Ep. 16: A Deeper Dive into Real-Time Problem Solving
On this episode of Inspiring Health, we’re exploring the concept of real-time problem solving – a key component of WellSpan’s Lean Management System.
Featuring:
Stahl began her time at Chambersburg Hospital as a candy striper, eventually earning her nursing degree and holding various leadership roles including Clinical Manager, Care Coordinator, Director of Patient Services, and Senior Vice President Patient Services/Chief Nursing Officer.
Stahl is credited with bringing telemedicine services to Critical Care Unit patients at both Chambersburg Hospital and Waynesboro Hospital by leading an initiative with Mercy Virtual Care. She also led the implementation of the first electronic medical record system at both hospitals. She has also been deeply involved with the Franklin County community, serving on volunteer boards and helping at the Cold Weather Shelter.
Stahl has worked hard to develop strong relationships between the health center and local nursing programs, as well as participating in mission trips to third world countries where she's played an active role in delivering care.
Sherri Stahl, RN, MHA, NEA-BC, CPXP Roxanna Gapstur, PhD, RN
As SVP, WellSpan Western Region, Stahl leads a team of senior WellSpan leaders in Adams and Franklin counties in the operations and continued enhancement of services at WellSpan Chambersburg Hospital, WellSpan Waynesboro Hospital, WellSpan Gettysburg Hospital, and WellSpan Health and Surgery Center in Hanover.Stahl began her time at Chambersburg Hospital as a candy striper, eventually earning her nursing degree and holding various leadership roles including Clinical Manager, Care Coordinator, Director of Patient Services, and Senior Vice President Patient Services/Chief Nursing Officer.
Stahl is credited with bringing telemedicine services to Critical Care Unit patients at both Chambersburg Hospital and Waynesboro Hospital by leading an initiative with Mercy Virtual Care. She also led the implementation of the first electronic medical record system at both hospitals. She has also been deeply involved with the Franklin County community, serving on volunteer boards and helping at the Cold Weather Shelter.
Stahl has worked hard to develop strong relationships between the health center and local nursing programs, as well as participating in mission trips to third world countries where she's played an active role in delivering care.
Transcription:
Roxanna Gapstur: On this episode of Inspiring Health, we're exploring the concept of real-time problem-solving, a key component of WellSpan's Lean Management System. Today, we're going to talk about where real-time problem solving fits in the Lean Management System framework, how we can apply it to improve safety for team members and patients, and what must be true about our teams to successfully deploy real-time problem-solving in every area of our organization.
Joining me today is Sherri Stahl. Sherri is our Senior Vice President for the Western region and has served in roles of increasing responsibility during her tenure with Summit Health, beginning as a nurse and later earning the role of chief nursing officer. Most recently, Sherri has demonstrated her Lean expertise by serving as our real-time problem-solving lead within the executive team.
Sherri, thanks for being here.
Sherri Stahl: Thank you, Roxanna. It's a pleasure to be here.
Roxanna Gapstur: Sherri, I think we should level set just a few key terms and definitions with our listeners. We really can't take for granted that some of our Lean thinking and even the concept of WellSpan's Lean Management System is new for a lot of people. And alternatively, for our team members in the west, Lean's already part of daily work life. So given that parts of our organization may find themselves at different places on the lean journey. Let's define what we mean by WellSpan's Lean Management System.
Sherri Stahl: Sure. Let's do that.
Roxanna Gapstur: The real purpose of a Lean Management System is to create a framework for leaders to support and empower teams to improve their own work processes while removing waste and focusing on adding value. And the value we're after is to be the value-based leader in our region, which means providing exceptional experiences, highest quality and safety and most affordable care.
Sherri Stahl: That's correct. And what is compelling about a comprehensive Lean Management System is that it helps all 20,000 team members take an active role in finding a better way to be the value-based leader in our region. It enables teams to see, solve and share together to improve their work by understanding the root cause of an issue.
