Those of you who know my background know that I spent the first 10 years of my career working in various manufacturing sectors (including GM, Dell, and Honeywell). I moved into healthcare in 2005, part of the wave of people who are transferring the Lean methodology of management and quality improvement into an industry that needs it greatly, given the patient safety problems, rising costs, and oft-disengaged workforce.
I generally hear my fair share of what I call “factory bashing,” primarily from professionals who have only seen a factory on TV. When people say, “we don’t want this hospital to be some sort of factory,” I am sympathetic that they picture something like the bleak factory that Family Guy’s Peter Griffin works in…
Peter Griffin’s job at a toy factory, shown below, looks a lot like a scene out of Charlie Chaplain’s movie Modern Times, as parodied here in my fake “Wii Lean” game last year.
Sadly, this is what healthcare professionals are often afraid of when they hear of methods from “Lean Manufacturing” coming into healthcare. I can’t fault people if they’ve never been to a factory. Rather than getting upset, I try to talk to them about what bad factories are like and what great factories are like.
Now, many healthcare people HAVE gone to Lean factories and they’ve seen that a world-class western factory is nothing like the sweatshops of days gone by. When I first started my career at GM, UAW workers would bemoan that management only viewed them as a back, arms, and legs — without a brain attached. That was one of the primary reasons that GM was so screwed up, in my opinion – that general disrespect for the workers.
ThedaCare learned from a snowblower maker, Ariens, that better healthcare quality was possible. Seattle Children’s learned from Toyota that Lean was about engaging all employees in quality improvement and the best patient care (stay tuned for a Healthcare Value Leaders Network podcast that I did with their President & COO Pat Hagan, due out on 3/31). I’ve been with hospital leaders who visited VIBCO, a Rhode Island manufacturer where everybody is engaged in continuous improvement and workers use their brains as much as they use their hands and backs. The hospital leaders desperately wanted to duplicate that culture in their own hospitals.
So one point I usually make is that “like a factory” is far too general of a statement to make. There are, in this world, a wide range of factories – anything from from sweatshops to world-class factories that are outstanding workplaces for hourly and salaried workers alike.
The expression should really be “We don’t want this hospital to be some sort of awful sweatshop factory where workers aren’t listened to.” Then again, I’ve heard many complaints from healthcare professionals that managers don’t care what they think and that they are supposed to “just shut up and do their job” (a real quote, I’ve sadly heard in factories and hospitals).
So I won’t bash hospitals in somes sort of blanket statement. I’d hope healthcare professionals would extend the same courtesy to factories.
Now the thing that prompted this blog post was an article in the March 2011 print edition of WIRED magazine. The piece “1 million workers. 90 million iPhones. 17 suicides. Who’s to Blame?” is now online.
The article, written by Joel Johnson of the tech blog Gizmodo, is about the allegedly horrible conditions at the Foxconn factory in China that produces all of Apple’s iProducts. By, “allegedly,” I mean I tend to believe the articles (WIRED has covered this many times before – it’s almost an annual issue for them, much like WSJ’s annual thoughtless bashing of Just-In-Time practices).
I am more than sympathetic to Joel Johnson’s points that Foxconn sounds like an awful place to work. Workers allegedly had to work 13 days straight for 12 hours a day to get the iPads out to market. Workers have to raise their hand to go to the bathroom. 17 workers have committed suicide. It does give one pause if our American addiction to gadgets and corporate “see no evil, hear no evil” offshoring practices are leading to inhumane working conditions for many. Apple does annual supplier audits… but I imagine these are like Joint Commission visits to hospitals, where all of their guidelines (such as no equipment stored in hallways) are ALWAYS followed (unlike the other 364 days a year in many hospitals).
Hospitals should NOT be like Foxconn factories, let’s make that clear. There’s no “respect for people” being demonstrated there, so these factories are arguably the furthest thing from “Lean.”
In the WIRED piece, Johnson wildly extrapolates from what he’s read about Foxconn to what he supposes factories are generally like. He apparently has the pop-culture view of factory life. I was about to suppose that he has never been to a factory, a Chinese sweatshop or an American Lean factory, but he writes in the piece that he’s eaten in the Foxconn cafeteria.
In the piece, he first writes:
“[Working at Foxconn] seems incredibly boring – like factory work anywhere in the developed world.”
That’s an incredibly unfair generalization.
He then adds:
“But the work [at Foxconn] isn’t inhumane – unless you consider a repetitive, exhausting, and alienating workplace over which you have no influence or authority to be inhumane. And that would pretty much describe every single manufacturing or burger-flipping job ever.”
Wow, that’s incredibly unfair and misguided. Try telling Toyota, Autoliv, or VIBCO workers that they have no influence or authority. Hell, not all fast food or restaurant jobs are like that, if you remember my post about Nick’s Pizza & Pub in Illinois.
Unlike some writers, I’ve actually been to Nick’s and I’ve met Nick himself. I’ve talked to many of his workers and his workplace exhibits the same respect for people and investment in people’s job development as any Lean workplace. The chain In-N-Out seems to have a great culture where employees have a voice (it should be noted I have only eaten there… often). So you can’t even bash all “burger flipping” jobs with a broad brush.
As you can tell, I’m really disappointed with the WIRED piece. To those reading… if you have a chance to visit a great factory in your community, PLEASE do so. I think you’ll be pleasantly surprised at what you see, if they are a top-notch Lean facility. You are not going to see something like Foxconn or Lucy’s chocolate factory… so let’s please stop unfairly ripping an entire industry, especially if you have never set foot inside a factory.
About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as the new Executive Guide to Healthcare Kaizen. Mark is also the Chief Improvement Officer for the technology company KaiNexus.