Debunking the Program-of-the-Month Myth

“This is what you and I were talking about four years ago—before the Kaizen Curmudgeon blog even existed: ‘Jaded Julie announces to everyone within earshot, “I’ve seen them all—Total Quality Management, Quality Circles, Baldrige, ISO 9000. We tried them, spent a lot of money, management lost interest, and they went away. They were all just the program of the month, like this new Lean stuff. It will go away too.” '

“To which I responded, ‘No, Jaded Julie, you’re wrong (mostly). Lean is not the program of the month, and it has worked too well to simply ‘go away.’ Here are the facts:

· All of the programs that you listed came from a common origin, W. Edwards Deming’s principles of driving out fear, employee empowerment, studying and improving processes, and reducing waste.

· The programs had many elements in common, such as people working together in teams.

· Over time, the programs evolved, became more sophisticated, and were given new names.

· Programs came and went because they were mismanaged. On this point you were correct, Julie: Management often lost interest before the programs could pay off.’ “

“You’re right, Curmudge. I was too quick to criticize; I’ve learned a lot in the past four years. Lean has been working well for us, and it has become widely used in health care organizations. But what are some of the other current programs? When I encounter them in my reading, I want to know what the author is talking about. However, it’s my guess that success doesn’t depend so much on the program itself but on how vigorously it is implemented.”

“Let’s start with an old name, Gemba Kaizen . Although this is the predecessor of Lean, the name is a trademark and is not used very much. Among the principles of Gemba Kaizen are management’s role in upholding standardization, focusing on the process, analyzing process data, establishing and implementing countermeasures, following PDCA cycles, revising standards, and policy deployment.”

“That sounds a lot like Lean. Because it is Lean’s predecessor, that should be no surprise. Lean has also strengthened the emphasis on housekeeping (5S), process analysis using value stream mapping, and A3 problem solving.”

“Most of what we have discussed can also be found in Six Sigma, where their project elements include Define-Measure-Analyze-Improve-Control. In addition, there is emphasis on process control, statistical design and analysis of experiments, and training of project leadership (black belt and green belt).”

“I assume, Curmudge, that you are going to mention the Institute for Healthcare Improvement’s (IHI) Model for Improvement.”

“IHI is sort of like a supermarket; if you need something, they are likely to have it. In this case, IHI can provide a lot of guidance as well as tools for improving a process. Principal elements in their Model for Improvement include: Forming the Team, Setting the Aim, Establishing Measures, Selecting Changes, Testing Changes using plan-do-study-act cycles, Implementing Changes, and Spreading Changes. A newer IHI tool is their Improvement Map .”

“Although the Improvement Map is free of charge, Curmudge, I understand that its use requires installation of Microsoft Silverlight software.”

“Here’s an improvement program—also fairly new—that comes from The Dartmouth Institute for Health Policy and Clinical Practice. It’s called Clinical Microsystems. To me, it looks like a highly structured, Lean-like approach to process improvement with preprinted documentation. The microsystem is ‘your unit,’ and it is defined as ‘the place where patients, families, and care teams meet.’ For people in the unit, job #1 is to provide care, and job #2 is to improve care. Steps on their Improvement Ramp include: Assessment of the unit, Theme (identified in the assessment), Global and Specific Aims (specific numeric goals), Ideas for Change, and then Plan-Do-Study-Act cycles. The organization provides so-called Greenbooks for applying these steps to specific units within a hospital (Inpatient Units, Emergency Department, etc.).”

“As you suggested, Curmudge, these programs—the old as well as the new—have a lot of features in common. So tell me, how does the newcomer decide which of these she will propose to her organization?”

“Jaded Julie, although we favor Lean and call it the Affinity Performance Excellence System, one does not need to be a purist. Pick and choose what might work best in your organization or unit. And feel free to supplement from the works of Quint Studer (Hardwiring Excellence) and James C. Hunter (Servant Leadership).”

“When we wrote much of this four years ago, we were contemplating changing my name to Enthusiastic Emily. Whatever came of that?”

“Jaded Julie, it will never happen. Your name has become a household word, or at least a hospital-wide word. You will no longer be jaded when I am no longer a curmudgeon.”