Lean in Sweden

Last week we had the privilege of entertaining a group of four guests from Sweden.

The team comprised of:

Catharina von Blixen Finecke (a senior politician) Vice chair of the regional federation of Skane and Chair of The Foundation for Employment Security Fund for Local and Regional Government in Sweden. Catharina arrived clutching a copy of 'Making Hospitals Work'

Bent Christensen (a senior clinician) Chief Executive of Skane University Hospital which is the amalgamation of two large university hospitals in Malmö and Lund that are well on their way down the path of their lean journey.

Isa Arbin and Birger Eriksson (senior lean coaches) from the Swedish government body that provide training to staff from these regional and local authorities. So they are, really, taking this lean stuff seriously.

We felt honoured that not only had these folks travelled from Sweden just to meet us, but that they had brought with them a very clear agenda, their focus on the continued implementation of lean in their regional authorities, (which includes hospitals in Sweden) as well as local authorities - and how could we possibly assist them on their mission. After many hours of friendly and humorous discussions we agreed that some form of a collaboration was the way forward.

Having, now, been approached by several regional authorities from mainland Europe, regarding one form of collaboration or another, this has left us wondering if lean is actually gaining more traction at a regional level in mainland Europe than in the UK?

May we take this opportunity to thank Catharina, Bent, Isa and Birger for their time invested in meeting with us and here’s to a long lasting and fruitful collaboration.

Hospital Acquired Infections

We often state that extended LoS in hospital increases a patient’s chances of acquiring an infection which will at best, extend their LoS even further - or in the worst case lead to a fatality.

Obviously, however, even in the rare cases where the patient’s LoS is appropriate and not extended the chance still exists.

This reminds me of a recent (& memorable) discussion with a good friend of ours, the Medical Director for Local Health in Florence, Fabrizio Gemmi.

Fabrizio’s current campaign involves the training staff in the importance of hand washing. During this training he states that the duration spent on this important hand washing activity should take a minimum of 20 seconds to be effective. To assist folk in ensuring that they spend at least 20 seconds washing their hands (without using a stopwatch) Fabrizio came up with a remarkably simple but effective solution. He suggests that whilst washing their hands staff should sing (in their heads - or out loud if they wish) Happy Birthday to You…… Twice.

I’ve since timed myself doing this (I chose the singing it in my head option – for obvious reasons) & it does actually take 20 seconds.

More recently I decided to do a little more research on the impact of HIAs on healthcare systems and came across one site in particular http://www.haiwatch.com/ that grabbed my attention. It is a commercial site belonging to Kimberly-Clark but features some frightening data that they have compiled.

In the US alone they state that:

The Centres for Disease Control (CDC) report published in March-April 2007 estimated the number of U.S. deaths from healthcare associated infections in 2002 was a staggering 98,987

HIAs represent an estimated annual financial impact of $6.7 billion to healthcare facilities.

World wide they state that:

According to the World Health Organization (WHO), at any point in time, 1.4 million people worldwide suffer from infections acquired in hospitals.

The risk of acquiring an infection whilst in a hospital in developing countries is 2-20 times higher than in developed countries.

Faced with these chilling and head spinning numbers and acknowledging that the basic precaution of hand washing is pivotal in preventing HAIs, Fabrizio’s business case for his Happy Birthday to You…… Twice campaign seems (without wishing to state the obvious) more than bullet proof. The investment required is minimal and the improvement opportunity is vast.

They Batch Whilst We Queue

I’ve just returned home from driving my youngest daughter and her friend to our nearest, local, cinema.

This cinema is located on the outskirts of town in a busy retail park, which seems to be the norm these days.

To service the retail park there is a very long three lane carriageway in both directions. There’s no alternative.

Unbeknown to me (and probably to all the other road users in both directions) the local authority had decided to conduct some important maintenance along this carriageway.

As a result both the inner and outside lanes, on both carriageways were completely closed for several miles, leaving just one lane open, the middle one.

I could only guess from the evidence (because nobody thought to tell me) that the outside lane was closed whilst folks from the local authority cut the grass on the central reservation whilst the inside lane was closed for them to sweep up leaves and clear the drains (I did actually witness this activity just starting to take place right at the beginning of the lane closure)

Not only had they closed a very long section of the inside lane whilst a very slow activity had just commenced (they could have closed just small sections at a time where the work was actually taking place) but the ‘grass cutting’ activity in the outside lane had obviously been completed some time ago yet the lane was still closed.

Assuming that both activities (being performed by the local authority) were planned to take place at the same time they obviously weren’t synchronised. Not even remotely.

So the outside lane was still closed even though the work had been completed and miles of the outside lane were closed even though the work hadn’t really started. And guess what - the paying customer, the road users had to do – queue (and for a very long time)

Fortunately my daughter and her friend had the foresight to figure out that they needed 3D glasses to watch the film so wanted to leave for the cinema early to buy some, so we made it just in time.

Sitting in the queue driving home (there is no alternative route from the retail park) gave me the opportunity to reflect on my frustration.

It reminded me of everyday practices in healthcare:

Processes are not synchronised to suit the customer, the patient, but to suit the care providers.

The care providers actually batch the customer, the patient, to suit their working patterns.

No one tells the customer, the patient, that any of this is going to happen.

The result being that the customer, the patient, ends up in a large queue just like me in suck in that middle lane, the difference being that whilst I was merely bored and frustrated the customer’s needs in healthcare are far, far, greater and yet share the same experience.

I hope the traffic has died down before I drive back to the cinema to pick my daughter up, because I’m sure those lanes will still be closed.