e-HealthExpert.org - Primum non nocere

Health service union Unison is planning to seek a judicial review over the government's plans for a massive reorganisation of the NHS.

Health service union Unison is planning to seek a judicial review over the government's plans for a massive reorganisation of the NHS.

By Rob Lamberts, MD Dr. Wes (a cardiology blogger who all should read) wrote a very compelling post about technology and the bondage it can create for doctors.: The devaluation of doctors’ time continues unabated. As we move into our...

By MARGALIT GUR-ARIE Every day millions of Americans and billions of people around the globe are routinely accepting colorful pieces of paper in return for their labor and placing those hard earned possessions in modern glass buildings whose owners they...

By PAUL LEVY Google recently announced that it was abandoning Wave, a multimedia social media collaboration tool. I'm sorry about this, as I thought it had great potential. That being said, I never used it, so perhaps I was typical....

A key cultural aspect of Lean is the “daily huddle.” Sure, this practice isn’t exclusive to Lean, but it fits with the core concepts of continuous improvement and “respect for people.”

In this post, we can view a video about the daily huddle at the Snohomish location of The Everett Clinic. I’m curious to hear your thoughts – what did you see that you liked? What would you do differently? How does this compare to huddles you might do in your workplace – healthcare or otherwise? In this post, I also veer into a discussion of statistical process measures…

There are different approaches to doing huddles, but here are some key points that I’ve emphasized in my work with healthcare organizations:

• It’s a stand up meeting
• Have everyone there (unless you absolutely can’t shut down the process)
• Have a 5-minute time limit
• It’s a meeting for short two-way communication snippets
• It’s a time to review recent performance
• It’s a time to raise issues and surface ideas, not a time for in-depth problem-solving
• It should be led by a senior team member (not a manager)
• Do the meeting in the gemba, not a conference room
• Everyone checks their title at the door

In the video, there’s clear evidence that Everett Clinic happens to follow some of these guidelines. For others, we can’t tell. Try to check them off as you watch, perhaps.

One thing that stood out to me from the video: Isn’t it amazing that a major detail like “which doctors are here today?” wasn’t communicated clearly before their daily huddle? That seems like a good thing for people to know, huddle or not, and that wasn’t happening?

What’s your reaction to that video?

Come back tomorrow – there’s one detail from the video that I’m going to elaborate on in a separate post.

Oh, also, on the topic of standup meetings, this is something that Bob Sutton covers a bit in his upcoming book Good Boss, Bad Boss: How to Be the Best… and Learn from the Worst. I’m going to be recording a podcast interview with Bob later tonight. If you have any questions for him, email me using the Contact menu up top.

Other Posts That Might Add Value:

• Guest Post: Deming, Lean, and Healthcare Transformation
• Dr. John Toussaint Talks Lean Healthcare on The Lean Nation Show
• Right Method, Wrong Culture
• What Makes You Want to Do Better?
• Archived SlideCast of my Webinar on Gemba Walks

There is a new way to position patients for arthroscopic rotator cuffs and other surgeries on shoulder and clavicle. MAQUET has just unveiled a new surgical arm positioning system called Trimano 3D. Attached to the surgery table, the Trimano 3D allows orthopedic and trauma care surgeons to move the patient's arm to the desired location and orientation, and to fix it in place for the duration of a procedure. The support arm includes a sterile arm rest and adapter and is used to locate and hold the patient's arm securely in the required position throughout the operation. The unrestricted manoeuvrability of the Trimano, rapid and accurate repositioning can be carried out at any time during the operation. The patient's arm can also be lifted off the support and moved freely, in order to monitor the results of the operation. The initial preparation for the positioning of the patient's arm can be made in the induction room. The arm is positioned on the support arm and an arm pad. Then, in the operating theatre, the patient's arm is simply transferred from the arm pad onto the sterile arm rest. An adapter that was developed in parallel, makes it easy to mount the arm rest into place. It connects the arm rest with the support arm resulting in greater handling and control for the user. Link to demo video of Trimano 3D... Press release: MAQUET -- ASSIST SYSTEMS FOR THE OPERATING THEATRE...... Michael

The delayed French electronic health record, Dossier Medical Personnel (DM-Personnel), will be launched by the end of the year, the agency responsible for the programme has said.

Updated: an embedded player with the recording my appearance can be found at the bottom of this post.

I appeared on Steve Wilson’s live internet radio show, where we talked about the Healthcare Value Leaders Network and what we (and our members) are doing to help accelerate and promote Lean adoption and transformation.