Roxanna Gapstur: Sherri, I'm wondering if you've ever thought you understood the cause of a problem and later found out it was something entirely different. Maybe you didn't ask the right questions or investigate thoroughly enough. And when the issue happened again, you realized it wasn't really fixed.
Sherri Stahl: Yes. We have discovered that oftentimes that we tell ourselves stories about why something happened when in fact the root cause is not embedded in our story, but rooted in another process. Asking the right questions takes practice and requires curiosity and psychological safety to exist. Sometimes you need a buddy to challenge your assumptions.
Roxanna Gapstur: Right. And Sherri, you know, this very well when we don't use a systematic approach to problem-solving, we're likely not to find the real root cause of the problem, especially in a complex system like a health system, because the causes of problems are often more difficult to find than you might think they would be. And sometimes there's more than one cause because we're functioning in a very complex world.
Sherri Stahl: So real-time problem-solving then is the methodology for truly understanding the cause of a problem, fixing it for good, and then spreading those learnings across the system. It's one of the seven or eight management components in a Lean Management System and supports the principles of operational excellence, enterprise alignment, and continuous improvement, helping to build a sustainable culture of continuous improvement.
Roxanna Gapstur: Exactly. We're driving a culture shift as much as we're deploying tools. And Sherri, can you tell us a little bit more about the real-time problem-solving methodology?
Sherri Stahl: Absolutely. And to do that, I'm going to build on the see, solve, share together model you mentioned earlier. See, develop a system by which everyone in the organization consistently identifies when a patient or employee is harmed. Solve to root, implement countermeasures as close to real-time as possible. And share, share countermeasures across the system and implement them locally as close to real-time as possible, a diagnostic tool for leaders to understand the organization's problem-solving capabilities. So coach to see, solve and share. We review problem-solving across the system that enables an all teach, all learn environment.
Roxanna Gapstur: Sherri, thanks for breaking down the purpose of the model. And can you help us think through applying real-time problem-solving to a harm event? How would it help us react and, even better, prevent harm events?
Sherri Stahl: Of course. We can talk about it here. And then we want listeners to go out to SharePoint and watch a short video made by our performance improvement team in the west, which illustrates the application of real-time problem-solving in a clinical area. The application of real-time problem-solving starts with embracing the scientific method of Four C Thinking to identify a problem, solve it to root, which prevents it from reoccurring.
Let's talk about this Four C Thinking, which has a tool that coaches us through the thought process. First, the four C's stand for concern, cause, countermeasure and check. So concern is stating the problem as a gap between what happened and what should have happened. We map out the sequence of events by stating the issues that led to the problem. We then determine cause. We'll use the five why's to determine the root cause of each issue leading to the problem.
After this, then we move to the third step, countermeasure. We determine the countermeasures to permanently address every root cause. Then the final step is check. We follow up on the actions to implement and validate the countermeasures, recognize the people involved in the problem-solving, and then share the learning. The Four C Thinking then becomes the standard method to solve issues. We then share this work across the system so that w we are all safer.
Roxanna Gapstur: I think understanding our current system of safety is really important. After all, the keystone behavior for our entire Lean Management System is employee and patient safety.
So what we know about WellSpan's safety right now is that we're about average on patient safety. And although we've improved in both the acute and ambulatory settings, we're not a top performer across every measure and we have gaps in care for patients of color across our quality measures.
A safety system that depends on heroism is not going to be a very safe system. No one individual in an organization can catch every error. So by seeing and touching problems together, we can use specific Lean tools like A3s and scientific thinking to deploy real-time problem-solving and improve our own processes and outcomes. We can solve those issues to the root cause and share them across the system. We can really move toward achieving zero harm.
Sherri Stahl: Roxanna, you're so right. And that's why the help chain is so important. The help chain is exactly what it sounds like. It is the process that our problem follows until it's solved. It starts with our frontline employees who identify that there's an issue. And first and foremost, for clinical areas, they make sure that the patient is safe and stable. This is always our first concern.
