Lean Hotels

By Pascal Dennis (bio)

Lean in the service industries is a frequent topic in this blog.

The great hotel chains -- Ritz, Hyatt, Marriott, Westin, Disney and others -- are superb Lean companies.

Marriott's Twelve Guiding Principles of Leadership and Customer Service, for example, reads like a Lean manifesto:

1. Continually challenge your team to do better.
   


2. Take good care of your employees, and they’ll take good care of your customers, and the customers will come back.
   


3. Celebrate your people’s success, not your own.
   


4. Know what you’re good at and mine those competencies for all you’re worth.
   


5. Do it and do it now. Err on the side of taking action.
   


6. Communicate. Listen to your customers, associates and competitors.
   


7. See and be seen. Get out of your office, walk around, make yourself visible and accessible.
   


8. Success is in the details.
   


9. It’s more important to hire people with the right qualities than with specific experience.
   


10. Customer needs may vary, but their bias for quality never does.
    


11. Eliminate the cause of a mistake. Don’t just clean it up.
    


12. View every problem as an opportunity to grow.
    

Marriott's standard - our principles will be in the nightstand drawer of every Marriott room.

A few years ago, I was staying at the Sharm al Shaikh Marriott, at the bottom of the Sinai peninsula.

Being a natural pain, I decided to check Marriott's adherence to its standards, in this relatively remote hotel.

Sure enough, I found the principles were there were supposed to be.

The hotel manager smiled when I told him, and described Marriott's training & development processes.

Ritz, Hyatt, Westin, Disney & the rest all have corresponding principles & practices. Well done - and please continue!

Are there any other industries that could learn from Lean hotels?

Oh, I don't know, perhaps Health Care...?

Best regards,

Pascal

Andy & Me and the Hospital – now available!

By Pascal Dennis

There is much opportunity, Tom-san!
Andy Saito

Dear friends,

I’m thrilled to announce the release of Andy & Me and the Hospital – Further Adventures on the Lean Journey [Amazon and Productivity Press].

Tom Papas and his sensei, Andy Saito, face perhaps their greatest challenge yet – a major New York City hospital.

Why a book about Toyota methods (aka ‘Lean’) in a hospital?

Because health-care is a dark realm full of opportunity. If we don't get it right, it could bankrupt us.

Why this book?

I want to answer some basic questions. What does a Lean transformation in a hospital feel like?

What overall approach should we take? What kind of leadership and behavior change is needed?

How do we develop and engage people? How do we improve processes?

How do we build a management system? How do we translate what Deming called the ‘profound system of knowledge’?

At the same time, I want to provide a clear and simple guide to Toyota methods and thinking, how they fit together, and the spirit that animates them.

Why a sequel to Andy & Me and The Remedy?

People seem to like Tom Papas and Andy Saito, and they’re like family to me now. Moreover, their journey is perhaps a useful metaphor for leaders at all levels.

Gave it everything I got. Hope you find it enjoyable and helpful.

Best regards,

Pascal

PS Special Offer from my publisher:

Please feel free to contact Charles Regan at the Taylor & Francis group for a bulk offer or customized version of Andy & Me and the Hospital,

E: Charles.regan@taylorandfrancis.com
P: 917-351-7122

Pascal Dennis Bio

Pulling the Health Care Andon – Epilogue

By Pascal Dennis

In my Nov 16 blog I described the indignities my mom faced in a major downtown Toronto hospital. (Not forgetting to acknowledge all the good people we met who worked in this bad system.)

It was personal piece that triggered heartfelt commentary. “This could have happened in any American, British, Australian hospital…” was common refrain.

(Note: Canadians have to use the existing system. The Canadian Health Care Act essentially outlaws private medicine.)

I sent detailed, respectful letters highlighting process problems to senior leaders at the hospital and at the Ministry of Health.

I’ve received nothing back from the latter.

I finally heard back from the former. Here’s how the VP of Patient Affairs responded:

• Our hospital is just great


• We have no problems


• It’s all your fault (and your mom’s)

I’m paraphrasing, of course, but this was the core message – and reflects the nature of the challenge in health care.

How would a top shelf organization respond to honest customer feedback?

How would, say, Toyota, Marriott, Proctor & Gamble, Cleveland Clinic have handled it?

They’d thank the customer, no? Then a deep dive on root causes.

Let me once again recognize & commend all our health care friends and colleagues working to fix all these bad processes.

We have a great deal of work to do, no?

Best regards,

Pascal

Pascal Dennis Bio

Pulling the Health Care Andon, part 2

Pulling the Health Care Andon, part 2

I few months back I pulled the andon (Japanese for ‘Help Chain’) on a major Toronto hospital where my mom had suffered a number of indignities.

Thought I’d let you know what happened.

Quick overview: Mama went in for lower back surgery to treat a very painful spinal stenosis. The operation was a success and her orthopedic surgeon and OR staff, superb.