From the show preview description:

As a partnership of two nonprofits, Healthcare Value Leaders facilitates networks of healthcare delivery organizations that are using lean and also educates the broader healthcare community about lean. Senior Fellow at Lean Enterprise Institute, author of the book Lean Hospitals and Founder/Contributor at LeanBlog.org Mark Graban, will be talking about the organization’s mission, its work, and the current and future opportunities for collaboration and learning with other healthcare delivery organizations. Call into the show at 646-200-3898 with questions or comments or email them to wctsinc@gmail.com.

Recording of the discussion:

Other Posts That Might Add Value:

• Jim Womack: “Tipping Point” for Lean Healthcare?
• ThedaCare, Lean, and Primary Care in the News
• Notes from Dr. Brent James at the Shingo Prize, Part 2 – Comments on Lean
• Audio from 3rd “Lean Nation” Appearance – Talking Lean Healthcare Again
• Learning and Sharing Lean Healthcare in Winnipeg

By JONATHAN BUSH Recently, I got to shake hands with and also have lunch with doctor-writer extraordinaire Atul Gawande! He was nearly everything I had made him out to be. He wore a snappy blue blazer, a jumble of ID...

Students commencing medical school and master's of medicine program at Stanford this year will all get an Apple iPad. The school is trialing a program to see whether the devices are practical to integrate into the academic curriculum. Before you dismiss this as medical education being sacrificied in the name of fanboy hype, consider this -- when some of our editors were in medical school, the semesterly (mandatory) fee for handouts and photocopies was about the cost of a lower-end iPad. And that was years ago. We can only imagine the charges now. So moving the medical education culture of endless handouts and notebooks over to a compact tablet device could be very smart. More from Stanford officials: The decision to provide the devices was prompted by a desire to give students flexible access to the content that they need whether it is a virtual cadaver in dissection lab, annotated lecture slides and videos in the classroom, or journal articles for evidence-based practice in clinic. “We want to explore the use of iPads and other technologies to help students access the enormous amount of medical knowledge that is being produced constantly,” said Charles Prober, MD, the school’s senior associate dean for medical education. “Part of the challenge facing medical students, and all doctors, is the overwhelming amount of information. Devices like the iPad may be able to help users access that pool of knowledge.” The school will monitor the use of the iPads through regular surveys to help determine how helpful they are to students, pointing out that past experiments with similar electronic devices, such as the Kindle, in academic settings haven’t been successful. “We really don’t know yet how the incoming medical students will use them,” said Henry Lowe, MD, senior associate dean for information resources and technology. But, as a physician using an iPad himself, he’s found the device to be extremely helpful and believes it is growing in popularity among doctors. “Physicians are a mobile group,” Lowe said. “They’re moving around from clinic to clinic, from patient to patient. … I’ve seen a variety of reports from across the country saying that physicians have seized on the iPad as a helpful device.” Press release: iPads to be distributed to incoming class by Stanford medical school ... More at SCOPE Blog...... Michael

Siemens has released a new "1.5" version of its popular Acuson SC2000 ultrasound system that features the eSie Measure Workflow Acceleration technology. This update aims to make things go smoother and faster in the examination room. -- eSie automates a lot of the tasks normally done manually, which allows clinicians to focus more on the exam and less on manipulating the ultrasound device. To streamline exam workflows both on the user level and in the entire lab, the Acuson SC2000 system offers eSieScan workflow protocols, which bring higher reproducibility and quality standards to the echocardiography workflow. Customizable according to user or department requirements, eSieScan workflow protocols dramatically reduce the need for user interaction and the number of keystrokes during the imaging process. IN Focus coherent imaging enables the user to focus on the entire field of view instead of a single focal zone. By using the power of 64 parallel receive beams, this technology dramatically improves image quality at all depths without any user intervention to ideally display the cardiac structure and motion for superior diagnostic volumetric imaging. IN Focus technology drives the imaging power of the 4Z1, 4V1 and the V5M transducer. Expanding its application versatility, the Acuson SC2000 system now features a new 5 MHz transesophageal probe, which is interchangeable with other Siemens ultrasound platforms to ensure maximum return on investment. Siemens’ Echo in a Heartbeat technology delivers vastly more diagnostic information than today’s conventional systems. Easily integrated into a routine adult echocardiography exam, it enables new workflow pathways to improve diagnostic efficiency. Non-stitched, real-time full-volume imaging provides wider access to patients and captures true physiologic information including color flow and accurate volume quantification for the left and right ventricle. In addition, the system features the Rapid Stress volume stress echo application, with full-volume acquisition in one single heartbeat per stage and auto-extraction of reference planes for comparison. The resulting volume stress workflow enables the only volume stress echo solution for patients with arrhythmia. Consequently, faster acquisition time and comprehensive review of all wall segments in one single capture leads to potentially improved accuracy and time savings. Press release: Siemens Demonstrates Improved Efficiency in Routine Echocardiography Exams at ESC Product page: ACUSON SC2000 ...... Michael

