Earlier this morning, I attended a presentation at SHS/ASQ about Lean implementation in multiple emergency rooms in a large health system. There were a lot of positives and one red flag that I heard that might be worth discussion.
- There was a large emphasis on the front line staff owning the process design with a high level of reinvigorated patient focus
- They didn’t use the circumstances and culture of the E.D. as an excuse to not use kaizen (or, really, the typical 5-day kaizen event). Much as Barnes Jewish got creative with their 6/3 process, this system developed a 2-day kaizen event model that would work for them.
The red flag, which comes back to an issue of management commitment and senior leadership focus:
The presenters said, basically, that “strict productivity guidelines” get in the way of having time for process improvement. Yes, productivity is important (quality is more important, but then again these things go hand in hand). Productivity is important, but productivity measures, goals, targets, and guidelines are NOT the end goal.
Why would you let your productivity goals get in the way of freeing up time for improvement? How else are you going to improve productivity if you don’t give nurses and staff enough time to work on the process? You’re NOT going to improve productivity by setting more goals and different targets. You have to staff properly so you can take care of patients (of course) and work on improvements. Too many hospitals habitually underinvest in improvement time and resources it seems.
Productivity goals are NOT a matter of federal law. These goals are set by management. Management can change them — IF they’re serious about Lean (and, more importantly, if they’re serious about improvement).
Seems like senior leadership at this organization doesn’t get it (or doesn’t realize the dysfunction their goals are creating). Do you see similar dysfunctions in your organization? Have you been able to influence your senior leaders or have they managed to see the light?
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