Lean Healthcare

LEI Brings the Healthcare Gemba to You, Virtually

By Jon Miller Published on January 24th, 2010

Way back in the day when I was traveling all over the country as an interpreter for Japanese consultants I imagined what it would take to remove the non-value added part of this process: the travel. I imagined a the Japanese sensei walking around with a TV camera and me with a monitor, headphones and mic, thousands of miles away. Thankfully that never happened, and my time on the gemba was a great education.
Interpreting between languages, unlike document translation, requires that you can hear and be heard. While interpretation via phone or wireless headsets is possible, it is not practical for interpreting on the noisy manufacturing shop floor during a lean consulting event. There is too much noise, context, body language and visual information needed to do the job successfully. Not to mention that This was back in the days before the internet browser was commonly used, much less live video feed via internet. Now that the technology is catching up, sometimes I wonder about the “virtual gemba consultant”.
The Lean Enterprise Institute is taking lean training online in an innovative way. If this experiment works, you will be able to go to the healthcare gemba virtually to learn what ThedaCare is doing with lean and hoshin kanri. The LEI are interactive video event is titled Strategy Deployment: The Key to Leading the Lean Enterprise. The video above is a preview for this two-part event, described as:

To truly become a lean organization, we need a new management system – and the “Strategy Deployment” (also known as hoshin kanri or policy deployment) method is a critical piece of lean management for Toyota, for other manufacturers, or for health systems like ThedaCare. Through this video experience, you will see ThedaCare’s leading lean practices at their “gemba” and you will interact with a leading figure in the development of the ThedaCare Improvement System.

The first part is the on-demand video training with people from ThedaCare talking about their use of strategy deployment while showing you examples of their work virtually from their gemba. The second part of the video training event features ThedaCare CEO Emeritus John Toussaint, MD answering questions from the viewers on February 24th, 2010 11AM EST. According to LEI this video event has intentionally not been highly produced. That is not only appropriate as an experiment, but also to give a feel for the genuine people and work at the virtual gemba.
Citing travel costs and the need for short-response, ad hoc support, several clients have asked us for the “virtual sensei”. So far we have responded by creating Gemba Academy to make high quality lean training videos widely available through online and DVD. The Lean Enterprise Institute’s experiment combines recorded video with live video streaming to allow for interaction with the expert on screen. This is an interesting experiment in lean learning.
How far away are we from a “virtual gemba walk” with the lean sensei watching a live feed from another city while the client is on the gemba with a head-mounted video camera and wireless internet transmitter? Good or bad idea? What do you think?

  1. Harish

    January 24, 2010 - 6:25 pm

    Hi Jon,
    Interesting concept. I have my reservations though. A virtual walk could be useful to a certain extent. But to get the full bang for the buck, you have to be physically there. You need to see how the employees interact with the system.
    It sounded a little too good to be true.
    As for the video, why are there so many charts and papers on the wall? Do you think Ohno would have approved a wall full of papers and charts? Is it not Ohno who said, Facts are more important than data?
    Won’t people get blinded by so much paper work that they start to ignore them? How much information can one person take?

  2. Doug

    January 24, 2010 - 10:22 pm

    Sounds like a great idea by LEI. I will definitely check it out. Thanks for posting this even though they are your competitor.

  3. Mark Graban

    January 28, 2010 - 9:12 am

    Jon – I appreciate you posting this. I’m deeply involved in this project on the technology side at LEI. I understand this is a mixed bag. In our Healthcare Value Leaders Network, we do in-person gemba at a member site 2 to 3 times a year. We’re looking at virtual gemba, in different forms, as a supplement, not a replacement for real gemba. We’ve run this event as an internal Network event (non-public) and it was well received. It’s not as good as being there, I’m sure, but it’s better than nothing, I think. We are also experimenting with broadcasting (for the internal network) portions of the in-person meetings so more people can experience what is happening.
    BTW, Norman Bodek is doing more training and consulting via an HD video cam terminal attached to his Mac. It eases the travel burden on him, physically, and seems to work well.
    When I was in consultant mode, I always wished I could have a video conference connection with my clients on the week I was away. It’s a supplement to in-person consulting, not a replacement, I think.
    So our experiments continue. PDCA. If the internal network trial had been a failure, we would have stopped.

  4. John Toussaint

    January 28, 2010 - 10:27 am

    The Thedacare visual tracking process is modeled after Toyota and focuses on Safety,Quality,People,Delivery,Cost. Each business unit has the same tracking process but the data is very focused on the key metrics for that individual unit. Frontline staff are the people both developing the measures and documenting the daily performance. This data is important to the daily gemba that occurs with front line physicians and nursing staff and is used for daily improvement by these staff.
    Bottomline,this isn’t data for data’s sake which I see most of the time in healthcare.Instead it is information that drives improved performance.

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