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Rants and raves

Appreciating people – and the sport of cricket

It's with great pleasure that I write to you about the two most recent Health Systems columns by William "Ike" Eisenhauer.

The article "It's Not All about the Numbers" in the August issue struck a chord with me, as it resonated my personal belief about the overemphasis on numbers within healthcare. Although, given my IE training, I am always excited about numbers, I have noticed that empathy and passion go a long way in establishing change and achieving meaningful improvement.

In my old job as an improvement engineer with a health system in Madison, Wisconsin, I was tasked with establishing an advanced care planning program to promote the conversation about end-of-life care, palliative care and completing advanced directives. Initially I was gung-ho about processes, metrics and creating fancy graphs, looking at the recruitment numbers for the program.

But the best outcome for me was when I talked with a 90-year-old patient about her experience with the program and she mentioned, "I finally feel at peace, and thank you for offering this program."

In the craze for standardization, we forget to customize and cater to individual needs.

I loved the fact that Eisenhauer follows the sport of cricket, as mentioned in his October column "Engineering Health across Boundaries." I also was thinking about the ads during the Indian Premier League about health insurance for visitors, as my parents visit us every summer. Keep writing, and keep inspiring.

Ajay Jayakumar
Mayo Clinic Health System
La Crosse, Wisconsin

Customer response is top priority

In "Leaning a Little too Far" (September), Lou Keller offers wise counsel on lean's excesses in healthcare. His point about efficiency at the expense of customer effectiveness is the theme of my two-part article that appeared several years ago in Interfaces titled, "Taking the Measure of Lean: Efficiency and Effectiveness," (March-April 2011).

Keller's article ties in as well with more recent writings of mine: "Lean – Going Astray in Healthcare?" in the spring 2014 issue of Competitive Advantage. I stated that key lean lessons imported by healthcare from manufacturing are dubious even in manufacturing. In a nutshell, lean's early customer focus – on delivering quicker, more flexible, higher quality response to customers – was compromised when lean came to be identified primarily with eliminating wastes. Waste elimination has its place, but not at lean's forefront.

Perhaps lean went that way because most people in manufacturing never see a real customer, and so lean's customer-centered purpose eroded. Since healthcare and human services in general are customer-facing, those sectors would be well-advised to downplay wastes in favor of customer responsiveness.

Richard J. Schonberger
Independent researcher/author/speaker
Bellevue, Washington

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