One new thread was started last week, titled “Sitter Ratios,” that caught my eye. Unfortunately, many of the Lean web forums and groups (including various Yahoo Groups and LinkedIn Groups) have a lot of discussion that involves people looking to copy others – their improvements, their processes, and (in this case) their staffing levels. We really have to be careful with that…
First off, the poster doesn’t mean “babysitters” for home, they mean a hospital job that’s described on this website as:
A hospital sitter is an individual privately hired by the patient or his family members to come and stay with the patient at the hospital. The hospital sitter then provides personal care that the patient may not receive otherwise. Hospital sitters are a valuable resource to many families that are unable to take time off to be in the hospital around the clock. Hospital sitters provide these families the peace of mind…
In one respect, the sitter might be a “workaround” — if nurses aren’t available as often as needed, we could ask “why?” and do things to improve the system and support processes that would allow nurses to have more time with patients (using programs like the NHS Releasing Time to Care, based on Lean). Why are the patients not receiving certain patient care? That’s another discussion…
One thing I’ve seen in hospitals is that there’s a general lack of Industrial Engineering (aka Management Engineering, in healthcare) basics that would allow a department or manager to determine the right staffing levels based on inputs including patient demand, quality and safety requirements, and that hospital’s processes.
Staffing levels are too often based on budget numbers or benchmarks of other hospitals.
Does Toyota set its staffing levels based on benchmarks? No way. They understand their process well enough to know what the right staffing level should be. And hospitals can do the same. If Toyota has better processes and less waste than GM, than Toyota’s factory should have a different (lower) staffing level. I’m sure even the individual Toyota factories determine their own staffing levels based on their own process (how does the San Antonio factory vary from the older Kentucky plant?).
Back to the LEI forum post, it asked:
Does anyone know of a benchmarked standard for sitters in a hospital environment? Looking for a ratio if available.
Obviously we’re working on improving this regardless of if we’re better or worse then a benchmark, but I was curious if anyone out there knows a standard. If the benchmark says we should be better than we are now, we’ll use that as our crisis to help promote change.
I’m not suggested the original poster just wanted to copy… but we have to be careful with benchmarks. I’d rather focus on my own process and use time otherwise spent benchmarking on understanding and improving my own process.
I’d hope an organization can find a mandate for improvement other than “our staffing levels are higher than other hospitals that we benchmarked.” There needs to be a natural spirit of improvement in a Lean culture. I doubt benchmark numbers are going to be very motivating for hospital staff.
Again, if your hospital has a different layout and different processes than other hospitals, you might not be able to use some other hospital’s staffing numbers.
My understanding is that Toyota spends very little time and energy on benchmarking others. Focus that energy on your own system, I’d say.
Looking back to my post about the interview with Masaaki Imai, look at the story he told about Taiichi Ohno:
… one time, he was the manager in charge of a machine shop, and he understood that in the machine shops typically one operator was assigned to one machine. But from the standpoint of people’s efficiency, he noticed that each operator had a lot of idle time while the machine was working. So experimentally, he assigned two machines to one operator to see how that could be done. Then, after very careful observation, he was able develop several methods that made this possible for all workers. To do this they needed to standardize the work procedure, and that’s when he first introduced standard work. Then he increased the number of the machines to three, and in about six months one operator was taking care of four machines.
Ohno didn”t go benchmark other machine shops – he looked at his own process and engineered it. I’d argue hospitals can do the same thing. Once, I helped a hospital microbiology lab determine the right staffing levels based on workload data (including demand variation) and how long it generally took to do work (including the variation and without setting “quotas.”). We made the case that they needed to add a 5th “plate reader” and management listened to the data. Previously, it was just “an opinion” that the lab needed more people. Engineering and process data trumped opinion and gut feel.
When I tweeted about this last week, somebody raised the issue of learning from others. I agree that high level efforts like the Healthcare Value Leaders Network (an effort I’m involved) in is constructive sharing – organizations visit and talk with each other, sharing their lessons learned about Lean. We have a good culture in the Network of “learn, but don’t copy” (this is an informal guideline). Our efforts aren’t about copying the exact standardized work or copying staffing levels. I think it’s a better form of “benchmarking” (we don’t call it that) than following a bunch of benchmark data that might not have context.
What are your thoughts on benchmarking, and why?
- Absolutely worthless, don’t waste your time
- Sort of helpful, but be careful in how you use it
- I couldn’t live without benchmarking
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