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It may (is?) not limited to the medical education system. Having spent the last six years working with Lean systems, after receiving a degree in Management, I wish I could have received education on Lean techniques before I entered the job market. The best (and only) class I had was Industrial Management, where a new professor (both to the school and to any post-secondary educational system) shifted the class into TQM (you gotta love those classes in the early 90′s!)

This spring, a son of our V.P. graduated with his MBA from a prominent school in the US (which I will not name). During his undergrad and his masters courses, he had NO oppportunity to learn about Lean. He did, however, learn some details from our plant, as he Interned here during the summers. How is it that our educational system cannot see the benefit of 1)Waste reduction within their own system or 2)The value of teaching waste reduction to our future?

I am currently working on a project with our local university (it’s a small school, but it’s a start!) I intend to be a guest lecturer throughout the term, providing some insights into Lean Systems. I hope to include some hands-on practicals in the lectures as well…perhaps a “go and see” then report back. Our local university is open to the idea, but (like traditional management) seems to be very slow to move forward.

Still, we have to start somewhere, right? If education is key, we need to drive it back to our suppliers. However, we can’t expect them to take on the entire load. We must be willing to assist them and take on some of the burden.

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Mr Levy said, this morning:

“The issue is not that the doctors don’t care about patient safety, and it is not about their being greedy — it is that medicine has never been built around the idea of systemic improvement. Instead, it is a cottage industry, in which each provider has been trained for years to act as an independent agent.”

So Mr. Levy is implying a root cause is the medical education system? I wonder what is being done, then, to train everyone in the hospital system to be team players then?

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You have struck a pretty negative chord with this blog’s audience, which if you read other posts and comments, this is not normally a group that turns on people. I hope you’d take that into consideration. It probably *is* that your words come across as attacking, defensive, and excuse making – if you want to attribute that to bad writing, so be it. If this group jumped to conclusions and accusations about your industry and field, I think you did the same, unfortunately, which didn’t help the level of discourse. Offsetting penalties, I suppose. Loss of down.

We criticize many companies and leaders in many industries as “dolts” (as you described our words) on this blog and maybe we shouldn’t. I try very hard to work at the “respect for people” aspect of Lean, in terms of not criticizing others or attacking them without trying to put ourselves in others shoes and asking “why?” first, whether we’re attacking dolts who layoff employees with Lean, dolts who take exorbitant pay while their company crumbles, dolts who provide horrible customer service, etc. You’re not alone in being criticized, you are unique in stepping up to try to respond, which I admire. I just wish we had turned this into something more constructive.

My initial post on your blog were some questions, no attacks or snottiness on my part. I asked why the problems turned up by JCAHO weren’t addressed earlier and more proactively — a question I still think is a fair one. I thought my questions were posed in an inquisitive and respectful way. You responded with “hospitals are different” so we’ll have to leave it that…. it’s too bad we didn’t get much beyond that level of discussion. Maybe we’ll get there eventually.

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Please don’t dismiss the value of the discussion – unfortunately, some of the words used by both sides could have been better, and have alienated the parties of what could be a productive discussion. We know the Lean methods work in healthcare. And we know the nature of the business can be a frustration in making things happen. As one who work for a hospital and is a Lean advocate, I’ve seen firsthand the difficulties, and the successes. As in any industry, and as we saw in the early days in manufacturing, it takes awhile to figure out the best way to “reach the organization”, including, in this case, the physicians. So if we can refrain from the name-calling that’s been a part of this interchange, we can bring a productive dialogue forward. Lean works anywhere – it’s just a matter of finding the right formula. Let’s work together to bring positive change to our organizations.

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But I will tell you, in all honesty, that the very kind of language you have used would make it difficult for you to be successful in the health care environment. I am an ally in pursuing the techniques and approaches you advocate, and when I try to suggest that you have not understood the underlying culture of hospitals and doctors, you dismiss me out of hand.

Thanks very much for the back-and-forth, though.

As to why doctors don’t wash their hands, ask them yourselves and see what the answers are. I have done that, dozens of times; but any recitation of what I have learned that I give on this site will certainly just be described as an “excuse” or as part of a characterization of me as having been “captured” by that profession. So I will leave it to others to try to explain.

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I don’t buy this whole “you’re thinking like engineers” crap. We’re thinking of the customers (the patients) when we ask why better systems aren’t in place for safety — what are you thinking of? Not offending doctors? Get real. When I’m in a hospital, I’m a jerk, I tell them all to clean their hands, and if they’re annoyed at me so what.

Back to the Lean philosphy (for those of us who are managers and/or more well rounded than your view of an engineer), it’s very much based on psychology (thanks to the teachings of Dr. W. Edwards Deming and others). Lean, done right, takes care of customers AND employees. We focus on systems to prevent problems rather than having to blame people when things go wrong. Good engineers also think about all of these things, especially people who design systems. So maybe medical people NEED to start thinking more like engineers and quit screwing up so much. Engineers have done a much better job improving airplane safety than the medical profession and industry has done improving health care safety. So get off your own high horse. You’re new to that industry, it seems like you’ve “gone native” as they say.

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You say, “When you ask a question like this — “Even if a doctor has a unique set of skill should they be allowed to work around a system based on the patients safety?” — you are showing a high level of naivete or lack of understanding.”

So what is the answer to that question you posed? Is it wrong to even ask the question? Are doctors that thin skinned? Or is it the administrators? What is the understanding we lack other than “you’re different?”

There’s a difference between “understanding the underlying culture” and making excuses for it.

We’ve tried discussing on this blog “why” doctors don’t always wash their hands, as one example of a cultural challenge. What is the answer? Why can’t it be changed?

Can anyone else answer that?

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When you ask a question like this — “Even if a doctor has a unique set of skill should they be allowed to work around a system based on the patients safety?” — you are showing a high level of naivete or lack of understanding.

What I have been trying to say here and what I have written about on my blog is that the organization of an academic medical center is qualitatively different from any other business I have ever seen. The issue is not that the doctors don’t care about patient safety, and it is not about their being greedy — it is that medicine has never been built around the idea of systemic improvement. Instead, it is a cottage industry, in which each provider has been trained for years to act as an independent agent.

When you fall into the trap of denigrating those who work in this environment, you undermine the chances that they will listen to you about using the very techniques and system approaches you are advocating. So, get off your high horses for a moment, and think instead about how you would solve this kind of problem. Stop thinking solely like engineers and try to apply some other disciplines (e.g., pyschology, negotiation).

There are a number of us out there who are actually trying to implement the approaches you would advocate. Please give us a little credit for trying to adapt them to our environments rather than just saying we are dolts who obviously don’t understand.

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Imagine if your “simple” factory had assembly line workers who brought in car buyers. Could you hold the guy installing the windshield accountable if making him mad meant lost car sales, because he’d jump from GM to Ford?

Crazy, huh?

That kind of stuff wasn’t in the movie Sicko, but it makes me want to suggest a sequel.

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