Friday, September 25, 2009

Surgical Care Improvement Value Stream Report Out Today! CCRMC, Building One, Conference Room One at 10:00 AM

To All Staff-

Greetings,

I'd like to remind everyone that the findings from the Surgical Care Improvement Value Stream will be presented this morning. Teams went to Gemba(現場), and many were in your areas this week. I thank you for your cooperation and participation.

In a stand up report using an A3 format the current state will be presented. Teams will show us what they found and present a vision for the ideal future state. Taking the time to learn about our system and ways to deliver the highest quality and highest value service to individuals and their families is essential. Reflecting on our improvement work in the Congestive Heart Failure (CHF) Value Stream, much of the ideal future state presented in their stand up report has now become standard work delivered to every patient every time.

It is imperative that we learn together. Our aim is to provide the highest quality and highest value service to our community, making possible, health for all.

Please join us at CCRMC Building One Conference Room One at 10:00 am.

I slept and dreamt that life was joy.
I awoke and saw that life was service.
I acted and behold, service was joy.
- Tagore


This is ours to do. If not us, then who?

I look forward to seeing you there.
Anna

Friday, September 11, 2009



As we look back on the events of September 11, 2001, we remember the bravery, courage, and humanity shown that day and the many to follow. We remember those lost, and those whose lives have been forever changed.

Sunday, September 6, 2009

Being Still

Be still and know...

I’m often asked what my plans for our organization are. For many of us, and I know for myself, not knowing what is going on, where we are going, what will happen tomorrow or other sorts of "blanks" or "voids" can lead to an uneasy feeling. Sometimes when faced with a “blank” we create stories, and sometimes, we even convince ourselves that our stories are in fact the truth. This behavior of filling in the blanks is not that unique. It turns out we do this quite often. Our stories not only help us make sense of/or tolerate the unknown, they move us to action when we are faced with the facts - even facts that feel too difficult to bear. Our stories add texture and context to what information we do have.

This is all sounding vague. Let me draw from the IHI website about the value of storytelling:

Anyone involved in quality improvement efforts knows that scientific principles are at the center of this work. But even the most evangelical quality engineer will caution that this only part of the solution. Improvement strategies and measurement tools are most effective when embedded in an organizational cultural that ensures that changes are embraced and sustained. And there is no better means of inspiring cultural change than through the simple craft of telling stories. As Donald Berwick, MD, MPP, puts it, "Measurement is important, but it’s the stories behind the numbers that are the most enduring wellspring for change."

So what does this have to do with where we are going? How is this connected to what is happening today at Contra Costa Regional Medical Center? It is a time of change for CCRMC, and with that, a time for new opportunity. We have an opportunity to find a new way forward together.

As Edgar Schein notes in his new book Helping, “ Many people in senior management or leadership positions have the ability to be effective change agents.” He says we must do this "by not only learning how to help, but also to learn to accept help." This is what makes leadership so complex. By accepting help he says, we become “genuinely involved in the culture of the group, and how to give help to the group and to individual subordinates as individual areas of improvement are identified." (Helping: How to Offer, Give, and Receive Help, 2009, p 132)

Elias A. Zerhouni echoes this perspective noting that leaders who want to fix things or make change, will be most successful "if they initially adopt a helping role which, in turn requires their willingness to be helped. Once they create a climate of trust, they will elicit crucial information about what is going on and learn the local cultural rules and norms." Discovery and creativity, he argues, are eminently social processes. (Letters from Leaders, 2009, p 61).

So does this mean that part of leadership may include becoming vulnerable, and available? Maybe to rush to find the answer or fill in the blanks is not always helpful? Although it sounds quite simple, this isn't easy stuff. Maybe this is why Hoshin Kanri directs us to "go and see" (Genchi Genbutsu / 現地現物) in order to understand?

I have no answers today. I too am filled with questions, but I do believe that to lead is also to learn.

...and maybe, at least for me, sometimes I just have to be still.

Tuesday, August 25, 2009

What does a Public Option look like?

