Category: Post 2.1 (page 1 of 1)

Hello Wafa,

Thank you for your response to Samson’s post. I recall one of my former workplaces hiring a Lean consultant to address “muda”, or waste (Lean Enterprise Institute, n.d.). Many of the ideas presented in Lean seem beneficial, such as reducing the amount of time used and distance walked to gather medical supplies.

However, it was difficult to fully implement Lean, primarily due to another important aspect of health care, namely infection control. Many infection control items, such as gowns, masks, and gloves, must be thrown away after each use and could be considered waste. Further, other medical devices are complex and difficult to clean. These items are also considered “single use” and seem to be a waste.

The evidence for lean in healthcare is mixed. Some of the literature available states the gaps in evidence for improvement (DelliFraine, Langabeer, & Nembhard, 2010), while other papers note the lack of evidence supporting the notion of improvement from Lean (Moraros, Lemstra, & Nwankwo, 2016). Other authors note the complexity of health care improvement, comparing it to a “black box” (Ramaswamy et al., 2018). On the other hand, Lean (and its derivative Lean Six Sigma) may be beneficial to improving infection control, specifically healthcare-associated infections (Improta, Cesarelli, Montuori, Santillo, & Triassi, 2018). Lean also showed promise in surgical procedures (Mason, Nicolay, & Darzi, 2015).

I see Lean being part of the TSL’s toolbox. Lean helps the TSL understand current processes and possible waste in the system, thus increasing awareness. Awareness is one of the characteristics of a servant leader according to Spears (Northouse, 2013). Conceptualization is another characteristic of a TSL – Lean forces the TSL to take a big-picture view of system processes to creatively identify areas of improvement.

Thank you for sharing your overview of Lean. I look forward to adding Lean to my toolset!

References:

DelliFraine, J. L., Langabeer, J. R., & Nembhard, I. M. (2010). Assessing the Evidence of Six Sigma and Lean in the Health Care Industry. Quality Management in Health Care, 19(3), 211–225. Retrieved October 11, 2018, from https://ezproxy.student.twu.ca/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=52764353&site=eds-live

Improta, G., Cesarelli, M., Montuori, P., Santillo, L. C., & Triassi, M. (2018). Reducing the risk of healthcare‐associated infections through Lean Six Sigma: The case of the medicine areas at the Federico II University Hospital in Naples (Italy). Journal of Evaluation in Clinical Practice, 24(2), 338–346. http://doi.org/10.1111/jep.12844

Lean Enterprise Institute. (n.d.) “Waste”. Retrieved October 11, 2018, from https://www.lean.org/lexicon/waste

Mason, S. E., Nicolay, C. R., & Darzi, A. (2015). Review: The use of Lean and Six Sigma methodologies in surgery: A systematic review. The Surgeon, 13, 91–100. Retrieved October 11, 2018, from https://doi.org/10.1016/j.surge.2014.08.002

Moraros, J., Lemstra, M., & Nwankwo, C. (2016). Lean interventions in healthcare: do they actually work? A systematic literature review. International Journal for Quality in Health Care, 28(2), 150–165. Retrieved October 11, 2018, from http://doi.org/10.1093/intqhc/mzv123

Northouse, P. G. (2013). Leadership: Theory and practice (6th ed.). Thousand Oaks: SAGE.

Ramaswamy, R., Reed, J., Livesley, N., Boguslavsky, V., Garcia-Elorrio, E., Sax, S., … Parry, G. (2018). Unpacking the black box of improvement. International Journal for Quality in Health Care, 30(Suppl 1), 15–19. Retrieved October 11, 2018, from http://doi.org/10.1093/intqhc/mzy009

Original post at https://create.twu.ca/sally81/2018/10/09/no-other-way/

Thank you, Sally, for your post. As a leader in health care, I have a nominal role in educating clients and their families, but nothing to the extent of those in education.

I have a question regarding TSL in education, specifically with parts of the curriculum that some find in disharmony with their personal values. For example, the Science 7 part of the curriculum as evolution by natural selection as a “big idea” (British Columbia Ministry of Education, n.d.). Further, one hot topic for the coming election is sexual orientation and gender identity.  The Ministry of Education announced in 2016 the requirement to reference SOGI in codes of conduct (The ARC Foundation, 2016).

I understand the characteristics of TSL include listening and empathy, as well as building community (Spears, as cited in Northouse, 2013). TSL education leaders would need to listen to different stakeholders with their concerns over these parts of the curriculum. As well, TSL education leaders need to empathize with educators and their diverse perspectives, especially regarding the required curriculum from the Ministry of Education. Finally, a TSL education leader seeks to build community among other educators as well as students and their families.

However, the current political climate appears to hinder the process of building community. Henderson (2018) notes the current controversy with SOGI, saying “the issue has been a polarizing one rife with misinformation about what the program is actually about.” I feel as though ideologies have become more crystallized, although I cannot provide any concentrate proof – I am certain people have been arguing loudly since the beginning of time!

I agree with your emphasis on critical thinking, especially in the current political environment. Seabreeze (2018) asked if TSL is more prevalent now than it was in the past. I would like to posit the opposite question – do you see a rise in authoritarianism and followers with a “sheep” mentality? With the rise of the Internet, I see the words in Daniel coming true with knowledge increasing (Daniel 12:4), but I don’t necessarily see an increase in wisdom. Sadly, even in the religious realm, I see too many people not reading their Bibles to critically analyze their study. Instead, they rely on their religious leaders to tell them what to think.

I look forward to your response!

