The recent debate on lean in health care, and specifically hospitals is heating up. Two Quality Digest Articles Why Lean? Why Now? and a follow-up story by the publisher of Quality Digest Lean Health Care and Quality.
I did a bit of research on the subject and it appears the a couple of months back the Minnesota Nurses Association has been very vocal in their distaste for Lean and standardization. I am right there with them.
Time features lean transformation at Seattle Children’s, debate ensues is very telling. The promotion of standardization is at issue.
“The two pillars of lean are continuous improvement and respect for people. However, there are aspects of lean that can ring alarm bells among employees who do not yet have a wholistic appreciation for lean. The first is standardized work. In lean, first you standardize, then you improve. Improving a non-standard process is like remodeling a house built on quicksand. It won’t do you much good in the long run.”
Lean continues to promote its application to service industry and hospitals. They believe (as in manufacturing) that standardized work is the place to begin improvement. This completely ignores the variety of demand that service and in particular hospitals get.
The Minnesota Nurse’s Union (or any other union) has right to voice there displeasure as this is a bad place to begin. The comment in the above article from Mark Graban of LEI (Lean Enterprise Institute) says nurses are “interested in talking about the hospital CEO’s paychecks than Lean.” Another comment says nurses are only interested in patient rations. My feeling is that nurses are over-worked by poorly designed systems that management has put in place using flawed thinking.
If we continue to standardize work in hospitals without accounting for the variety nurses and hospitals get from patients we will make things worse for patients, nurses, doctors and the bottom-line.
The system needs to be redesigned around the work by management, nurses, doctors and others working together to improve the system. This all begins by management changing their thinking around the design and management of work. Once management understands by seeing the damage of their thinking in a normative way can real changes impact the work.
Unfortunately, too few administrators spend time in the work. A checklist to be sure management shows up every once in awhile is hardly a solution. Decisions need to be made with the work with an understanding of it. The problem here is not the nurses, it is the management thinking.
Respect for people in service is not having someone stand over you with a stop watch like a machine or compliance to standard work that can’t cope with variety nurses get from patients.
Nurses should stand firm against any improvement initiative that doesn’t address the thinking problems of management.
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Tripp Babbitt is a columnist (Quality Digest, PSNews and IQPC), speaker, and consultant to private and public service industry.