Kidding aside, the book is awesome. Operationalizes the teachings of continuous improvement and total participation and puts them in the context of our common management systems and what needs to change. Why periodic improvement doesn't cut it. Really glad we got to hear Rother at N.E. Shingo Prize Conference - I always learn better from a teacher in person.

Side benefit... a weekend of "waste walks" without ever getting out of bed! Lean for slackers!

markrhamel's picture


A weekend in the ER, wow! Glad to hear that you are fine.

Love the lean for slackers quote!

The Toyota Kata book is one of my favorite lean books. It is instructive especially around the notion of target conditions and the application of the improvement and coaching kata (routines).

Stay well,