Sorta Systems ImageLast year I had a short stay at one of Boston’s best hospitals.  While I will be forever grateful for the excellent treatment I received while in their care, I wondered about a few systems that sat directly in front of my bed.  So, I took a picture to share later.  Here is what I saw:

  1. The storage bins at the left of the photo seemed a little messy and hard to reach, but they apparently served a useful function of putting bedside supplies near to the patient.  On two occasions, however, needed items were missing, requiring my caregivers to go in search elsewhere.   This raised a series of 5WIH questions for me. For example, who decided what and how much was needed in the room?  Why were bins sometimes empty?  Who was responsible to refill?  Where did the supplier go to fetch the needed items?  Also, was the cause of the missing parts traced?
  2. The whiteboard served only one purpose for me: it put a smile on my face. I wish I’d invested in the whiteboard market when I began my consulting career. They’ve multiplied exponentially since the advent of Lean.    My name, the date and the doc’s name (redacted) were up to date, but nothing else was filled in. Who designed the board?  Was all of the information needed?  Did anyone really know what my estimated discharge date was anyway?  If this visual system were essential to my care, then there would be cause for patient worry.  If the system was actually not impactful to either me or the caregivers that would also be cause for concern as it was wasting wall space and valuable caregiver time.
  3. The final sorta-system, a laminated visual aid that sat under the white board, was never used during my visit. It appeared to be related to patient safety, but neither the patient name nor the date was correct.  A checkbox on the visual aid indicated that I needed a walker.  I didn’t.

My question here is not whether or not any of these systems were potentially useful, nor am I questioning any of the actions or performance of my excellent caregivers and support staff.   My question is “How often do we audit systems that are supposed to be making us more productive?”

Recalling W. Edwards Deming’s 95/5 rule that 95% of the variation in the performance of a system is caused by the system itself and only 5% is caused by the people, if a system is not working as intended, what steps do we take to analyze and adjust?   And what are the consequences to the system if we just set it and forget it?  What impact to our employees and customers?

How often do you take stock of the systems that run your business?  When you do, what are your discoveries?   Please share a thought.



PS GBMP’s next public workshop – Problem Solving for Lean Teams in Healthcare – is a week from today at our new HQ in Boston’s Innovation/Seaport District. Seats remain. Visit our website to learn more/register your team.  Topic & workshop content is applicable to Lean teams from administrative and other functions of manufacturing organizations too! Hope to see you there!

3 thoughts on “Sorta-Systems

  1. Pingback: Hospital Observations from the Toast Guy – Lean Blog

  2. Andrew Bishop

    Bruce – Glad you made it through the “sorta-system”! Unfortunately, a trip to the hospital can be a risky business.
    We are faced with these same concerns (and artifacts – communication boards, supplies, educational materials and programs) in patient rooms. My “clients” (clinical and operations staff) here identify with your observations!
    How do we address the changes required by changing needs and environment to assure that systems are alive and relevant?
    Our most reliable resource is a highly engaged team who speak up when something doesn’t work or doesn’t make sense anymore, and who take ownership of problems and problem solving.
    Support from management (honoring people who identify problems, systematizing the capture and assignment of problems, and supporting development of problem solving skills) is the other part of the equation.

  3. Austin

    One of the most important resources in this system are the people that speak up when certain processes don’t work or need to be looked at more. If a system is not working, first, take a look at this process flow that shows how the steps fit together, discover primary business objectives, and organize a strategic plan. Once the above questions have been answered, the next task is to gather information that describes your organization’s current situation and the environment in which it operates. Once you’ve gathered the information you need to determine the current state, the next step is to make decisions based on that information, draft a plan and implement that plan.


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