References:

The ARC Foundation (2018). SOGI 1: policies and procedures. Retrieved October 11, 2018, from https://bc.sogieducation.org/sogi1/

British Columbia Ministry of Education (n.d.). Science 7. Retrieved October 11, 2018, from https://curriculum.gov.bc.ca/curriculum/science/7

Henderson, P. (2018). “Anti-SOGI candidate to run for Chilliwack school board”. Retrieved October 11, 2018, from https://www.theprogress.com/municipal-election/anti-sogi-candidate-to-run-for-chilliwack-school-board/

Northouse, P. G. (2013). Leadership: Theory and practice (6th ed.). Thousand Oaks: SAGE.

Seabreeze (2018). Reply to “No other way”. Retrieved October 11, 2018, from https://create.twu.ca/sally81/2018/10/09/no-other-way/

Original post here: https://create.twu.ca/chiefanalyzerofthings/2018/10/09/servant-and-strategic-leadership-tools-hc2/

Thank you, Health Angels, for your post on TSL and health care. Your post is thought-provoking and interesting. As a fellow leader in health care, you encourage me to think about my contributions to the culture of health care, whether those contributions are beneficial or detrimental.

I want to add some information to your post for discussion. First, you state, “health care professionals are overworked” and many professionals suffer burnout. You also discuss burdens placed on both the patients and the health care workers.

One dimension to consider is the phenomenon of workplace violence. A health care worker’s load may not only affect wait times, but also the length of time a worker can spend with a patient. Physician appointment times are usually 15-20 minutes long (Linzer et al., 2015). Limited interaction time with patients contributes to burnout, leading to cynicism and exhaustion (Anandarajah, Quill, & Privitera, 2018). This cynicism and exhaustion can negatively affect staff behavior. Shafran-Tikva , Chinitz, Stern, & Feder-Bubis (2017) note staff behavior playing a role in the creation of violence in hospitals. Finally, Hutchinson & Jackson (2013) note nurses claim hostility from other members of the interdisciplinary team to be their most significant concern with regards to workplace violence.

You say creating a culture of learning is the key. I would beg to differ. I do not believe burnt out staff members are in a position to learn if their concern is navigating workplace stress and recovering from burnout. I would like to propose the importance of a “culture of caring” before transitioning to a culture of learning.  This culture of caring seeks to improve the work life of health care workers. Health care workers need care to provide care. Bodenheimer & Sinsky (2014) say “care of the patient requires care of the provider”, and propose to transform the Triple Aim into the Quadruple Aim.

Regarding your section on Critical Thinking, I have an alternate viewpoint regarding resources in health care. You state, “there is no money”, yet the Government of British Columbia recently committed $500 million dollars on home and community care (British Columbia Ministry of Health, 2017). Further, Simpson (2012) says this about money:

Nor, as Canadians have seen over the past decade, do large amounts of additional money necessarily buy change. Most of the money reinforced the status quo, which is what one would expect in a provider-driven, bureaucratically administered system. Canada poured tens of billions of dollars into health care, following the Romanow commission recommendation, but got a poor return on that investment. Those tens of billions of dollars represented the costliest lost public-policy bet of this generation.

I say the larger problem with our health care system is not money per se. I heartily agree with your second point: health care organizations and governments are rigid. I would like to expand that point to say the public is also rigid in its view of health care – people are frightened of the word “private health care”, even though many of the health care delivery organizations are private (Simpson, 2012). Further, the public will not accept a decrease in services, nor would they accept an increase in taxes. Therefore, health care is stuck trying to deliver services in the same way with an old plan and an increasing bill. A TSL leader with visioning and strategic thinking could “creatively envision value-added future oriented organizational goals” (Mitchell, Strong, Williaume, & Wu, 2017) and may have better solutions for the looming health care collapse.

Again, thank you for your well-written post. I look forward to your reply.

References:

Anandarajah, A. P., Quill, T. E., & Privitera, M. R. (n.d.). Adopting the quadruple aim: The University of Rochester Medical Center experience moving from physician burnout to physician resilience. AMERICAN JOURNAL OF MEDICINE, 131(8), 979–986. Retrieved October 10^th, 2018, from https://ezproxy.student.twu.ca:2420/10.1016/j.amjmed.2018.04.034

British Columbia Ministry of Health (2017). An action plan to strengthen home and community care for seniors. Retrieved October 10^th, 2018, from http://www.health.gov.bc.ca/library/publications/year/2017/home-and-community-care-action-plan.pdf

Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: Care of the patient requires care of the provider.Annals of Family Medicine, 12(6), 573–576. Retrieved October 10^th, 2018, from https://ezproxy.student.twu.ca:2420/10.1370/afm.1713

Hutchinson, M., & Jackson, D. (2013). Hostile clinician behaviours in the nursing work environment and implications for patient care: a mixed-methods systematic review. BMC Nursing, 12, 25. Retrieved October 10^th, 2018, from http://doi.org/10.1186/1472-6955-12-25

Linzer, M., Bitton, A., Tu, S.-P., Plews-Ogan, M., Horowitz, K. R., Schwartz, M. D., & for the Association of Chiefs and Leaders in General Internal Medicine (ACLGIM) Writing Group*. (2015). The end of the 15–20 minute primary care visit. Journal of General Internal Medicine, 30(11), 1584–1586. Retrieved October 10^th, 2018, from http://doi.org/10.1007/s11606-015-3341-3

Shafran-Tikva, S., Chinitz, D., Stern, Z., & Feder-Bubis, P. (2017). Violence against physicians and nurses in a hospital: How does it happen? A mixed-methods study. Israel Journal of Health Policy Research, 6, 59. Retrieved October 10^th, 2018, from http://doi.org/10.1186/s13584-017-0183-y

Simpson, J. (2012). Chronic condition: Why Canada’s health-care system needs to be dragged into the 21st century. Toronto: Allen Lane.