Raise your hand if your organization is NOT working on patient flow.
Challenges with patient flow plague every hospital and health system in the country. They are some of the most complex and difficult-to-solve problems that healthcare clinicians and administrators encounter. It often feels like a game of whack-a-mole...as soon as one problem is solved another one appears...or Groundhog Day...why are we working on that again, I thought we solved that problem 6 months ago!?! As we all know by now, there is no silver bullet or one magic solution, but there are some common pitfalls that are made by leaders when trying to tackle patient flow.
Over the next 3 blogs, we will provide guidance on how to avoid making some of these common mistakes and harness the problem-solving power of your team to identify, implement, and support solutions that will stick.
In this post, we are going to tackle the topic of including frontline caregivers in the problem-solving process.
It is well-known that the further we get from where the work happens, the less we know about the problems being experienced. Sidney Yoshida’s model from over 3 decades ago, the Iceberg of Ignorance, is an excellent illustration of where the knowledge of problems in the work lies.
Respect for every individual is at the heart of lean thinking. How can we honor and show respect for our caregivers if we do not engage them in the problem-solving process? We need their deep understanding of the work to identify the problems, flow-stoppers, barriers to following standards, as well as their insights into the customer experience. The usual resistance comes in the form of not being able to pull them away from their daily work...so get creative. Take the discussion to them, solicit the best thinking of your nurses with well-crafted questions during daily huddles, through surveys or real-time feedback while observing in the gemba, or schedule staff to come in before or after a shift. Meet with providers during their routine business meetings or schedule workshop time during off hours. If you are serious about fixing the problem once and for all, the downside of not including direct caregiver input always outweighs the barriers.
Frontline caregivers are the key to unlocking sustainable solutions. Since they are the ones most affected, it is their adoption of new processes and changes in behavior that is needed. If we engage the frontline in the performance improvement process, leadership provides staff with the agency to design their work in a way that meets the target while also meeting their needs. This agency puts them in the driver's seat, increasing their ownership and buy-in for the improvement. They become the advocates, selling the ideas to their co-workers.
We cannot expect creativity and innovation to come without challenging the status quo. So, if you want to amplify your results, ensure there is diversity across the team. Include staff from different professions, departments, backgrounds, and years of experience. This allows for diverse thoughts and ideas to come forward, leading to creative solutions. We often talk about initiatives and tactics for improving psychological safety and enhancing our DEIA...turn that into action by engaging the staff, seeking out diversity in our improvement teams, and letting them know their voice is important.
And I challenge you to think about ways to tap into the vast knowledge of your workforce as you tackle the systemic challenges around patient flow. Make the investment...it will be worth your time, effort, and expense. We cannot do it without them!