Comments on: Criticism of Lean at Park Nicollet Hospital http://www.leanblog.org/2009/06/criticism-of-lean-at-park-nicollet/ Mark Graban's leanblog.org - Lean Healthcare, Lean Thinking, Lean Manufacturing, Toyota Production System Fri, 10 Feb 2012 10:01:31 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: Mark Graban http://www.leanblog.org/2009/06/criticism-of-lean-at-park-nicollet/#comment-8799 Mark Graban Sat, 06 Mar 2010 15:12:14 +0000 http://leanblog.bigbigdesign.net/2009/06/criticism-of-lean-at-park-nicollet-hospital/#comment-8799 Salvatore - thanks for your comment. You can choose not to believe me if you want. And it wasn't a nurse hugging a "lean rep" it was a nurse hugging a peer co-worker. We were teaching the nurses and techs how to improve their own work... Sounds like you are a victim of what we call, on this blog. L.A.M.E., or Lean as Misguidedly Executed. If you just have sycophants running doing nothing that benefits the staff or the patients, that's not Lean, or at least it's not effective Lean. I've read a lot from John Seddon about how Lean has been so badly misapplied in the British civil service... but where I disagree with John is that he completely discounts Lean... I criticize Lean done badly and still have hope that it is being done well more often than not. For more: http://leanblog.org/lame Salvatore – thanks for your comment. You can choose not to believe me if you want. And it wasn’t a nurse hugging a “lean rep” it was a nurse hugging a peer co-worker. We were teaching the nurses and techs how to improve their own work…

Sounds like you are a victim of what we call, on this blog. L.A.M.E., or Lean as Misguidedly Executed. If you just have sycophants running doing nothing that benefits the staff or the patients, that’s not Lean, or at least it’s not effective Lean. I’ve read a lot from John Seddon about how Lean has been so badly misapplied in the British civil service… but where I disagree with John is that he completely discounts Lean… I criticize Lean done badly and still have hope that it is being done well more often than not.

For more: http://leanblog.org/lame

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]]> By: Salvatore Romano http://www.leanblog.org/2009/06/criticism-of-lean-at-park-nicollet/#comment-8797 Salvatore Romano Sat, 06 Mar 2010 14:50:37 +0000 http://leanblog.bigbigdesign.net/2009/06/criticism-of-lean-at-park-nicollet-hospital/#comment-8797 I am a civil servant who works in one of the many Benefit Delivery Centre (BDC) in England where LEAN has been implemented. From the start it has brought nothing of value that a qualified manager should not or should not be doing anyway & it has not done any visibly good or made my or others work easier. The only people who implement it are the usual sycophants, known as LEAN champions whose only motivation is personal & come across like St Paul after his conversion on the road to damascus when they speak of LEAN. I cannot believe that nurses would hug LEAN reps in the way described. It sounds like something out of a communist propaganda pamphlet! I am a civil servant who works in one of the many Benefit Delivery Centre (BDC) in England where LEAN has been implemented. From the start it has brought nothing of value that a qualified manager should not or should not be doing anyway & it has not done any visibly good or made my or others work easier. The only people who implement it are the usual sycophants, known as LEAN champions whose only motivation is personal & come across like St Paul after his conversion on the road to damascus when they speak of LEAN. I cannot believe that nurses would hug LEAN reps in the way described. It sounds like something out of a communist propaganda pamphlet!

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]]> By: Mark Graban http://www.leanblog.org/2009/06/criticism-of-lean-at-park-nicollet/#comment-5114 Mark Graban Thu, 25 Jun 2009 13:13:49 +0000 http://leanblog.bigbigdesign.net/2009/06/criticism-of-lean-at-park-nicollet-hospital/#comment-5114 Steve- good luck to you, no easy answers, but I'll try:<br /><br />1) Make sure the staff is involved (that lean isn't being "done to them.")<br /><br />2) Make sure purpose of lean is clear (to improve customer service, quality, cost).<br /><br />3) Make sure there's no risk of lean leading to layoffs, alleviate this fear and commit.<br /><br />4) Have the team members be involved in defining the problem. Identify waste WITH them first hand at the gemba.<br /><br />5) Make sure the team is involved in the countermeasures and solutions. They need to own the change.<br /><br />6) This won't happen in a week. Sometimes you need to go slow to go fast. Steve- good luck to you, no easy answers, but I'll try:

1) Make sure the staff is involved (that lean isn't being "done to them.")

