LifeWings is on their way to becoming a Lean organization with the help of Senior Advisor to the University of Toyota, Matthew May.

At its essence, Lean is the principle, ingrained in every employee and manager's mind and practices, that they are personally and primarily responsible for incrementally making their job better, more streamlined, more value added, every single day. It is a culture that values personal continuous quality improvement. Toyota processes over one million improvement ideas from their employees every year. As a result, they are the world's largest and most profitable automobile manufacturer.

Hospitals may be embracing the adoption of Lean principles in the way they design the delivery of care even faster than their adoption of simulation. This is a growing market demand to which Lifewings has responded.

We've be working with one of the premiere faculty members of Toyota University to learn how to become a Lean organization ourselves and then seek to embed Lean practices into our consulting services for our clients.

Going forward, to be successful our clients must become owners and not just renters of the technology and services we provide, and using the practices of Lean will help them create a culture of continuous improvement around our methods.

By February of 2008 LifeWings will be a company that has Lean embedded into its daily work practices (leading by example), and we will also embed Lean into our Hardwired Safety Tools workshops. We will provide services faster, more realistically, and with better methods for permanent improvements for our clients.

Our new company motto…THINK LEAN!

The Shared Mental Model

Every healthcare team should have a good Shared Mental Model. The Shared Mental is important because true team coordination depends on it; each team member is able to predict what other team members are going to do. In addition, the better the model is, the faster the error correction rate. Everyone has a picture of what it should look like. With this simple tool in place team performance improves and the inevitable errors of the human care provider are detected, trapped, and corrected before they harm the organization or patient.

Here are four questions that should be answered for a successful Shared Mental Model:

What is happening?

Make sure that each team member has an accurate assessment of the situation. Does everyone on the team know what should be happening? The only way to know for sure is if you have done an adequate briefing of the game plan.

What will I do?

Everyone on the team must know what their role is and how to execute that role. Everyone should understand the exact procedures and sequences to follow. Each team member should also understand what the leader expects them to do.

How will I do it?

Team members must also know precisely what to expect from one another. Who is going to do what? And when?

Who does what?

You must know what others will do. If you don't know what your teammates are going to accomplish, you cannot effectively coordinate your own activities.

Finally, when you have completed your briefing you must ask yourself the following questions:

1. Does everyone really know what is happening?
2. Does everyone know what they will do?
3. Does everyone know how they will do it?
4. Does everyone know what the other team members will do?

If you cannot answer yes to any of these questions you must re-brief.

"When a team outgrows individual performance and learns team confidence, excellence becomes a reality."

-Joe Paterno

Improvement in Employee Satisfaction Surveys with LifeWings Teamwork Training and Tools

Specifically, in an academic health center LifeWings worked with the office of the CMO. The goal was to improve staff satisfaction. The staff realized that not only is turnover costly in terms of replacement and recruitment costs, their care-giving teams need greater permanence to cut down on teamwork and communication errors.

The leadership wanted teamwork training that fostered a sense community among the staff and that would change the way the staff felt about themselves and the institution for which they worked.

The LifeWings teamwork training and tools implementation projects gave the hospital leadership the ingredients to meet their goal. The hospital found that employees (as measured by an Employee Satisfaction Survey) that attended the teamwork training and worked in departments using the Hardwired Safety Tools had a greater sense of teamwork and satisfaction with their place of work than those employees that had not attended the training and did not work in departments using the safety tools.

Guidelines for Leaders When Working Toward Project Success, Part II:

Lean Thinking for Knowledge Work
By Matthew E. May

"Lean thinking at Toyota looks nothing like most oversimplified, rule centered and expert driven corporate improvement programs. There is no one best way, no 10-step model, no sensei (teacher or master) and no multiphase implementation plan. Instead, lean thinking conveys a higher viewpoint that empowers knowledge workers to become independent goal seekers who leverage deeper problem solving skills and critical thinking capabilities in service to customers."

Q:

To date, what is the greatest challenge your organization faces with CRM implementation?

