Improving Care Delivery Through Lean: Implementation Case Studies
Positive Lean in Health care
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Transcript of Positive Lean in Health care
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ROSS FACULTY
Bill Lovejoy
WORKSHOP
Positive Lean in Health Care
Bill Lovejoy
Positive Lean in Health Care
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Who am I?
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Conclusions: Challenges to lean practice
High in-group excitement, less so outside the team
Regression to past levels of performance
Project fatigue
If nothing changes, cynicism can grow
Background:
Years of project work at
UM and other hospitals
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Two MAP projects 2013:
Merge lean and POS in VA and UM hospital projects
Outcome:
Enthusiastic embrace of Lean-POS at the VA Hospital
Less so at UM
Differences:
No clear tactics, sort of a grab bag without structure
Prior buy-in by VA hospital lead was able to overcome this
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Personal Interactions
Jane DuttonProfessor of Management and Organizations
John Billi, M.D.Professor of Internal Medicine, UM Medical School Vice President for Medical Affairs
David Shaked
CEO Almond Insight, change management consultancyAuthor of Strength Based Lean 6 Sigma
Other Key References
Kim Cameron, Gretchen Spreitzer
UM Ross School of Business Center for Positive Organizational Scholarship
David CooperriderWeatherhead School of Management
John ShookFormer director UM Japan Technology Management Program
The Head of consulting firms Lean Transformations Group and TWI Network, Inc.
First, some acknowledgements
This presentation is a mash-up
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Why would a left-brain guy like me
be attracted to the Positive perspective?
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Who would you rather spend time with?
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Positive approach What is it?
Philosophical underpinnings
Tactics
What can lean and POS learn from each other?
Why especially in health care settings?
Examples from health care
Testimony from audience
Summary
Lean approach What is it?
Philosophical underpinnings
Tactics
Lovejoy
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Lean: What is it
A set of beliefs and practices that
evolved after WW2 to help Japan recover economically,
facilitating the production of high variety at minimal costby reducing waste and employing flexible systems.
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History: Let a thousand flowers bloom
Taichi Ohno 19501960s in Japan, later in the US
Toyota Production System, Just-in-time
W. Edwards Demming 1950s in Japan, later in the USStatistical Process Control, Total Quality Management
Motorola 6 sigma 1980s
Process capabilities
Then combine them into a bouquet
Lean 6-sigma or just Lean
Lean Positive Learn Healthcare Interactive Lovejoy11
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Philosophy of lean
Lean Positive Learn Healthcare Interactive
Problems are opportunities (no problem is problem)Parameters become decision variables
Use existing resources within the organization
Workers as experts
Continuous improvement
Eliminate all waste
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Tactics of Lean
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Lean Positive Learn Healthcare Interactive Lovejoy14
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Define (what problem do you want to solve?)
Control (disseminate, make is SOP)
Improve (test your recommendation, validate it)
Analyze (gather data, evaluation possible improvements)
Measure (what is your current state of performance?)
repeat
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The Language of Lean
Kaizen
Pull Production System
Visual management
Kanban
Bottleneck logic
Value Stream Mapping
Level production
Takt time
Genba Gembutzu
Current and Future States
5 Whys = 1 How To
Poka Yoke
Jidoka Standardized work
Muda
A3
5S
Genba Genbutsu
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An emphasis on the visual
Lean Positive Learn Healthcare Interactive Lovejoy17
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Positive approach What is it?
Philosophical underpinnings
Tactics
What can lean and POS learn from each other?
Why especially in health care settings?
Examples from health care
Testimony from audience
Summary
Lean approach What is it?
Philosophical underpinningsTactics
Lovejoy
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What is Positive business research and practice?
A focus on dynamics that are typically described by words such as
excellence, thriving, flourishing, abundance, resilience, or
virtuousness
The study of phenomena associated with what individuals and
organizations aspire to be when they are at their very best.
Lean Positive Learn Healthcare Interactive
Cameron, Dutton and Quinn. POS: Foundations of a New Discipline, 2003
Cameron & Spreitzer, 2011
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Problem!
Lets solve it!
Figure out its root cause
Eliminate it
Change SOP
Fantastic!
What did they do?
