A hospital CEO on lean and the Covid resurgence
A small group of private hospitals in South Africa has had the same CEO for more than a decade. Let's call him Ezekiel – a fictitious name, to protect the group from unnecessary distractions right now. Ezekiel is a fervent, long-time student of lean thinking, having read widely and attended workshops and conferences. Two of his favorite books are “Andy & Me and the Hospital”, by Pascal Dennis, and “The Work of Management”, by Jim Lancaster. He is a lean enthusiast, looking for value in healthcare, manufacturing and wherever else he can find it.
In truth, we learn about lean by reading and attending workshops and conferences, but real understanding only comes when we do and develop our skills repeatedly. Ezekiel will say he is not good at lean, yet he has managed to spread lean thinking and practices effectively to many of the group's hospitals. This was achieved by trying new things, experimenting, retaining what works and supporting the team in problem solving.
These hospitals operate in the places most affected by Covid-19 here in South Africa, especially now during the second wave. Ezekiel promised to write an article about the group's experience during the first wave. His ambition was to report how communication at all levels (through small work teams meeting, masked, with the ward and through virtual meetings with the whole group), training, standard work and a focus on people helped them cope with the difficult conditions that so many healthcare professionals around the world face. The demands of the time were overwhelming the group, so the article had to wait, but he wrote the e-mail below about the situation at the beginning of the resurgence. I would like to share it, because it may speak to healthcare leaders around the world who are on the front line in the fight against the pandemic.
“After the initial surge of infections began to subside, I got caught up in the work of guiding us through the recovery and the return to the new state. [...] For a while, the excitement and the focus were on preserving the momentum of the crisis to transform our organization in calmer times, and to remain responsive and build the learning and flexibility we had to practice so intensely into our everyday lives.
It is interesting to think that emerging from the first crisis was harder and more exhausting than its beginning.
We also recognize that some people did not adapt; some could not come with us, and we had to let them go. Although this was necessary and allowed us to carry on in the hospitals that were not doing well, it also required direct presence and effort in the ‘gemba’ to care for and train the teams left behind. I am very excited that we have replaced the departing leaders with a lean process engineer, who came to us from the local automotive industry. I can't wait to see this unfold.
We have also spent time deepening the management system in our support systems (finance, HR, payroll, IT and supply chain), and this is now creating its own momentum, as the people in these systems have really taken ownership and freed us to focus on patient care.
An exciting development was the national PPE kanban system, and we are now going to extend it to our entire supply chain to improve our inventory and supply management. So far, we have had enough PPE on hand at all times – making it possible to protect our people.
The South African second wave has already engulfed most of the country, and the rate of increase in infection, the hospitalization rate and possibly the mortality rate threaten to be higher than the first time.
That said, our teams have shown resilience, quickly returning to PPE and the discipline needed to keep their patients and themselves safe. Responding to the crisis seems easy – extending it into routine is where the challenge lies. Despite the second wave, we were thrilled to see that all our hospitals and teams were able to respond quickly and flexibly, opening red zones, tightening screening and infection control, and effectively preventing the virus from entering our system without our knowledge, so that we can contain it while we care for people with and without the infection.
Now that we have what seems to be a safer way of controlling infection in our hospitals, we are becoming aware of the need to create safe spaces for our patients, their families and our staff within the hospital, and for their families in their homes, communities and public transportation systems. This is where the risk of infection now seems greatest.
Finally, we are grateful for the way our teams have responded and embraced standard work, solved problems and shared what they have learned so far. This has allowed us to avoid closures, cuts and layoffs, and our economic position is almost back to where it was at the end of March – probably a little stronger because of our new discipline. We are doing what we can to make sure this lasts”.