Convalescent care was another story. Here’s a key point summary:

1. No target discharge date or discharge plan


2. No standard discharge process. Everybody we spoke to had a different opinion.


3. Poor communication. Key staff members repeatedly failed to return phone calls or provide clear information on Mama’s condition, treatment and support plan


4. Poor hand-off with community chronic care system


5. A rogue ‘case manager’ who tried to hustle an 82 year-old patient, who was in great pain from an 8 inch incision in her back, out of the hospital after 2 days – and declined to attend agreed upon patient conferences or respond to calls.

The events could easily have taken place in an American, British, or Australian hospital.

The Rest of the Story
I sent letters to the hospital CEO and the Minister of Health. No response from the latter – and no surprise. Ontario’s vast Ministry of Health has 32 Deputy Ministers. Guess how many are focused on patient experience?

To be fair, Ontario has belatedly acknowledged the problem and appointed a ‘patient ombudsman’

We did receive a letter from the hospital’s ‘Director of Patient Experience’. Sorry to say, it’s full of howlers

1. Everything is just great at our hospital – we have no problems at all


2. Your mom was walking around and was ready to leave on the second day – (??)


3. Any problems are all your family’s fault

Denial, deflection and disrespect for patients.

“No problem is a big problem,” my Toyota senseis used to say.

How can they possibly improve their processes and outcomes? How can patient experience be anything by a crapshoot?

I’ll forward all this to Ontario’s new ‘patient ombudsman’, and send another note to the hospital CEO. I’m not expecting anything, but you have to give feedback.

Let me salute again the growing number of hospitals around the world that are in the midst of heartfelt process and cultural transformations.

I’m lucky enough to work with some of you. You’re fighting the good fight, and though it’ll take a long time, you’re going to win.

Best wishes,

Pascal

Pascal Dennis Bio

Andy & Me and the Hospital – and the Great Paradox

By Pascal Dennis

Just sent the manuscript for Andy & Me and the Hospital, the latest Tom Papas-Andy Saito adventure, to my publisher.

God-willing, the book will be published in early Spring 2016.

The ‘Great Paradox’ of Health-Care is a central theme. As Tom puts it, “How can there be miracles within the silos, and disaster across them?”

Tom is referring, of course, to the epidemic of medical errors, infections, mis-medications and the like that kill hundreds of thousands of Americans each year.

(The epidemic is almost certainly as severe in other countries, if not more so.)

How indeed can this be?

Health care workers are among the best educated and most capable in all of industry. They’re committed and caring and use the best and latest technologies.

Something is rotten in the state of Health-Care.

Tom Papas and Andy Saito are on the case.

Keep you posted.

Best regards,

Pascal

Pascal Dennis Bio

Pulling the Health Care Andon

By Pascal Dennis

This one’s personal, folks. I’m pulling the andon (Japanese for ‘Help Chain’) on a major Toronto hospital where my mom has suffered a number of indignities – after undergoing successful low back surgery.

The Great Paradox of Health Care once again. Magic within the silos, and too often, indignity between them.

The events I’ll describe could easily have taken place in an American, British, or Australian hospital.

Quick summary: Mama went in for lower back surgery to treat a very painful spinal stenosis. The operation was a success and her orthopedic surgeon and OR staff, superb.

Convalescent care was another story. Here’s a key point summary:

• No target discharge date or discharge plan


• No standard discharge process. Everybody we spoke to had a different opinion. Several staff members blamed Mama and our family for our difficulties.


• Poor communication. Key staff members repeatedly failed to return phone calls or provide clear information on Mama’s condition, treatment and support plan


• Indifferent staff:

• Ms. M, the social worker, was especially uninterested in our requests for information. When we finally agreed on a time for a case conference, Ms. M failed to show up. No explanation or apology.


• Then one morning, without warning, Ms. M told Mama, “Get your clothes on, you’re leaving!”


• I called Ms. M at once, of course, and explained this was complete surprise. We still didn’t have a discharge date or support plan. “It’s your fault,” she told me. “Why didn’t you have all this done in advance?”


• In fact, I’d had several in advance chats with CCAC, the agency that handles home care service. They told me, “We can’t do anything till we hear from the hospital about your mom’s condition.”


• When I pointed this out, Ms. M et al said, ”The CCAC don’t know what they’re talking about!” Then they blamed our family again, for good luck, I suppose.

When I think of Mama’s surgery experience the following words come to mind: professional, capable, and compassionate.

How to summarize Mama’s convalescence experience?

• Lack of standards, lack of process


• Lack of communication


• Shame and blame the patient


• Denial, deflection and outright lies

(Let me also add that Canadians have no choice. We have to use the existing system. The Canadian Health Care Act essentially outlaws private medicine.)

I’m pulling the andon for all of us who have endured such treatment. (Letters are on their way to requisite senior executives and bureaucrats.)

But all is not lost. We met many excellent people doing their best in this bad system.

Let me also salute the growing number of Canadian hospitals that are in the midst of heartfelt process and cultural transformations.

I’m lucky enough to work with some of you. You’re fighting the good fight, and though it’ll take a long time, you’re going to win.

Godspeed,

Pascal

Pascal Dennis Bio

New Book Update - Andy & Me and the Hospital

By Pascal Dennis

Hi folks,

Resurfacing at last after an intense summer working on Andy & Me and the Hospital, the latest Tom Papas and Andy Saito adventure.