Lets figure that out
and learn from it
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Philosophy of Positive Approaches
People and organizations are already repositories of many good
things. Every person and every organization has times when theyare at their best, and those times are worthy of study and
reflection.
Organizations are dynamic and evolving, endogenously defining
themselves. The direction of that growth can be influenced
Positive meaning, climate and relationships nourish people,
generating the energy required to continue to improve, allowing for
an endogenous bootstrapping of improvements in organizations.
Small wins can lead to significant changes
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Tactics of Posit ive Approaches
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Develop Positive Meaning
1. Define people and units in terms of their strengths
2. Strengthen the connection between peoples work and
their belief that they are having a positive impact on
others
3. Diffuse positive meaning through spreading of
authentic stories where employees, management and
project teams made a positive difference for others
Tactics: POS group at UM
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Stimulate Positive Emotions
1. Actively focus on what is working and enabling desired
outcomes
2. Strive for the momentary experience of more positive than
negative emotions
3. Show gratitude
4. Recognize the link between the physical environment and
individual flourishing
Lean Positive Learn Healthcare Interactive Lovejoy25
Tactics: POS group at UM
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Build Positive Connections
1. Respectfully engage others; show esteem, respect and
care for another person
2. Engage in task enabling (help others)
3. Build trust
4. Engage in play
Lean Positive Learn Healthcare Interactive Lovejoy26
Tactics: POS group at UM
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Philosophy of Appreciative Inquiry
1. Human system grow in the direction they persistently ask
questions about. The very first questions we ask are
fateful, they determine the direction of the inquiry, and
who you will interact with.
2. Reality is co-created by people all the time
3. Every living system has many untapped, rich and
inspiring accounts of the positive. Linking the energy ofthis core to a change agenda and changes never thought
possible are suddenly and democratically mobilized.
D. Cooperrider and D. Whitney. A Positive Revolution in Change: Appreciative
Inquiry Case Western Reserve University working paper, undated.
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Tactics: Appreciative Inquiry
Determine topic of inquiry: This needs to be generative,
excites people
Discover: Organizational inquiry (interviews, anthropology)
or sometimes objective identification of high performers
Dream: Building on what is going well, what would a
wonderful future look like?Design: Generate concrete propositions about what should
happen in that future.
Destiny: Act on the propositions
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Example: Sexual Harassment consulting
Consultant concerned that years of workshops etc. have not
decreased the incidents or perceptions of sexualharassment in the organization.
What would an AI approach look like?
Lean Positive Learn Healthcare Interactive
D. Cooperrider and D. Whitney. A Positive Revolution in Change:
Appreciative Inquiry Case Western Reserve University working paper,
undated.
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Determine topic of inquiry:This needs to be generative, excites people.
Not generative:
reduce sexual harassment or reduce lawsuits
Lean Positive Learn Healthcare Interactive
D. Cooperrider and D. Whitney. A Positive Revolution inChange: Appreciative Inquiry Case Western Reserve
University working paper, undated.
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Determine topic of inquiry:This needs to be generative, excites people.
Not generative:
reduce sexual harassment or reduce lawsuits
More generative:
Develop a new-century organization a model of high
quality cross-gender relationships in the workplace
Lean Positive Learn Healthcare Interactive
D. Cooperrider and D. Whitney. A Positive Revolution inChange: Appreciative Inquiry Case Western Reserve
University working paper, undated.
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Company-wide interviews by employees: study and share their stories
about what it means to create and sustain high-quality cross-gender
relationships in the workplace.
Using the stories as a basis, create propositions about what a future
would look like.
Lean Positive Learn Healthcare Interactive
For example, Every task force or committee, whenever possible,
should have co-chairs of different genders.
This organization was eventually singled out as one of the bestplaces for women to work
D. Cooperrider and D. Whitney. A Positive Revolution inChange: Appreciative Inquiry Case Western Reserve
University working paper, undated.
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Positive approach What is it?
Philosophical underpinnings
Tactics
What can lean and POS learn from each other?
Why especially in health care settings?
Examples from health care
Testimony from audience
Summary
Lean approach What is it?
