Redesigning Clinical Workflows to Return Joy to Patient Care
Thinking Outside (And Inside) the Box

Redesigning workflows is complex work. The teams involved in a Rapid Improvement Event often find it challenging to think “outside the box” in order to make significant changes to work flow processes.

45948539_sThere are many reasons why:

  • The team members have not been exposed to alternatives.
  • Others in the gemba are deeply invested in the current workflow and push back on change.
  • The organization’s culture is historically conservative and change-resistant, especially early in a Lean journey.
  • There are real or perceived regulatory, litigation, and safety risks in changing some workflow processes.
  • The leadership has not adequately communicated its support for truly new and creative redesign.

Fortunately, most teams will overcome their challenges and develop significantly improved workflows with the support of leadership and coaching by Lean sensei. And the changes often dramatically improve the care experience for patients, staff, and providers.

But, as those of us who have had the benefit of “learning by doing” on our Lean journey know, just because we have a better workflow does not mean that we will experience improvement. That improved workflow has to be implemented in order to realize the gain.

This requires that everyone involved actually learn and follow the Standard Work of that new workflow. As we know, when we don’t see improvement in results we need to ask some key questions:

  1. Is there Standard Work?
  2. Is it being followed?
  3. If not, what is the reason the worker is not able to follow the Standard Work?
  4. Can the Standard Work be improved?Graph improving

Graph-improvingIronically, in order to realize the benefits of the new workflow that was designed with “Outside the Box” thinking, we need to work “Inside the Box” by following the new Standard Work. If we don’t, we can’t tell if the redesigned workflow is resulting in better outcomes.

And, once we are following the Standard Work, then we can further improve upon it. In fact, Standard Work is nothing more than the best way we know how to do something at the moment, with the full expectation that we will continue to improve it.

It’s one of the many counterintuitive aspects of Lean that we have to work “Inside of the New Box” in order to realize the benefits of our thinking “Outside of the Old Box”.

What do you think?

Have you succeeded in “Outside the Box” thinking to redesign your workflows?

Have you succeeded in working “Inside the Box” of your new standard work?

Please share your experience with a comment below.

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