One of the big medical stories to emerge from the US engagement in Iraq is the improving recognition of TBI -- largely from IEDs (traumatic brain injury from improvised explosive devices). Now, BAE Systems, the big European defense contractor, has unveiled its latest concussion sensor for soldier helmets, named Headborne Energy Analysis and Diagnostic System (HEADS -- see what they did there?). About 7,000 1st generation sensors have already been installed in helmets of U.S. military warriors, but the new devices feature much more effective reporting capabilities that will hopefully help in getting medical attention quicker to those that need it. Some details from BAE's press release: The HEADS smart sensor is also designed to provide medical professionals with important data that may help determine the severity of a possible TBI. “With our Generation II HEADS sensor, we’re providing medical teams with a valuable diagnostic tool that utilizes radio frequency technology,” added Coltman. “With our new ‘smarter’ sensor, if a soldier is exposed to a blast, possibly sustaining a concussion, not only will the HEADS visual LED display be triggered at the time of the event, but once the soldier enters a specified area, such as forward operating base or dining facility, a series of strategically placed antennae will scan all available HEADS units and send data to a computer, identifying any soldiers who may have sustained a blast-related brain injury.” The sensor itself is small, lightweight and can be secured inside virtually any combat helmet. Although imperceptible to the wearer, it is designed to continuously collect critical, potentially lifesaving data, including impact direction, magnitude, duration, blast pressures, angular and linear accelerations as well as the exact times of single or multiple blast events. That information is then securely stored until it can be quickly downloaded and analyzed by medical teams using a simple USB or wireless connection. Compatible with most helmets, the HEADS sensor is unobtrusive and won’t interfere with additional helmet-mounted equipment soldiers may need, such as goggles and other sensors. Deliveries on the initial Generation II HEADS order are expected to begin in April 2011, and be completed by July 2011. Press release: BAE Systems Unveils Its Heads Generation II Helmet Sensor ... (hat tip: Gizmag)... Michael

Frederick, MD based Akonni Biosystems has announced issuance of a patent titled "Apparatus, system, and method for purifying nucleic acids." The method described by the patent utilizes the company's TruTip kits, which consist of pipette tips that contain a nucleic acid binding matrix in order to speed up the process of extracting DNA or RNA samples for PCR. From the press release: TruTip Extraction Kits were released to the market last November and are the latest products by Akonni Biosystems to be protected by a U.S. Patent. When used with Mettler Toledo RAININ EDP 3-Plus Advanced Electronic Pipettes with LTS, TruTip Extraction Kits are not only fast and easy to use, but will concentrate DNA/RNA on the order of 5 to 20 fold and offer the same yield and purity as traditional methods without requiring any major capital equipment. TruTip Extractions Kits are also available for Eppendorf’s epMotion liquid handling systems when ultra-rapid, hands-free automation and sample throughput from 16 to 384 extractions per day is important. Press release: U.S. Patent Issued for Akonni Biosystems' Ultra-Rapid Nucleic Acid Extraction Technology... Product page: TruTip™ Pipette Solutions Overview...... Smit

For 10 days every August, my family and I travel to an isolated canyon filled with aspen, pine, and wildflowers just north of Mono Lake in the Eastern Sierra.
This year, we'll hike, explore old mines, harvest sage, and study the complex ecosystem of the Mono Basin.
I'll also do a solo hike along 50 miles of the John Muir trail from Mammoth to Yosemite Valley.
From August 6-16, I'll have episodic web connectivity, so I will not be blogging.
By 6pm tonight, I'll be into the wild!

