When things in the operating room get difficult, Dr Llorenç Mateo from the Consorci Sanitari del Alt Penedès-Garraf usually repeats to his colleagues a mantra: “Stable environment.” In an emergency, it’s all too easy to give in to stress and do the first thing that comes to our minds; what we should do, instead, is take a breath and identify the cause of the bleeding.
The Covid-19 crisis is remarkably similar to this scenario. The first few days, when chaos dominated, at the Instituto Lean Management we fell into the same trap. “Perhaps this is not the time to think. It’s the time to run, to focus on the D in PDCA, maybe even to jump to solutions,” we thought. Yet, when we spoke to the lean hospitals in our network – many of which have been our partners-in-learning for many years – we heard a different story. For example, Vicenç Ibañez (one of the practitioners featured in this article) reminded us that “having to run doesn’t mean we should stop thinking”. After all this is a marathon, not a sprint, and making level-headed decisions is the only way to complete it. Stable environment, remember?
Indeed, as we read about the experience of the three hospitals below, the level-headedness in decision making and the ability to anticipate the next development in the crisis are clearly a common element. While healthcare organizations were struggling to stay afloat and sending distress signals left, right and center, hoping for someone to come and rescue them, a number of lean hospitals took matters in their own hands and tapped into their knowledge and experience (with lean as one of the legs) to find new and creative ways to stay ahead of the emergency. (Check what Rosa Simón has to say about the supply of PPE, for example.) They have not stopped reviewing their standards, developing their people or learning; in fact, they have done it more than before.
Within days these organizations were able to implement radical changes – in some cases, ones that had been discussed for months and months – and to introduce practices that before wouldn’t have even been considered. Many of these will end up staying (telehealth, for example, like Ana Alvarez says below), proving the extraordinary ability of problem solvers to generate out-of-the-box thinking and innovation – even in the most stressful and overwhelming of scenarios.
Indeed, within hours everything changed. The dedicated pathway for trauma patients in the ER of the Garraf hospital, for instance, was transformed into an extension of the ICU. Its creation had cost the team a lot of sweat and tears over many months. For the first few days of the emergency, we saw all the work they had done with us disappear and we began to wonder whether or not we had actually helped them over the years. But then we realized that perhaps the physical changes are not that important. What really matters is the way of thinking that allows an organization to swiftly adapt to changing circumstances, and there is no doubt that over the past few weeks these hospitals have proved to have interiorized it. As we slowly overcome the Covid-19 threat and slowly go back to “business as usual”, this mindset will be more important than ever: if there is one thing that never goes away, that’s problems (the first one being the backlog of work accumulated during the crisis).
It’s beautiful to see that the lean seeds we have planted together with them are growing. We have given these people the tools to learn how to learn and now it’s their turn to teach us what they have learned in this crisis.