Philosophical underpinningsTactics
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Work with existing resources
Lean Positive Learn Healthcare Interactive
Similarities between Lean and Positive
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Work with existing resources
Respect for employees, workers as experts, the potential lies within them
Lean Positive Learn Healthcare Interactive
Similarities between Lean and Positive
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Work with existing resources
Respect for employees, workers as experts, the potential lies within them
Envision and strive for a better future state
Lean Positive Learn Healthcare Interactive
Similarities between Lean and Positive
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Work with existing resources
Respect for employees, workers as experts, the potential lies within them
Envision and strive for a better future state
Redefine problems as opportunities
Lean Positive Learn Healthcare Interactive
Similarities between Lean and Positive
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Work with existing resources
Respect for employees, workers as experts, the potential lies within them
Envision and strive for a better future state
Redefine problems as opportunities
Disseminate best practices
Lean Positive Learn Healthcare Interactive
Similarities between Lean and Positive
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Work with existing resources
Respect for employees, workers as experts, the potential lies within them
Envision and strive for a better future state
Redefine problems as opportunities
Disseminate best practices
Emphasize learning and progress (personal and organizational)
Lean Positive Learn Healthcare Interactive
Similarities between Lean and Positive
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Work with existing resources
Respect for employees, workers as experts, the potential lies within them
Envision and strive for a better future state
Redefine problems as opportunities
Disseminate best practices
Emphasize learning and progress (personal and organizational)
Small wins beget big changes
Lean Positive Learn Healthcare Interactive
Similarities between Lean and Positive
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Lean Posit ive methods
Organizations are static, until we
intervene, move from currentstate to future state and stay
there until next intervention
Organizations are evolving all the
time, change is happening, soidentify and focus on positive
change
Get to the root cause. Why do
problems happen?
When and where do problems
NOT happen?
Lean Positive Learn Healthcare Interactive
Differences between Lean and Positive
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Lean Posit ive methods
Organizations are static, until we
intervene, move from currentstate to future state and stay
there until next intervention
Organizations are evolving all the
time, change is happening, soidentify and focus on positive
change
Get to the root cause. Why do
problems happen?
When and where do problems
NOT happen?
Knowledge and practice focus Meaning focus, and emotional
and relational climate
Lean Positive Learn Healthcare Interactive
Differences between Lean and Positive
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Lean Positive Learn Healthcare Interactive
Differences between Lean and Positive
Lean Posit ive methods
Structured knowledge Tacit knowledge
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Lean Positive Learn Healthcare Interactive
Differences between Lean and Positive
Lean Posit ive methods
Structured knowledge Tacit knowledge
Quantitative data Narrative data
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Lean Positive Learn Healthcare Interactive
Differences between Lean and Positive
Lean Posit ive methods
Structured knowledge Tacit knowledge
Quantitative data Narrative data
Variability is evil Without variability in practice,
there would be no positive
deviance
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Lean Positive Learn Healthcare Interactive
Differences between Lean and Positive
Lean Posit ive methods
Structured knowledge Tacit knowledge
Quantitative data Narrative data
Variability is evil Without variability in practice,
there would be no positive
deviance
Questions framed in problems to
be solved
Questions framed by what is
going really well?
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Lean Positive Learn Healthcare Interactive
Image credit: Pickycovers.com
What can Lean and POS learn from each other?
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Attention to relational aspects of human interaction
Lean Positive Learn Healthcare Interactive
Lean can learn from Positive approaches
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Attention to relational aspects of human interaction
Attention to the qualitative aspects of human thriving
Lean Positive Learn Healthcare Interactive
Lean can learn from Positive approaches
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Attention to relational aspects of human interaction
Attention to the qualitative aspects of human thriving
No problem is problem but also No celebration is problem
Lean Positive Learn Healthcare Interactive
Lean can learn from Positive approaches
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Attention to relational aspects of human interaction
Attention to the qualitative aspects of human thriving
No problem is problem but also No celebration is problem
Attention to an energizing and generative corporate mythology
Lean Positive Learn Healthcare Interactive
Lean can learn from Positive approaches
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A systematic approach to personal and organizational
development
Lean Positive Learn Healthcare Interactive
Positive can learn from Lean approaches
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A systematic approach to personal and organizational
development
A common language
Lean Positive Learn Healthcare Interactive
Positive can learn from Lean approaches
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A systematic approach to personal and organizational
development
A common language
A more balanced address of unacceptable behaviors
(problem is problem)
Lean Positive Learn Healthcare Interactive
Positive can learn from Lean approaches
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Positive approach What is it?