Then, we focus immediately on containing the issue, so that is not replicable. The employee who sees the problem then contacts their next in line leader and they partner for the Four C Thinking. If they can not immediately solve to root, then this moves up the help chain for the leader then to escalate to their leader, thus advancing in the leadership structure.
This occurs over and over again until solved and sometimes requires the leader to cross over into another department for partnering and escalation. Thus, with this escalation, you can see how it becomes a cascade up of a help chain. It is that process that should be laced with psychological safety, so the true root cause can be identified and solved.
Roxanna Gapstur: Thank you, Sherri. We also know success won't come overnight, so successfully implementing a Lean Management System requires team members to have a strong desire to learn, be curious, be innovative and be committed to the system. Team members must embrace change. They want to see process improvements and leaders have to be committed to eliminating harm and solving problems to root cause.
And I'm really glad you were here with me today to take a deeper dive into our Lean Management System and the benefit of real-time problem-solving. Thank you for being here today, Sherri. I appreciate your dedication to Lean and your leadership.
Sherri Stahl: Thank you so much, Roxanna.
Roxanna Gapstur: That's all the time we have for today. We hope you'll join us for the next episode of Inspiring Health.
Roxanna Gapstur: On this episode of Inspiring Health, we're exploring the concept of real-time problem-solving, a key component of WellSpan's Lean Management System. Today, we're going to talk about where real-time problem solving fits in the Lean Management System framework, how we can apply it to improve safety for team members and patients, and what must be true about our teams to successfully deploy real-time problem-solving in every area of our organization.
Joining me today is Sherri Stahl. Sherri is our Senior Vice President for the Western region and has served in roles of increasing responsibility during her tenure with Summit Health, beginning as a nurse and later earning the role of chief nursing officer. Most recently, Sherri has demonstrated her Lean expertise by serving as our real-time problem-solving lead within the executive team.
Sherri, thanks for being here.
Sherri Stahl: Thank you, Roxanna. It's a pleasure to be here.
Roxanna Gapstur: Sherri, I think we should level set just a few key terms and definitions with our listeners. We really can't take for granted that some of our Lean thinking and even the concept of WellSpan's Lean Management System is new for a lot of people. And alternatively, for our team members in the west, Lean's already part of daily work life. So given that parts of our organization may find themselves at different places on the lean journey. Let's define what we mean by WellSpan's Lean Management System.
Sherri Stahl: Sure. Let's do that.
Roxanna Gapstur: The real purpose of a Lean Management System is to create a framework for leaders to support and empower teams to improve their own work processes while removing waste and focusing on adding value. And the value we're after is to be the value-based leader in our region, which means providing exceptional experiences, highest quality and safety and most affordable care.
Sherri Stahl: That's correct. And what is compelling about a comprehensive Lean Management System is that it helps all 20,000 team members take an active role in finding a better way to be the value-based leader in our region. It enables teams to see, solve and share together to improve their work by understanding the root cause of an issue.
Roxanna Gapstur: Sherri, I'm wondering if you've ever thought you understood the cause of a problem and later found out it was something entirely different. Maybe you didn't ask the right questions or investigate thoroughly enough. And when the issue happened again, you realized it wasn't really fixed.
Sherri Stahl: Yes. We have discovered that oftentimes that we tell ourselves stories about why something happened when in fact the root cause is not embedded in our story, but rooted in another process. Asking the right questions takes practice and requires curiosity and psychological safety to exist. Sometimes you need a buddy to challenge your assumptions.
Roxanna Gapstur: Right. And Sherri, you know, this very well when we don't use a systematic approach to problem-solving, we're likely not to find the real root cause of the problem, especially in a complex system like a health system, because the causes of problems are often more difficult to find than you might think they would be. And sometimes there's more than one cause because we're functioning in a very complex world.
Sherri Stahl: So real-time problem-solving then is the methodology for truly understanding the cause of a problem, fixing it for good, and then spreading those learnings across the system. It's one of the seven or eight management components in a Lean Management System and supports the principles of operational excellence, enterprise alignment, and continuous improvement, helping to build a sustainable culture of continuous improvement.