A:

It would be consistency of application with the tools. A tool is only as good as the people using the tool and it has to be used all the time. We have had great success in improvement of communication, teamwork, and satisfaction both physician and nursing.

Things are going great here. The LifeWings program changed the culture in a thinking mode of if you find it fix it. We have staff working to develop tools almost weekly for any issue we define as a problem. As for measurable outcomes, we do a procedure brief 100% of the time, we have caught allergies etc. in the time out process we have prior to procedure. We have tools that identify problems before they occur.

Jennifer S. Cord RN MSN
Director Women's Services
Provena United Samaritans Medical Center

Recent Innovators:

Texas Orthopedic Hospital-Houston, TX
Fall Seminar, "Creating a Team"

Salem Hospital-Salem, OR
L&D, NICU, & Mother / Baby Depts.

Texas Health Resources-Arlington, TX
Teamwork Skills Workshop for Risk Managers

SSM St. Mary's Health Center-St. Louis, MO
Risk Assessment / Training Visit

Texas Medical Liability Trust-Austin, TX
Fall Seminar Series

St. John's Lutheran Hospital-Libby, MT
Teamwork Skills Workshop

Got a question that you would like to see answered in one of our newsletters? Well, tell us about it! Send your question to kdebra@SaferPatients.com with the email subject as "Road Block Question."

If you would like a reference for any of our clients, please contact K.C. DeBra at kdebra@SaferPatients.com or (901) 844- 9226.

The Quest for Excellence

On November 2, 2007 The Nebraska Medical Center (NMC) was presented with the Nebraska Hospital Association "Quest for Excellence" award based on their application titled "Improving Cardiovascular Patient Safety: Implementation of Crew Resource Management". This award is given each year in recognition of "the highest level of professional acknowledgement in Nebraska's hospital quality improvement arena". The application focused on the implementation process of Crew Resource Management (CRM) to promote cardiovascular patient safety in the OR, Cardiac Catheterization and Electrophysiology Lab, as well as the results achieved thus far. Although a very high level of patient safety in procedure based areas was already in place at the NMC, CRM was pursued as a strategy to take the organization to an even higher level of excellence.

The application acknowledges the training by and collaborative relationship with LifeWings Partners LLC. LifeWings provided the initial leadership and employee training and tools development facilitation. In June of 2006, two NMC employees were trained to teach the LifeWings curriculum "in-house" in order to provide ongoing instruction and mentoring and sustain forward momentum for the program. To date, 258 physicians, 286 residents and 501 staff have attended CRM training at the NMC.

This represents over 99% of the staff and physicians in the procedure based areas within the NMC that were originally targeted for CRM training.

Implementation of and participation in CRM was declared a mandated process by the hospital's Board of Directors, and actively supported by the executive level of the organization. This level of championship is considered essential to the success achieved thus far. Lessons learned include the importance of customizing tools for each procedure based area; the development of tools that are focused, brief and obvious in their value to achieve buy-in; and having the "right staff and physicians" on the tool and implementation teams.

Although not without its ongoing challenges, implementation success is measured by looking to the large body of varying kinds of "good catches" that occur on a regular basis, compared to our adverse event tracking. Surveys seeking feedback on the "Culture of Patient Safety" demonstrate significant post implementation improvement in the perception of staff, physicians and residents. An impressive increase in un-eventful cases post CRM implementation has also been identified.

Mary Ellen Uphoff
Mater Black Belt, Six Sigma Dept.
The Nebraska Medical Center-Omaha

Book Competition!

The Elegant Solution
Toyota's Formula for Mastering Innovation

By Matthew E. May
Senior Advisor to the University of Toyota

"For the first time, an insider reveals the formula behind Toyota's unceasing quest to innovate and do more with less, a philosophy that has made it one of the ten most profitable companies in the world (and worth more than FM, Ford, DaimlerChrysler, and Honda combined.) "

Bill of Health - Hospital Safety Plan

The LifeWings patient safety improvement program was recently featured on the PBS Nightly Business Report.