I believe that we subconsciously apply Lean and Agile Methodologies every day of our lives and I can only imagine where we could go if we learned to apply the principles intentionally. I believe in improvement for Everyone. I want to be the “Everyday Agilist”.
This will be a very personal post for me as I will be speaking to the wonderful care my father received in his final days. We were fortunate enough to place him in one of the finest care facilities in the nation where the compassionate and caring staff were open to improvement opportunities with no judgment and with open hearts. As a family, we were truly fortunate.
When my mother passed suddenly as the result of a stroke, it became painfully obvious that the care the senior’s residence where my parents had an apartment was hopelessly inadequate to handle a large man with advanced Alzheimer’s disease. In fact, without my mother there to lobby on his behalf, even his treatment in the dining room quickly declined.
Fortunately, my mother (bless her heart) had anticipated his longer-term needs and had put him on waiting lists for some adapted nursing homes. With the change in his situation, he was immediately bumped to the top of the list and we moved him in soon after Mom’s passing.
Let me explain now that my father was never, by any stretch of the imagination, an easy man. Orphaned at a young age and armed with a seventh-grade education, this man built a successful construction business and ensured that his children all had the opportunity to explore their chosen educational paths. He was one smart and tough cookie. As his youngest, I like to think that I brought out his softer side and we had some wonderful discussions. I was fortunate to have a more flexible schedule than my siblings and I became responsible to settle him into his new home. I took up residence in his town and I spent every day in his room.
This proved a wonderful opportunity to “Go to the Gemba” and observe the work of a team of truly committed caregivers in their efforts to make my father comfortable.
Our biggest concern with my Dad’s care was fall prevention. Being 6 feet tall and over 200 lbs, it took two people to assist my father with toileting and he fell several times when losing patience and attempting to go on his own. While other family members complained bitterly about the lack of fall prevention, I took a different approach that was based on my underlying philosophy that these caregivers were not negligent but busy hardworking people determined to provide end of life care to a vulnerable population. It has always been my mantra that: “No one gets up in the morning and ask themselves how crappy a job can they do today and still have a job and a paycheck on Friday.”
I began to do what my Lean training has taught me: I observed. I observed that the nursing staff was watching my father hourly to make sure he was doing okay. At first, they did this inconspicuously from his doorway. I asked them to change their approach slightly and ask my father about his needs. I continued to observe and started to realize that my dear, gruff father had a consistent answer to their regular question: “Do you need to go to the bathroom Mister X?” was always answered with an impatient “No”. Again, I approached the staff with a small modification to the approach. This time I suggested a new question, something like: “Mr. X, it’s almost time for lunch, would you like to try to use the facilities and get washed up so you don’t have to interrupt your meal?” BINGO! Happy day, happier staff and no more falls…
Key Performance Indicators
To celebrate this success, I visited the administration offices to talk to them about the changes the staff and I had made. As it turns out, two of their Key Performance Indicators (KPI) were staff injuries and patient falls. For the care of one man, we had succeeded in both. His falls had been eliminated and staff no longer felt pressured by his impatience to assist him alone and risk injury. We began to talk about how this simple change could be repeated throughout the facility.
My transparency and communication had paid off, I decided to up my game a bit. Using a simple message board, I began to post short notes about activities that would interest my father. My simple Kanban board became a key communication channel when I was unable to be there. Dad was able to meet the visiting canine companion and share dog treats that I had placed on his table along with a note on the Kanban board. How heartwarming when he shared a memory of his childhood dog Sport, even when he could not remember what he had for breakfast or even having had breakfast.
We had a similar experience with the music therapist: she left a note asking about Dad’s favourite songs and I left a response. In his final days, weak and with his eyes closed, my father was tapping his toes to her performance of “Wildwood Flower”, no doubt remembering campfires with my aunt and uncle playing their guitars.
Although I still miss my father every day, I know in my heart that my Lean/Agile learnings made a difference…