2) Make sure purpose of lean is clear (to improve customer service, quality, cost).

3) Make sure there's no risk of lean leading to layoffs, alleviate this fear and commit.

4) Have the team members be involved in defining the problem. Identify waste WITH them first hand at the gemba.

5) Make sure the team is involved in the countermeasures and solutions. They need to own the change.

6) This won't happen in a week. Sometimes you need to go slow to go fast.

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]]> By: Steve http://www.leanblog.org/2009/06/criticism-of-lean-at-park-nicollet/#comment-5111 Steve Thu, 25 Jun 2009 02:37:29 +0000 http://leanblog.bigbigdesign.net/2009/06/criticism-of-lean-at-park-nicollet-hospital/#comment-5111 I may be joining a team focused on efficiencies and cost control in a hospital food service program. How would you (or others reading this) advise me on approaching both the hospital and other members on the team. I believe successful change will ultimately come from the staff employed in the facility and building a culture that enables that type of growth will show results. I may be joining a team focused on efficiencies and cost control in a hospital food service program. How would you (or others reading this) advise me on approaching both the hospital and other members on the team. I believe successful change will ultimately come from the staff employed in the facility and building a culture that enables that type of growth will show results.

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]]> By: Mark Graban http://www.leanblog.org/2009/06/criticism-of-lean-at-park-nicollet/#comment-5044 Mark Graban Fri, 05 Jun 2009 22:21:02 +0000 http://leanblog.bigbigdesign.net/2009/06/criticism-of-lean-at-park-nicollet-hospital/#comment-5044 Thanks for carrying my mantle, Bruce! Appreciate the thoughtful comments.<br /><br />I will probably write a separate blog post sometime about this discussion.<br /><br />If Lean is being done properly, it is a HUGE benefit to the nurses. It shouldn't be an annoyance or hindrance. I've seen nurses and techs come and give big hugs to lean implementation team members because lean improvements were making their work EASIER, allowing them to provide BETTER patient care.<br /><br />Nurses should DEMAND lean thinking in their hospitals.<br /><br />To the anonymous commenter, if you've come back at all, please email me and I'll send you a free book if you want. <br /><br />Mark Thanks for carrying my mantle, Bruce! Appreciate the thoughtful comments.

I will probably write a separate blog post sometime about this discussion.

If Lean is being done properly, it is a HUGE benefit to the nurses. It shouldn't be an annoyance or hindrance. I've seen nurses and techs come and give big hugs to lean implementation team members because lean improvements were making their work EASIER, allowing them to provide BETTER patient care.

Nurses should DEMAND lean thinking in their hospitals.

To the anonymous commenter, if you've come back at all, please email me and I'll send you a free book if you want.

