Sue Anne Brent, a charge nurse in Jail Health Services, was more than a little skeptical when she heard about Lean in King County. “I thought it was punishment,” she jokes. “I’ve been at the county for 16 years, long enough to know there is a lot of talk talk talk about ‘we are going to change things.’ But it was never us saying how we want to change things; it was always some entity who doesn’t do our work.”
Her Lean “aha moment” came during a process walk, when she and her team carefully watched the step-by-step work of developing the nursing care plan as their colleagues went through it. They were able to see ways to do their own work better. Moreover, they were able to do something about it. As she says, “I found we could make changes at our level. We are running our own show.”
A process walk may have convinced Brent to buy in, but it was not an easy sell.
In fact, the first time Sue Anne Brent did a process walk, she didn’t really do a process walk. “I’m still a little rebellious,” Brent confesses later. “I met with my team and we discussed the process. We didn’t think we needed to walk the process because we thought we knew the process.” As often happens, talking about the process didn’t reveal much insight.
Becca Cole, Brent’s Lean coach in the Creating Continuous Improvement course, told her that sitting in a conference room and talking isn’t a process walk. “What she’d talked about in the conference room was not reality,” Cole explains. “When you talk about how you do the work, you selectively or subconsciously edit. You really have to go to the work site and see the work happening; watch the real process.” Cole went with Brent to actually do a process walk.
Brent’s real process walk was an eye opener. “We knew there was waste, but it was amazing how much waste when we actually wrote it down.” Computers and electronic documentation has made some of the paperwork in the nursing care plan redundant, which Brent and her team knew even before the process walk. But seeing just how much of the work was waste—and how some of the value-added steps could be done in other ways—inspired them to make some changes.
Following the process walk, Brent’s team identified waste in the existing process that could be eliminated and found ways that the truly value-added steps could be retained or combined with other processes.