Team IZB of GGD Gelderland-Zuid works more efficiently, with help from Symbol

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De Munter: “A question Giovanna and I regularly ask ourselves: are there areas for improvement, things that are not going well? We never received complaints from patients, but of course we could always see if we could work more efficiently. In our department, do we tend to take (too) many actions? How far do you go in care, is the responsibility in a particular case with the GGD or with another health care provider? Giovanna already had experience with Lean, and suggested we start working with it. Together with Symbol, of course.”

Balance between delivering quality and working efficiently

“We have a great team that works well together, that has an eye for each other and where quality is paramount. So a lot goes well, but we wanted to take a really critical look at our processes. That’s where we could possibly make gains,” Van IJzendoorn says. “We certainly did not want to use Lean at the expense of our quality, but we did want to check whether the relationship between delivering quality and working efficiently was right. For example, there was a culture of consultation, but did that culture ever arise out of necessity and so do we have to keep consulting so much? Or has it become a habit, something we can change?” De Munter adds, “Employees did wonder: ‘Won’t I soon lose the fun and drive in my work?’ But by eliminating waste and superfluous actions you can work more efficiently while maintaining quality and job satisfaction. After all, you can then free up more time to spend on other tasks.”

Improvements from the team

Van IJzendoorn wanted to involve the entire team. Fifteen employees in all: doctors, nurses, two infection prevention experts and secretarial support. “I deliberately didn’t frame areas for improvement beforehand. I wanted the improvements to come from within the team, otherwise it’s ‘the manager who thinks something about something.’ It’s so much more valuable when team members themselves take a critical look at their processes, without someone deciding from above. Of course, our Symbol consultant, Daphne La Haye, supported this.” La Haye first gave the entire team a brief introduction to the world of Lean. Then, as a team, key processes were scrutinized, such as the process surrounding new reports. Van IJzendoorn: “How does a report come in to us, and to whom? Is that the right person? And how is the report then dispatched? We mapped all the processes from start to finish. Some team members found this start-up process time-consuming, but it was valuable and also necessary to come to good decisions. And because of the questions Daphne asked in between, slowly but surely everyone formed his or her own opinion about and vision of the process.”

Tasks and responsibilities visually clear

“Of course Daphne prepared well for our trajectory,” De Munter continues, “but because she did not yet know everything about our processes in terms of content, she was able to indicate very well what was unclear and discuss with us whether this was something that could be improved. But that did not mean that her will was law. I really liked that she let everyone tell their story. What do you think is important in this process, and why? What is your work in this process? What do you pick up, and why? And do you have to do this, or can it be left to someone else?” Van IJzendoorn adds, “The sessions with Daphne made it much clearer how everyone works, why that is the case, and which tasks and responsibilities lie with which people. Daphne then made this visual by drawing a pool (seen from above) on a large sheet of paper, where the lanes in the pool were the different disciplines in our department. All tasks and responsibilities were assigned to the appropriate lanes with sticky notes and colors. This made it come alive and allowed us to give good feedback to people who couldn’t be there that session. Team members know what is expected of them and where there needs to be handover or communication.”

All noses in the same direction

A new way of working sometimes requires a change in the current culture, and that is always difficult. “Some employees had a certain expectation from the process; not everyone was equally positive,” says Van IJzendoorn. “Before each session with Daphne, therefore, everyone could indicate with smileys how they felt – happy, neutral or slightly embarrassed. We could then take that into account in the sessions, and it was certainly discussed. Why had someone chosen a happy, neutral or embarrassed smiley? For example, looking at your own work critically can be very threatening – several people on our team expressed that as well. But when you are challenged about something that could be better, it is about the content – it is not a personal criticism. By discussing that over and over again, we slowly but surely got all noses in the same direction. A lot happened between sessions; I had regular 1-on-1 contact with team members about the process. This approach (the sessions as well as the personal conversations) eventually paid off.”

Nice results achieved

The GGD Gelderland-Zuid team achieved great results. De Munter: “One of the results is that it is now clear which consultation is for what. Previously, many cases were shared with everyone; that is now more structured. Not everyone is involved in everything anymore. Other agreements have also been made about our consultation moments. And in a decision list that can be viewed by everyone, all agreements made are recorded. In six months we will evaluate this list with the team. Do these agreements still work for us, or should we approach it differently?” Van IJzendoorn: “Our office has also changed since the process with Symbol. At one point Daphne said it was very messy. Some team members were glad she said that, others thought it was going a bit far. But we did do something with Daphne’s comment. The room has been cleaned up and there are fewer of us in one office space. As a result, we now work much more quietly, with more focus. Everyone benefits from that.”