First draft complete, working on the doodles and images with our splendid artist, Dianne Caton.

What’s the book about?

A major New York City hospital is in crisis. Tom and Andy get pulled in to help save it.

Tom is also in the midst of a personal crisis. Will the new challenge save or destroy him?

Why a book about Toyota methods and thinking in Healthcare?

Healthcare defines Lean’s frontier. The challenge, and opportunity, are immense. Moreover, if we don’t get it right, Healthcare could bankrupt us.

Why this book?

I want to answer some basic questions. What does a Lean transformation in a hospital feel like? What overall approach should we take?

What kind of leadership and behavior change is needed? How do we develop and engage people? How do we improve processes?

How do we build a management system? How do we translate what Deming called the ‘profound system of knowledge’ with our healthcare colleagues?

At the same time, I want to provide a clear and simple guide to Toyota methods and thinking, how they fit together, and the spirit that animates them.

One of the problems with Lean implementation has been the tendency to cherry-pick activities, rather than grasping the system as a whole.

What are the next steps?

Dianne and I will complete the doodles and figures and submit to our publisher. We’ll then get review copies out, after which we’ll adjust and polish the book as needed.

God willing, Andy & Me and the Hospital will be available in early 2016.

Best regards,

Pascal

Pascal Dennis Bio

Alpha & Omega - Reprise 2

By Pascal Dennis

I recently gave a talk to senior health care executives.

Admissions & Triage were common concerns.

How do we get better at these crucial first steps in our value stream?

Their concern is apt.

As the old Greek proverb goes, "When the first thing goes wrong, everything goes wrong."

I suggested they study the Quick Service Restaurant (QSR) industry.

Here's a piece from Reflections of a Business Nomad that explains why. [Here]

Best regards,

Pascal

What's the Most Dangerous Thing We Do?

By Pascal Dennis

Take a moment & reflect.

For most folks, I imagine the following come to mind:

1. Driving my car,
   


2. Flying on an airplane,
   


3. Going downtown in a major city
   
   

For most of us the answer is - wait for it:

Going to the hospital.

A Google search will uncover horror stories. Here are some:

Objective risk analyses confirm our worst fears - hospitals are deadly places.

Mis-medication, infection, falls, wrong-site surgeries and the like are at epidemic levels.

The Health Care crisis is a recurrent theme in this blog, in The Remedy, and in my upcoming book, Reflections of a Business Nomad.

And yet, in a grand paradox, Health Care folks are smart, hard-working and, for the most part, dedicated to helping patients.

How did things get so bad?

Complexity is part of the answer - hospital silos are far deeper and more numerous than ever before.

In 1950, for example, oncology largely comprises palliative care. Today, by contrast, oncology is a deep silo comprising specialties, sub-specialties and sub-sub-specialties.

Our inexperience managing complex systems is a second cause.

Yet a third cause is that everybody else has gotten much, much better, largely because of competition.

GM and Ford, for example, make splendid cars at reasonable prices. Competition from Toyota et al has transformed them.

So Health Care sticks out.

We'll continue to blog, reflect, and work with all the good people stuck in lousy management systems.

I'm hopeful, in fact, because of their skill & dedication.

But I'll be vigilant whenever, I or any of my family, go into a hospital.

You be too.

Best,

Pascal

Lean Hotels

By Pascal Dennis

Lean in the service industries is a frequent topic in this blog.

The great hotel chains -- Ritz, Hyatt, Marriott, Westin, Disney and others -- are superb Lean companies.

Marriott's Twelve Guiding Principles of Leadership and Customer Service, for example, reads like a Lean manifesto:

1. Continually challenge your team to do better.
   


2. Take good care of your employees, and they’ll take good care of your customers, and the customers will come back.
   


3. Celebrate your people’s success, not your own.
   


4. Know what you’re good at and mine those competencies for all you’re worth.
   


5. Do it and do it now. Err on the side of taking action.
   


6. Communicate. Listen to your customers, associates and competitors.
   


7. See and be seen. Get out of your office, walk around, make yourself visible and accessible.
   


8. Success is in the details.
   


9. It’s more important to hire people with the right qualities than with specific experience.
   


10. Customer needs may vary, but their bias for quality never does.
    


11. Eliminate the cause of a mistake. Don’t just clean it up.
    


12. View every problem as an opportunity to grow.
    

Marriott's standard - our principles will be in the nightstand drawer of every Marriott room.

A few years ago, I was staying at the Sharm al Shaikh Marriott, at the bottom of the Sinai peninsula.

Being a natural pain, I decided to check Marriott's adherence to its standards, in this relatively remote hotel.

Sure enough, I found the principles were there were supposed to be.

The hotel manager smiled when I told him, and described Marriott's training & development processes.

Ritz, Hyatt, Westin, Disney & the rest all have corresponding principles & practices. Well done - and please continue!

Are there any other industries that could learn from Lean hotels?

Oh, I don't know, perhaps Health Care...?