Mark

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]]> By: Bruce B http://www.leanblog.org/2009/06/criticism-of-lean-at-park-nicollet/#comment-5036 Bruce B Wed, 03 Jun 2009 20:05:56 +0000 http://leanblog.bigbigdesign.net/2009/06/criticism-of-lean-at-park-nicollet-hospital/#comment-5036 To comment on anonymous and Craig above: if the lean implementation really does pull doctors and nurses and nurses away from patients and cause them to run around with stopwatches and put up value stream maps on the walls then it isn't being done right. Mark G, the host of this blog, calls some implmentation LAME (lean as misguidedly executed). Reducing time with patient (some of which but probably not all is value added time) wouldn't be a rational objective in a well executed lean implementation. I would gues that when it came to time, the early part of the implementation would examine the time NOT spent on patient care and find out how to reduce that time (thereby increasing the ratio of value added time to non-value added time). That might mean stop doing things that don't add value and make the necessary no-patient things easier and faster (like making sure that nurses don't spend a lot of time looking for sphygmomanometers when they could actually be using one on a patient instead of walking around asking people if they have a spare sphygmomanometer).<br />I would think that a lot of error reduction and poka-yoking would be a big part of the early implementation as well. Most people receive this part well because in the lean methods this really comes down to respecting the inherent limitations of human performance -- be the humans, line workers or RNs -- and people generally like it when you repsect their humanity. In past methods we have we just say "They should just be able to {insert something that sounds easy but is really hard when you have to do it a bunch of time in a crazy ruch and disorganized environment}". I like to call that "shoulding on people." I would hope that anonymous would give another sensei a chance - one that has a lean philosophy and not a lame one. The concerns of Craig and anonymous are certainly valid but the experience doesn't match what lean really is. Somebody has given lean a bad name by taking people away from the very important work of patient care and made them run around with stop watches. Stop watches aren't a big part of lean. Sometimes you need them to get a rough estimate of cycle time in repeating discrete manufacturing proces or to measure basic work content or motion time maybe in quick changeover activities they are needed sometimes too, but I have benn doing lean activities for 7 years and I have spent precious little time with a stopwatch in my hand (thankfully) - it should not be a big part of you lean journey.<br />I do disagree with anonymous that service industries (including healthcare) aren't good fits for lean. I have done a lot of stuff in product development, marketing, IT, and HR admin and it fits quite well. I would think that health care would fit well as well (I have no direct experience). It is a mix of cognitive creative work and procedural work like most service industries. You just have to be able to elevate the paradigms of the TPS up the ladder of abstraction a little bit and you will find that the methods and philosophies of lean apply well in most situations. It might look a little different but value added time exists, non-value added time exists, errors happen, compexity exists in all types of work. Lean will improve those things. To comment on anonymous and Craig above: if the lean implementation really does pull doctors and nurses and nurses away from patients and cause them to run around with stopwatches and put up value stream maps on the walls then it isn't being done right. Mark G, the host of this blog, calls some implmentation LAME (lean as misguidedly executed). Reducing time with patient (some of which but probably not all is value added time) wouldn't be a rational objective in a well executed lean implementation. I would gues that when it came to time, the early part of the implementation would examine the time NOT spent on patient care and find out how to reduce that time (thereby increasing the ratio of value added time to non-value added time). That might mean stop doing things that don't add value and make the necessary no-patient things easier and faster (like making sure that nurses don't spend a lot of time looking for sphygmomanometers when they could actually be using one on a patient instead of walking around asking people if they have a spare sphygmomanometer).
I would think that a lot of error reduction and poka-yoking would be a big part of the early implementation as well. Most people receive this part well because in the lean methods this really comes down to respecting the inherent limitations of human performance — be the humans, line workers or RNs — and people generally like it when you repsect their humanity. In past methods we have we just say "They should just be able to {insert something that sounds easy but is really hard when you have to do it a bunch of time in a crazy ruch and disorganized environment}". I like to call that "shoulding on people." I would hope that anonymous would give another sensei a chance – one that has a lean philosophy and not a lame one. The concerns of Craig and anonymous are certainly valid but the experience doesn't match what lean really is. Somebody has given lean a bad name by taking people away from the very important work of patient care and made them run around with stop watches. Stop watches aren't a big part of lean. Sometimes you need them to get a rough estimate of cycle time in repeating discrete manufacturing proces or to measure basic work content or motion time maybe in quick changeover activities they are needed sometimes too, but I have benn doing lean activities for 7 years and I have spent precious little time with a stopwatch in my hand (thankfully) – it should not be a big part of you lean journey.
I do disagree with anonymous that service industries (including healthcare) aren't good fits for lean. I have done a lot of stuff in product development, marketing, IT, and HR admin and it fits quite well. I would think that health care would fit well as well (I have no direct experience). It is a mix of cognitive creative work and procedural work like most service industries. You just have to be able to elevate the paradigms of the TPS up the ladder of abstraction a little bit and you will find that the methods and philosophies of lean apply well in most situations. It might look a little different but value added time exists, non-value added time exists, errors happen, compexity exists in all types of work. Lean will improve those things.