"The work goes on, the cause endures, the hope still lives and the dreams shall never die." -Edward M. Kennedy

Remembering Senator Edward M. Kennedy for his tireless efforts and dedication to guarantee the basic right to health care for all Americans.


I've been following the social media coverage from other parts of the world covering the debate here in the Unites States regarding the pros and cons of a "public option" as part of health care reform. Some people in other countries have found it amusing and some have expressed feeling that their system has been misunderstood. Social media campaigns such as the WeLovetheNHS campaign have sprung up on twitter. Even Gordon Brown has found his way to Twitter to make a 140 character (or less) public proclamation of pride in Britain's National Health Service.

It prompted me to think about our system (CCHS). We too are a fully integrated health system based on primary care and prevention. I'll admit, I was feeling a little misunderstood as well. When I asked, I found others shared my feelings. I realized that like those who "lovetheNHS", I love our public system, CCHS. I am proud to be a public servant and proud to be a part of what has been since 1880, our community's public option.

So today I decided to take to heart Paul Levy's recent comments in his blog ecouraging us to "stand on a soapbox" and be "seen." He reminds us that "people have given their lives to allow us to have freedom of speech."

I realize and accept the debate about the public option appears to be dominated at the present time by debate about insurance/coverage/money, which is a critical discussion. I would, however, like to offer a moment of pause to remind those of you in our system (and others who may find it worthwhile) that the public option as we realize it through fulfillment of our mission is so much more. It's about safe, efficient, effective, timely, patient-centered and equitable care for everyone. It goes beyond coverage (but yes, it does include it). It's about health.

One of the things I have learned through my exposure to Lean Methodology is how important it is to go and see for yourself (Genchi Genbutsu / 現地現物) to thoroughly understand the situation. I would ask that we all take the time to understand and to "Go and see" , for ourselves what a public option is.

Earlier this month in his Directors Report Dr. William Walker said that "Above all, we should encourage people to get information from objective sources and not rush to judgment."

You can find Dr. Walker's podcast (available at http://cchealth.org/topics/podcast/) about this topic with others and let them know they can get more information at these sites:


http://aarp.convio.net/site/PageNavigator/Myths_vs_Facts
http://www.whitehouse.gov/realitycheck/
http://www.politifact.com/truth-o-meter/


Although you won't find any speeches or soap boxes, in the spirit of being "seen" and participation, I thought I would offer a friendly hello from a publicly owned and operated, fully integrated health system here in America.

Sincerely,
Anna

Saturday, August 22, 2009

Into a new world

"and we shall learn" -W. Edwards Deming

In response to our session on variation I thought you may like the video below. W. Edwards Deming uses powerful descriptions such as being in prison. Sound familiar to what some of those who played the game said?

What Deming says is needed is "transformation, which will come from movement into a new world."
Movement into a new world? What does that mean? Does it feel like we are, or should sustain our system as is? If we were to change, how should we change? Where is the new world? Are there any signs leading us?

For those of you who attended the session this week I'm curious to hear what you think of this video and if you have any thoughts about this concept of movement into a new world?

Thanks to everyone for coming and learning together. We'll try and post the video from our session here and on iSite in the next few days.

~Anna

Please join us for our next session:
Variation Happens
Thursday September 27th at 9:00am at CCRMC Building One Conference Room One.

Here is a very brief clip of Deming- Enjoy!

Tuesday, August 18, 2009

Uninsured in California: Interactive Map from the Sac Bee

http://www.sacbee.com/1098/story/2114278.html
Here is an interactive map of those under 65 without health insurance in each county in California. When you compare, bear in mind the actual numbers and the size of our system (whole system capacity) including the number of medical center beds compared to other counties.

What you all do every day is truly spectacular.

Anna

Monday, August 17, 2009

"The Good, the Bad and the Ugly?" I'll agree with two of those!

See the PBS Online NewsHour feature of Contra Costa County and the California Budget Process. Bravo Supervisor Gioia and Dr. Walker! I share your frustration.

I'm sure this was a difficult process for all. I do agree with Governor Schwarzenegger that this budget is bad and it is ugly, but I'm having a hard time finding the good.