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Doctor’s Music Video Teaches Asthma Treatment: But is it Lean?

September 27, 2013

When staff failed to follow asthma treatment guidelines at Glenfield Hospital in Great Britain, one of its physicians, Tapas Mukherjee, came up with a wonderfully creative and well-executed learning solution: a music video.

The story, as reported on the “Shots” blog at NPR, sparked a rambunctious debate here at the Maverick offices. Half of us thought it was a great example of Lean Learning. The other half said: “Even though we love the concept, it’s not actually Lean.”

Who’s right? Read on to find out…

First of all, everyone agreed the video is terrific. We love it. And it seems to be getting great results with encouraging hospital staff to learn and use the treatment guidelines.

According to the NPR story, before the video, less than half of the physicians made use of the treatment guidelines. One third of them didn’t even know the guidelines existed.

Two months after the video circulated, the hospital ran another survey. All of the doctors polled said they know the guidelines. Eighty percent said they were using them, and they also scored significantly higher on specifics such as knowledge of target stats. (They did not, however, report one way or the other on changes to actual patient care, which would be a better indicator of the true value of the learning solution.)

And, now, on to our Lean office argument.

Why the Video Exemplifies Lean Learning

First, the video as a learning solution goes a long way toward removing training waste. It pretty much digs into all eight wastes, especially these three:

  • Overteaching: At just five minutes long, the video provides only as much information as medical staff need to understand that their lack of applying the guidelines is having serious consequences for patient outcomes.
  • Unused Talent: Being created and acted in by a staff physician makes great use of in-house experts.
  • Inventory: The video was “housed” on YouTube. Staff watched it on their own smart phones, eliminating the need for lots of infrastructure.

The video also excels at adding Lean Learning value:

  • Emotional Connection: High marks for this value! Music, lyrics, a guy standing in a field, and more importantly, images of a patient who is suffering from improper care. The tongue-in-cheek humor is especially valuable because it allays the all-too-understandable defensiveness that might erupt in hard-working, caring practitioners if a heavier, preachier tone had been used.
  • Inside Out: A real internal expert made the video. This is a great example of a user seeing a need and creating his own content to address it.
  • Credibility: Even though the video is tongue in cheek, its creation by a physician at the hospital makes it very credible, especially in the world of healthcare, where physicians prefer to learn from other physicians.

Overall, big kudos to Dr. Mukherjee for creating an effective learning solution that eliminates training waste and adds Lean Learning value.

And Why It’s Not Lean

One of the most important methods of Lean Learning is the PDCA (PLAN-DO-CHECK-ACT) cycle.

PDCA graphic

If we were only evaluating the video on the basis on the DO quadrant, we’d be giving this vid a Roger Ebert two thumbs up.

But because Lean Learning is more than just removing waste and adding value, this video is missing, or is weak on, some important steps in the Lean process, such as a Good Problem Statement and a SMART goal.

But the primary element that’s missing is the Learnscape Map. And because we don’t have one, we don’t know why the staff isn’t learning and applying the asthma guidelines, or who among the staff isn’t doing so, or at what times/shifts it’s happening.

Without a thorough understanding of what was causing the problem, this learning solution’s creator skipped over the PLAN quadrant of PDCA and went directly to DO. (And, by the way, we don’t blame him for a second for doing so; he’s a busy physician, not an L&D professional.)

The video is a great learning solution, and do we want to see more like this? Absolutely. But, without the PLAN part of PDCA (not to mention CHECK, where you evaluate results, and ACT, where you either improve the solution or fully roll it out), this video is just another form of throwing stuff at the wall to see if it sticks.

This one sure did stick. The creator got lucky. And probably in part because he had a thorough understanding of the gemba—the place where the work is done—which gave him an intuitive grasp of the learnscape.

But for the vast majority of us, substituting intuition for learnscape mapping leads to directly to training waste and learning failure.

The Lean Learning Bottom Line

We would LOVE to see more training videos like these, especially because this one so powerfully evokes emotional connection, which creates learning motivation. BUT, to avoid relying on Lady Luck, we’d really rather see learning solutions created in the context of the PDCA cycle.

And PS … I had a great time this week delivering my presentation at the NE Shingo Prize Conference. What a great group of people and lots of powerful learnings that I’ll be sharing with you in future blog posts. Until then…

Let’s Ride!

Todd Hudson, Head Maverick


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