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]]> By: Craig Henderson http://www.leanblog.org/2009/06/criticism-of-lean-at-park-nicollet/#comment-5035 Craig Henderson Wed, 03 Jun 2009 16:14:58 +0000 http://leanblog.bigbigdesign.net/2009/06/criticism-of-lean-at-park-nicollet-hospital/#comment-5035 The sincere comment from “anonymous” above raises a valid concern - and I am sure the commenter is not alone. Similar reactions have occurred in many places before and often with a legitimate point-of-view as their basis. So here is a major concern of mine: <br />“Will “Lean” rush into the healthcare industry with the same successful, but frequentlly problematic, approach used in manufacturing, or will lessons learned from implementing Lean in other industries advance implementation practitioners forward as they cross over into healthcare?”<br /> <br />Lean is about adding or strengthening value, not taking it away. Assuming the commenter has first hand experience with the implementation of "Lean" in the helathcare industry, and the comments expressed represent important stakeholder groups like physicians and nurses accurately, then something has gone wrong. These groups should be driving "Lean" forward because they see "Lean" as good. These groups should recognize “Lean” as a way to get more of what they want and less of what they don’t want.<br /> <br />Implementing “Lean” in compliance with such a positive standard is possible and it is not difficult, it just takes the right process and a desire to make it work. The sincere comment from “anonymous” above raises a valid concern – and I am sure the commenter is not alone. Similar reactions have occurred in many places before and often with a legitimate point-of-view as their basis. So here is a major concern of mine:
“Will “Lean” rush into the healthcare industry with the same successful, but frequentlly problematic, approach used in manufacturing, or will lessons learned from implementing Lean in other industries advance implementation practitioners forward as they cross over into healthcare?”

Lean is about adding or strengthening value, not taking it away. Assuming the commenter has first hand experience with the implementation of "Lean" in the helathcare industry, and the comments expressed represent important stakeholder groups like physicians and nurses accurately, then something has gone wrong. These groups should be driving "Lean" forward because they see "Lean" as good. These groups should recognize “Lean” as a way to get more of what they want and less of what they don’t want.

Implementing “Lean” in compliance with such a positive standard is possible and it is not difficult, it just takes the right process and a desire to make it work.

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]]> By: Anonymous http://www.leanblog.org/2009/06/criticism-of-lean-at-park-nicollet/#comment-5031 Anonymous Tue, 02 Jun 2009 19:53:00 +0000 http://leanblog.bigbigdesign.net/2009/06/criticism-of-lean-at-park-nicollet-hospital/#comment-5031 Has anyone thought that maybe "lean" doesn't work in a service industry. It's easy to assign duties and make processes more efficient when you're on a line but when it comes to patients and other people-related services Lean does not fit. There are far too many changing and unknown variables when it comes to treating people than when building a car. Running around with stop watches on a nursing floor and putting up charts about flow and such do not encourage "buy-in". Nurses and doctors are there to serve the patients. They do not view patients as part of an assembly line. They are real and don't fit into a specific brand. The complaints aren't that "we need more staff". It's "we're trying to do our jobs but Lean is getting in the way of my job". When you take physcians and nurses away from their duties so that they can learn Lean you take away what that person has studied for and what a hospital needs, to care for the patients. To most people in the health care profession Lean is just another money maker/gimic for a person who wrote a book or for popularity with other CEOs. There have been many before and there will be many more. Has anyone thought that maybe “lean” doesn’t work in a service industry. It’s easy to assign duties and make processes more efficient when you’re on a line but when it comes to patients and other people-related services Lean does not fit. There are far too many changing and unknown variables when it comes to treating people than when building a car. Running around with stop watches on a nursing floor and putting up charts about flow and such do not encourage “buy-in”. Nurses and doctors are there to serve the patients. They do not view patients as part of an assembly line. They are real and don’t fit into a specific brand. The complaints aren’t that “we need more staff”. It’s “we’re trying to do our jobs but Lean is getting in the way of my job”. When you take physcians and nurses away from their duties so that they can learn Lean you take away what that person has studied for and what a hospital needs, to care for the patients. To most people in the health care profession Lean is just another money maker/gimic for a person who wrote a book or for popularity with other CEOs. There have been many before and there will be many more.