Philosophical underpinnings
Tactics
What can lean and POS learn from each other?
Why especially in health care settings?
Examples from health careTestimony from audience
Summary
Lean approach What is it?
Philosophical underpinningsTactics
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Critical national importance
Most challenging from a physics perspective
High relevance of values and ethics, no single bottom line
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Why is this important inhealth care settings?
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Lean Positive Learn Healthcare Interactive
In our complex health care system no
value is created until hands touch patients
Nurses are on the front line
Helping people at their most vulnerable
moments
Life saving
Nurses provide 24/7 care, doctors and
specialists round and leave
Example: Nursing
Photo credit: everydaylife.goalpost.com
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Lean Positive Learn Healthcare Interactive
Nurse labor costs are frequently thelargest hospital cost, and hospital
margins are not high (3% to 5%
operating margin) so labor costs are
closely monitored
Increases in patients/nurse
Need for more flexible nursing hours
= more disruptive schedules
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Lean Positive Learn Healthcare Interactive
Emotionally draining
Physically exhausting
Unpredictable work schedules
Life and death situations
Moral and ethical challenges
Many nurses have left the professionPhoto credit: blog.soliant.com
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Photo credits:
bls.gov
everydaylife.globalpost.com
Yet every day millions of
people receive excellent
treatment through the healthcare system
So there is ample opportunity
to learn from what works
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Lean Positive Learn Healthcare Interactive
Positive approach What is it?
Philosophical underpinnings
Tactics
What can lean and POS learn from each other?
Why especially in health care settings?
Examples from health care
Testimony from audience
Summary
Lean approach What is it?
Philosophical underpinningsTactics
Lovejoy62
I. Develop Posi tive Meaning
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1. Define people and units in terms of
their strengths
2. Strengthen the connection between
peoples work and their belief that they
are having a positive impact on others
3. Diffuse positive meaning through
spreading of authentic stories whereemployees, management and project
teams made a positive difference for
others.
II. Stimulate Positive Emotions
1. Actively focus on what is working and
enabling desired outcomes
2. Strive for the momentary experience
of more positive than negative emotions
3. Show gratitude
4. Recognize the link between the
physical environment and individual
flourishing
III. Build Positive Connections
1. Respectfully engage others; show
esteem, respect and care for another
person
2. Engage in task enabling (help others)
3. Build trust
4. Engage in play
The student team identified the strengths of the
pharmacy unit as well as causes of current
problems.
Conducting such an appreciative inquiry into
what the unit was doing well enabled them to
see the student team as individuals who
recognized their value.
This helped the staff imagine new and attractive
possibilities for the future.
The student team believes that this effort paid
significant dividends in the level of cooperation
and engagement they received from thepharmacy.
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I. Develop Posi tive Meaning
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1. Define people and units in terms of
their strengths
2. Strengthen the connection between
peoples work and their belief that they
are having a positive impact on others
3. Diffuse positive meaning through
spreading of authentic stories whereemployees, management and project
teams made a positive difference for
others.
II. Stimulate Positive Emotions
1. Actively focus on what is working and
enabling desired outcomes
2. Strive for the momentary experience
of more positive than negative emotions
3. Show gratitude
4. Recognize the link between the
physical environment and individual
flourishing
III. Build Positive Connections
1. Respectfully engage others; show
esteem, respect and care for another
person
2. Engage in task enabling (help others)
3. Build trust
4. Engage in play
When assembling surgical kits, nurses who met
the healthcare practitioners who would use the
kits worked faster and made fewer errors thannurses in a control group who had no beneficiary
contact.
When the patients photo was included in
their file, radiologists achieved 46 percent greater
diagnostic accuracy in scanning exams.
Hearing a patient talk for an hour about
experiences with treating a disease significantly
increased pharmaceutical employee engagement
scores on a survey two months later.
Ref: Outsource Inspiration by Adam Grant, in
How to be a Positive Leader: Small Actions Big Impact
by Jane Dutton and Gretchen Spreitzer.
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I. Develop Posi tive Meaning
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1. Define people and units in terms of
their strengths
2. Strengthen the connection between
peoples work and their belief that they
are having a positive impact on others
3. Diffuse positive meaning through
spreading of authentic stories whereemployees, management and project
teams made a positive difference for
others.
