Friday, April 15, 2011

When the Gemba is an ER

As any student of Toyota knows, going to the gemba is step one when investigating a problem.  This principle is often referred to as genchi genbutsu, and lean thinkers know why it's such a powerful and almost mandatory concept.

But what about when the gemba is an Emergency Room?

My first thought is that all workplaces are different, but what we're looking for pretty much stays the same.  In other words, a gemba is a gemba.  But, having spent enough time in ER's recently, I think there are a few differentiators that we can take into account:

  1. The doctors are the touch labor.  Whereas in manufacturing, we sometimes see the problem of the touch labor employees not being respected and their voices not being heard, we sometimes have the opposite problem in healthcare.  Doctors are so well-respected, and sometimes so feared, that they can have an almost unwieldy amount of influence.
  2. Everybody is at a computer.  No, they're not playing solitaire or checking Facebook.  They're working extremely hard to enter their patient encounter information into the system.  In modern healthcare, it feels like everything is dependent upon electronic information management.
  3. Flow is hard to see.  Many ER's were not designed with one-piece flow in mind.  Or cellular flow.  Or pull systems.  Or level loading.  Or visual management.  Or any of the other concepts that help improve flow and make flow visible.  The structural design of many ER's can make it almost impossible to see the flow of patients through the system.
If you're a lean thinker looking to make the move to healthcare, these are just a couple of thoughts to keep in mind.  But, if you're a lean thinker, you've probably been to many gembas and you probably know that each one has their own set of differentiators.  An ER is still a gemba, just one that maybe requires a little extra patience and finesse.