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]]> By: Craig Henderson http://www.leanblog.org/2009/06/criticism-of-lean-at-park-nicollet/#comment-5030 Craig Henderson Tue, 02 Jun 2009 18:30:07 +0000 http://leanblog.bigbigdesign.net/2009/06/criticism-of-lean-at-park-nicollet-hospital/#comment-5030 Mark, your comments about employees seeing the management of pens and pencils as “out of synch” with what they believe are more pressing concerns is right on the money but perhaps not strong enough. The good name of “Lean” takes a hit when action plans and continuous improvement projects are not driven from the “bottom up”. Misapplication of the proven approach makes it easy for detractors to blame “Lean” principles and methods for landing projects on the list that don’t seem to make sense. Of course, in reality, it’s how “Lean” is being applied causing the problem. <br />When too much damage of this sort occurs, it ultimately blocks effective communication. Instead of “Lean” being an important “short-hand term” interpreted by all stake holders as equivalent to “a better way”; the term now represents principles and methods producing a mixed bag of benefits and problems. Under these circumstances, as Leadership continues to use the term thinking they are still communicating “a better way”, in reality, many listeners are interpreting “Lean” in a less positive way - buy-in begins to suffer as a result. This type of communication problem can seriously hinder any plan to maximize the benefits of deploying “Lean”. Mark, your comments about employees seeing the management of pens and pencils as “out of synch” with what they believe are more pressing concerns is right on the money but perhaps not strong enough. The good name of “Lean” takes a hit when action plans and continuous improvement projects are not driven from the “bottom up”. Misapplication of the proven approach makes it easy for detractors to blame “Lean” principles and methods for landing projects on the list that don’t seem to make sense. Of course, in reality, it’s how “Lean” is being applied causing the problem.
When too much damage of this sort occurs, it ultimately blocks effective communication. Instead of “Lean” being an important “short-hand term” interpreted by all stake holders as equivalent to “a better way”; the term now represents principles and methods producing a mixed bag of benefits and problems. Under these circumstances, as Leadership continues to use the term thinking they are still communicating “a better way”, in reality, many listeners are interpreting “Lean” in a less positive way – buy-in begins to suffer as a result. This type of communication problem can seriously hinder any plan to maximize the benefits of deploying “Lean”.

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]]> By: John Toussaint http://www.leanblog.org/2009/06/criticism-of-lean-at-park-nicollet/#comment-5028 John Toussaint Tue, 02 Jun 2009 14:55:53 +0000 http://leanblog.bigbigdesign.net/2009/06/criticism-of-lean-at-park-nicollet-hospital/#comment-5028 Growing is important for lean to work long term.<br /><br />This is true because the significant improvements in productivity that lean produces(3-5% at Thedacare) eventually lead to redeployment. If there is no new growth redeployment is very difficult.This doesn't happen in healthcare organizations for years because turnover is high in the industry(8-15%) but eventually the improved efficiency catches up.<br /><br />The other point is that business strategy and lean are two different things.Strategy is based on market place conditions and an assessment of products and customers. Lean is the philosophy and methodology to operationalize the strategy. I can safely speculate that Park Nicolet would be doing much worse if it wasn't for it's lean operations. They are a great organization and will weather this economic downturn coming back stronger.This may require a strategic direction change but their commitment to lean will be critical to their long term operational and financial success. Growing is important for lean to work long term.

This is true because the significant improvements in productivity that lean produces(3-5% at Thedacare) eventually lead to redeployment. If there is no new growth redeployment is very difficult.This doesn’t happen in healthcare organizations for years because turnover is high in the industry(8-15%) but eventually the improved efficiency catches up.

The other point is that business strategy and lean are two different things.Strategy is based on market place conditions and an assessment of products and customers. Lean is the philosophy and methodology to operationalize the strategy. I can safely speculate that Park Nicolet would be doing much worse if it wasn’t for it’s lean operations. They are a great organization and will weather this economic downturn coming back stronger.This may require a strategic direction change but their commitment to lean will be critical to their long term operational and financial success.

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