Lean Management and TCOM


We shared a video recently on our Facebook and Twitter from the New York Times called “We Trust You” from the series, The Art of Better. This video, created by Charles Duhigg, examines issues of innovation, motivation, and productivity through the lens of the automobile industry in the U.S.

The parallels between how one factory was transformed by stakeholder empowerment and innovation and the potential for TCOM to transform systems of care and build trust among system stakeholders, were striking to our team.

General Motors opened their Fremont factory doors in 1980. The Fremont site was considered an embarrassment to American manufacturing and dubbed “the worst workforce in automobile industry in the United States.”

Why?  For some of the same reasons that systems of care increasingly focused on measuring and managing hours of care provided instead of quality of care provided struggle to achieve good outcomes.

What happens when any type of work is all about quantity, not quality? What happens when the assembly line never stops?

No one is special, nothing is driven by a shared vision. Every worker (or provider) becomes a cog in the machine of production.

By 1982, GM closed down the Fremont site, which had become known for underperforming and disenfranchised workers and defective vehicles.

In 1984, Toyota purchased the factory and was mandated to hire back all the site’s former employees. How could Toyota infuse those disempowered and apathetic workers, who had “failed” the factory the first time around, with motivation and enthusiasm for innovation and quality?

With information, expertise, and empowerment: Toyota sent all workers overseas for training. There, they were allowed to stop the assembly line to fix any errors or make improvements. They were given POWER over the machine.


 

LEAN MANAGEMENT

This approach – now known as LEAN MANAGEMENT – gives workers the ability to take control and ownership, unlocking innovation and motivation.  The responsibility for solving a problem lies in the hands of the person or people closest to that problem, regardless of their title. The primary responsibility of leadership is to ensure that all levels of the system have the knowledge needed to effectively solve problems.

TCOM – Transformational Collaborative Outcomes Management – also emphasizes solving problems by using the knowledge of those closest to it –those receiving care and those providing it.  TCOM tools facilitate communication about the real needs and strengths of kids, families, and adults in our service systems.  Meaningful information is collected about those needs and strengths, and all levels of the system are empowered by access to the aggregated information needed to better manage and plan care, to monitor and celebrate outcomes, to manage and design programs, and to allocate resources where they are most needed.  When systems of care are aligned in this way, trust is engendered among and between all stakeholders in that system.


At our 12th Annual TCOM Conference in November, presenters from all levels of the system gave examples of the power of access to information to solve problems and improve care:

Jennifer Cass, LCSW, and Kathryn Pruitt, MFT, from Uplift Family Services addressed the topic of Collaboration and Collaborative Documentation across all levels (providers, families, etc.) in their closing plenary presentation at our 12th Annual TCOM Conference. Uplift Family Services uses Collaborative Documentation as a clinical tool to provide kids and families the opportunity to provide input and perspective on the services they will receive and their progress. Not only does it increase transparency between the clinical and physical world, but it allows for the families to become an integral process of their own care. Here the clinicians and the families have access to the data and have a voice.

Timothy E. Hougen, PhD, from San Bernardino County stressed the increased need for more clear communication between social workers and probation officers to the courts and other agencies.  In his presentation, “Communicating Beyond the TCOM Circle: Interagency Communications in San Bernardino,” Dr. Hougen talked about how the Department of Behavioral health uses the TCOM Tools to help structure communication by creating narrative reports with the purpose to better communicate with social workers, probation officers, etc. Creating narrative reports provided a means by which TCOM was understood as the structure behind the report.

Lori Chaffers, MSW, and Lea Dougherty, LSW, conducted a workshop entitled “Building Greater Collaborations for Better Outcomes.” In this workshop, participants identified why greater collaboration was particularly important for older youth and transitions and how the youth voice and empowerment are essential components in the collaboration process. Lackawana County has an Independent Living Collaborative with over 30 organizations working with transition age youth. The information collected is used in all aspects of managing the system from individual planning->supervision->systems operations.


In each of these examples (and many others across the international TCOM Collaborative), stakeholders in the system of care are given meaningful knowledge – and the empowerment that flows from that knowledge – about the current, collaboratively gleaned needs and strengths of children, families, and adults in care.  That knowledge and empowerment flows naturally into innovation and improved care.

Systems of care are enhanced and are more effective, more efficient, and more trusted.

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