On Fridays I write about emerging technologies that I experience at the office and in my day to day life.
Recently, I wanted to join a colleague for an elegant meal in Washington DC which would enable us to catch up on many strategic issues during our dining experience. (We went to Nora - it was fabulous.)
A few moments after we agreed on the restaurant, an email appeared in my inbox from OpenTable with all the details - where, when, how to get there etc. Really amazing integration of email, the web, calendaring, and restaurant table availability databases.
OpenTable has created a software as a service model for supporting in restaurant and customer facing workflow that is easy to use, convenient, and timesaving.
I was curious about their business model and technology. I did some searching on the web and found a discussion forum entry that seems to explain it all. This is not an official OpenTable communication, so it may not be perfectly accurate, but it seems reasonable.
"I use OpenTable at work, so I can explain it pretty well. I believe the restaurant pays a flat rate per person, and that rate is higher for an online reservation versus a reservation taken in person or over the phone. The "high point" (a kind of coupon) reservations are actually for restaurants that want to fill tables at off-peak hours. I would imagine that these reservations are going to cost the restaurant significantly more than a normal reservation, which is why these are generally seen only at higher end restaurants.
There isn't a certain number of tables that can be booked only through OpenTable. When I make a reservation for someone over the phone, I use an interface quite similar to the one that you use online. The difference is that I can look through the whole book and decide that we can fit in another table at 7:30. So, if you look online and don't see the time slot you want, you can always call the restaurant to see if you can get a table at your desired time.
We can also take notes about your reservation (birthday, anniversary, wants a booth, needs a high chair, et cetera), and also keep permanent notes on each guest (prefers a certain waiter, always gets Fiji water, VIP, etc.). When you put a comment in online, it automatically shows up in our reservation notes. Along with that information, we also see if it's your first time at the restaurant, and if you have OpenTable VIP status."
A web-based, software as a service that supports restaurant and customer workflow. That's cool!

Here’s a great article with a number of quotes from William Considine, the CEO of Akron Children’s Hospital in Ohio. The article, from the Akron/Canton Smart Business publication is titled “William Considine embraces Lean Six Sigma to improve Akron Children’s Hospital.”

I get accused sometimes of overstating the importance of having the CEO on board — well beyond that, actually driving Lean and being willing to help set expectations for culture and behavior in the organization. Maybe you shouldn’t just give up and quit if that senior leadership isn’t on board, but it certainly makes a huge difference.

Considine seems to get it:

“We all know that culture eats strategy every day,” he says. “You can have the best strategy in the world, but if you don’t have a good culture, you’re going to have a hard time implementing that strategy. Lean Six Sigma is a real investment in culture. It communicates to your people that you really value them and what they do.”

The article highlights some classic examples of how a hospital was able to avoid multi-million dollar construction efforts through Lean. Instead of falling back on the old easy “more people, more space” solution, they improved the process by engaging the staff in the perioperative services area. This saved ACH $3.5 million, but it also got people engaged in improvement.

Considine emphasized this point:

“We’re going to them and saying, ‘You know your work better than anybody. We want to empower you and give you the resources to look at ways to improve your efficiencies,’” Considine says. “And they love being a part of it.”

The CEO talked about getting others on board with Lean — he didn’t do it in a “thou shalt” top-down, command-and-control manner:

“One thing you need to do is respect everybody’s opinions and I do,” he says. “At the same time, advance positive energy in what we’re doing. I find people want to be around positive energy.

“You know how you feel when you’re in a room with a bunch of naysayers. Quite honestly, people don’t want to be around negative energy. I don’t give it a lot of credibility. If people want to voice it fine, I don’t hover around it though. I move on to that positive energy and, ‘OK, we’ll take that input. We’ll process it, and we’re going forward.’ The large majority of people go forward.”

There’s an interesting and challenging balance to strike — when to listen and build consensus (which might take forever) and when to put a stake in the ground as a leader… while still respecting people’s opinions and feelings.

He also, in the article, talks about the need to focus on the positive and what people do well, not just the negative things and the waste.

He also talks about the balance between having a formal Lean Promotion Office (they have one) and just letting Lean happen organically:

“The key is you want to empower the people,” Considine says. “You don’t want to have so much structure there that it’s bureaucratic. Keep it simple.

“The thing is you want the people on the front line to say, ‘Hey I got this idea. I do this job every day and I think I can make this job, these processes, a little simpler, more efficient.’”

There’s a lot covered in the article – celebrating successes, communicating, and building on your successes. They also share a huge success in reducing waiting times for MRIs (from 25 to 28 days to just 3). A good uplifting piece for a Friday, I think.

Disclosure: Akron Children’s Hospital is a member in the Healthcare Value Leaders Network, an effort in which I’m involved.

Other Posts That Might Add Value:

• A First-Person Lean Leadership Story from John Toussaint, MD
• Dr. John Toussaint Talks Lean Healthcare on The Lean Nation Show
• Right Method, Wrong Culture
• Another CEO Talk: “Can I Say That?”
• An Industrial Engineer as Hospital CEO