By September 28, 2011 10 Comments Read More →

Automation is Not Always the Answer, in Retail or Healthcare

Lately, there have been many stories in the news about supermarkets ripping out self-service checkout scanner, stories like this: “Supermarkets start bagging self-serve checkouts.” 10 years ago, the supermarkets saw this technology as a clear cost savings – reducing labor costs. But, some costs increased, including “intentional and accidental theft, including misidentifying produce and baked goods as less-expensive varieties,” not to mention customers being slowed down or confused. Robots (like these scanners) can’t be a smiling face… but I don’t believe, for a minute, that the supermarkets are ripping the scanners out because they want to provide better customer service. I would guess that the cost savings didn’t really materialize.

So what are the lessons and parallels for hospitals?

There are many cases where hospitals are seduced by technology, including:

  • Robots that deliver meals or supplies to inpatient units
  • Pharmacy robots that grab medications off a shelf to be delivered to patients
  • “Track systems” that automate the movement of blood tubes in a laboratory
  • Inventory cabinets that help track inventory and trigger restocking
  • Self-service emergency department check in kiosks (a practice I was skeptical about 4 years ago)

What are my experiences with these technologies? Well, I’ve been hit by a delivery robot in a hallway after being promised “it had sensors that tell it to stop.”

I worked with a hospital pharmacy that realized the robot didn’t really generate any labor savings because they had to pay somebody to run a machine that put pills into single-dose packaging that the robot could handle. When this pharmacy (at a children’s hospital) built new space, they didn’t buy a new robot.

I know of cases where hospital laboratories tore out their track systems (including this PDF case study from my former employer, ValuMetrix Services). Track systems are often called “total lab automation” and they are, from my experience, very slow conveyor belts that save labor but slow down turnaround times. These labs often automated a bad layout. When the high volume testing areas were really far away from the location where specimens arrived, the real Lean solution was changing the physical layout, not automating the waste of transportation. Washington Medical Center reduced FTEs when they put in the track system. When they took the track system out, under the guidance of a Lean consultant, they reduced turnaround times dramatically while adding back in just 1.5 FTEs. Sometimes, it’s better to have people transport specimens instead of a robot.

Some hospitals have been ripping out automated inventory cabinets. I know of one that removed 93 out of 100 of these cabinets, replacing the cabinets and their expensive maintenance contracts with simple wire racks and two-bin kanban systems. When they looked deeply into their process, the hospital learned that a vast majority of “chargeable” supplies were not actually charged to specific patients. The billing functions that were tying usage into patient charts just weren’t being used. The automated cabinets often created a bottleneck, where nurses had to stand in line to get supplies. With the open shelving, multiple nurses could grab what they needed at the same time, reducing delays in patient care. Automated cabinets were still retained when items were expensive and/or charged to patients and/or security threats.

I don’t know if Parkland Hospital took out their E.D kiosk. If they follow the lead of supermarkets, they just might (or they already have).

I’m not anti-technology. I just believe strongly in the “Toyota Way” principle that states:

“Use Only Reliable, Thoroughly Tested  Technology That Serves Your People and Processes”

In many of the cases above, technology was adding cost and delaying care… not really adding any value to the process.


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Mark Graban's passion is creating a better, safer, more cost effective healthcare system for patients and better workplaces for all. Mark is a consultant, author, and speaker in the "Lean healthcare" methodology. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. His most recent project is an eBook titled Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also the VP of Improvement & Innovation Services for the technology company KaiNexus.

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10 Comments on "Automation is Not Always the Answer, in Retail or Healthcare"

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  1. Gary
    Twitter:
    says:

    Timely article, it was only yesterday that I read about the boom in voucher fraud at self-service checkout scanners in the UK:

    “In July, a Cambridgeshire couple, Nigel and Penny Ward, pleaded guilty to reusing a Tesco Clubcard voucher repeatedly to obtain almost £1,100 worth of free groceries. The £17.50 discount voucher was genuine and had been sent to the couple by Tesco but it was only meant to be used once, but they used it 62 times. In what was believed to have been the first ever prosecution for voucher fraud they were sentenced to a 12-month community order and had to pay £500 in compensation to Tesco.”

    http://bit.ly/nRdQLk

    • Mark Graban
      Twitter:
      says:

      I’m really surprised that rises to the level of criminal offense. Unethical on the part of the customer, perhaps, but isn’t it Tesco’s fault that their store policy was violated?

      • Gary
        Twitter:
        says:

        I completely agree that this is a Tesco’s store policy issue. As with any “opportunity” if something is left open like this, people for whatever their reasons may be will attempt to utilize it.

        Tesco should have managed this risk in a better manner and possibly identified it at an earlier stage.

  2. That’s incredible. I find it hard to believe that would be a criminal offense in the US. Depending on the circumstances, I would even question whether or not it was unethical. Did the voucher state “one time use only”?

    Nick Castelucci
    J&M Enterprises
    Thermoforming Molds

    • Geoff says:

      Hi Nick,

      As a club-card holder I can attest that they do state one time use. Also they state only redeemable when using the club-card. However there does not appear to be any real controls (technology or otherwise) on the use or connection of the two.

      Personally I am usually torn when I hear stories like this. On one hand I get it is effectively leakage and others pay. On the other I quite admire the ingenuity of the individuals.

  3. John Hunter says:

    Very good post. I am a big proponent of technology. My career path was basically from helping management improve organizational performance to IT program manager doing that same thing. I did that because there were so many opportunities to improve using technology.

    But there are big problems. As you say many technology solutions are lousy. If people applied PDSA thinking they would be much better off. agile software development does this to a reasonable degree (I think they could do more in that vein but it is decent now). A big reason I moved into technology myself was because getting IT solutions implemented properly (even half way decently) was nearly impossible. And this is true all over.

    If you use PDSA, systems thinking (Deming’s view not computer systems) and agile software development methods you will avoid the all too common technology messes and instead take advantage of technology. You also need people that have the right skills and knowledge – knowing how to use technology properly seems to be less common that you would think given all the technology around us.
    John Hunter recently posted..The Need to Improve Management While Building Organizations Fit For Human BeingsMy Profile

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