Roxanna Gapstur: Exactly. We're driving a culture shift as much as we're deploying tools. And Sherri, can you tell us a little bit more about the real-time problem-solving methodology?
Sherri Stahl: Absolutely. And to do that, I'm going to build on the see, solve, share together model you mentioned earlier. See, develop a system by which everyone in the organization consistently identifies when a patient or employee is harmed. Solve to root, implement countermeasures as close to real-time as possible. And share, share countermeasures across the system and implement them locally as close to real-time as possible, a diagnostic tool for leaders to understand the organization's problem-solving capabilities. So coach to see, solve and share. We review problem-solving across the system that enables an all teach, all learn environment.
Roxanna Gapstur: Sherri, thanks for breaking down the purpose of the model. And can you help us think through applying real-time problem-solving to a harm event? How would it help us react and, even better, prevent harm events?
Sherri Stahl: Of course. We can talk about it here. And then we want listeners to go out to SharePoint and watch a short video made by our performance improvement team in the west, which illustrates the application of real-time problem-solving in a clinical area. The application of real-time problem-solving starts with embracing the scientific method of Four C Thinking to identify a problem, solve it to root, which prevents it from reoccurring.
Let's talk about this Four C Thinking, which has a tool that coaches us through the thought process. First, the four C's stand for concern, cause, countermeasure and check. So concern is stating the problem as a gap between what happened and what should have happened. We map out the sequence of events by stating the issues that led to the problem. We then determine cause. We'll use the five why's to determine the root cause of each issue leading to the problem.
After this, then we move to the third step, countermeasure. We determine the countermeasures to permanently address every root cause. Then the final step is check. We follow up on the actions to implement and validate the countermeasures, recognize the people involved in the problem-solving, and then share the learning. The Four C Thinking then becomes the standard method to solve issues. We then share this work across the system so that w we are all safer.
Roxanna Gapstur: I think understanding our current system of safety is really important. After all, the keystone behavior for our entire Lean Management System is employee and patient safety.
So what we know about WellSpan's safety right now is that we're about average on patient safety. And although we've improved in both the acute and ambulatory settings, we're not a top performer across every measure and we have gaps in care for patients of color across our quality measures.
A safety system that depends on heroism is not going to be a very safe system. No one individual in an organization can catch every error. So by seeing and touching problems together, we can use specific Lean tools like A3s and scientific thinking to deploy real-time problem-solving and improve our own processes and outcomes. We can solve those issues to the root cause and share them across the system. We can really move toward achieving zero harm.
Sherri Stahl: Roxanna, you're so right. And that's why the help chain is so important. The help chain is exactly what it sounds like. It is the process that our problem follows until it's solved. It starts with our frontline employees who identify that there's an issue. And first and foremost, for clinical areas, they make sure that the patient is safe and stable. This is always our first concern.
Then, we focus immediately on containing the issue, so that is not replicable. The employee who sees the problem then contacts their next in line leader and they partner for the Four C Thinking. If they can not immediately solve to root, then this moves up the help chain for the leader then to escalate to their leader, thus advancing in the leadership structure.
This occurs over and over again until solved and sometimes requires the leader to cross over into another department for partnering and escalation. Thus, with this escalation, you can see how it becomes a cascade up of a help chain. It is that process that should be laced with psychological safety, so the true root cause can be identified and solved.
Roxanna Gapstur: Thank you, Sherri. We also know success won't come overnight, so successfully implementing a Lean Management System requires team members to have a strong desire to learn, be curious, be innovative and be committed to the system. Team members must embrace change. They want to see process improvements and leaders have to be committed to eliminating harm and solving problems to root cause.
And I'm really glad you were here with me today to take a deeper dive into our Lean Management System and the benefit of real-time problem-solving. Thank you for being here today, Sherri. I appreciate your dedication to Lean and your leadership.
Sherri Stahl: Thank you so much, Roxanna.
Roxanna Gapstur: That's all the time we have for today. We hope you'll join us for the next episode of Inspiring Health.