II. Stimulate Positive Emotions
1. Actively focus on what is working and
enabling desired outcomes
2. Strive for the momentary experience
of more positive than negative emotions
3. Show gratitude
4. Recognize the link between the
physical environment and individual
flourishing
III. Build Positive Connections
1. Respectfully engage others; show
esteem, respect and care for another
person
2. Engage in task enabling (help others)
3. Build trust
4. Engage in play
The student team uncovered individuals personal
motivations for working in the VA system was the
opportunity to help the veterans who fought forthe country.
Approximately one-third of interviewees were
themselves veterans.
Talking about this helped strengthen theconnection between pharmacy employees
personal mission and positive impact on others.
The student team recommended that
management accentuate veteran assistance in
their mission.
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1. Define people and units in terms of
their strengths
2. Strengthen the connection between
peoples work and their belief that they
are having a positive impact on others
3. Diffuse positive meaning through
spreading of authentic stories whereemployees, management and project
teams made a positive difference for
others.
II. Stimulate Positive Emotions
1. Actively focus on what is working and
enabling desired outcomes
2. Strive for the momentary experience
of more positive than negative emotions
3. Show gratitude
4. Recognize the link between the
physical environment and individual
flourishing
III. Build Positive Connections
1. Respectfully engage others; show
esteem, respect and care for another
person
2. Engage in task enabling (help others)
3. Build trust
4. Engage in play
The VA student team received feedback from their
hospital sponsors about the positive difference
they were making through their work.
The story of how the head of the pharmacy
division was emotionally impacted by the first
team presentation was repeated, and kept the
team motivated, throughout the project.
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I. Develop Posi tive Meaning
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1. Define people and units in terms of
their strengths
2. Strengthen the connection between
peoples work and their belief that they
are having a positive impact on others
3. Diffuse positive meaning through
spreading of authentic stories whereemployees, management and project
teams made a positive difference for
others.
II. Stimulate Positive Emotions
1. Actively focus on what is working and
enabling desired outcomes
2. Strive for the momentary experience
of more positive than negative emotions
3. Show gratitude
4. Recognize the link between the
physical environment and individual
flourishing
III. Build Positive Connections
1. Respectfully engage others; show
esteem, respect and care for another
person
2. Engage in task enabling (help others)
3. Build trust
4. Engage in play
The pharmacy student team recommended daily
huddles in the pharmacy, not only to shareinformation but also to institutionalize expressions
of gratitude on a regular basis.
The team envisioned a daily huddle that would
start with each person sharing - one at a time-
what they are grateful for, or what they arecelebrating that week.
In addition, this tactic would provide some
motivation for staff to notice positive cues around
them.
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I. Develop Positive meaning
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1. Define people and units in terms of
their strengths
2. Strengthen the connection between
peoples work and their belief that they
are having a positive impact on others
3. Diffuse positive meaning through
spreading of authentic stories whereemployees, management and project
teams made a positive difference for
others.
II. Stimulate Positive Emotions
1. Actively focus on what is working and
enabling desired outcomes
2. Strive for the momentary experience
of more positive than negative emotions
3. Show gratitude
4. Recognize the link between the
physical environment and individual
flourishing
III. Build positive connections
1. Respectfully engage others; show
esteem, respect and care for another
person
2. Engage in task enabling (help others)
3. Build trust
4. Engage in play
Before their first presentation, the student teamactively worked to put themselves in the shoes of
the front-line staff and empathized in a way the
staff could feel.
The result was, in their first presentation, members
of the staff were visibly moved, recognizing thatthis team gets it and understands their lives.
The staff could feel that the MAP team understood
them which increased their willingness to share
information and facilitate the projects progress.
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Lean Positive Learn Healthcare Interactive
Positive approach What is it?
Philosophical underpinnings
Tactics
What can lean and POS learn from each other?
Why especially in health care settings?
Examples from health care
Testimony from audience
Summary
Lean approach What is it?
Philosophical underpinningsTactics
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Still Evolving
What works and what does not?
What are best practices?
What specific tactics work when merging Leanand POS in health care settings?
How about you?
Share your experiences!