Blame Outsourcing or Bad Processes & Bad Management?

This article from the Vancouver Sun caught my eye: “Outbreaks show the vital role of hospital cleaners.” The article is written by a union official (which is disclosed at the end of the piece). The author, Bonnie Pearson, is right that housekeeping staff and cleaners play an important role in patient care. They aren’t just “mopping up,” they are preventing infections.

Citing outbreaks of C. diff in some Vancouver hospitals, Bonnie is correct in identifying a problem, but it seems her proposed countermeasure is the same as it would be for nearly anything – more union workers.

From the piece:

The BC Centre for Disease Control found that: “There were insufficient numbers of cleaning staff to meet the basic daily needs of the facility and they were not adequately trained in appropriate cleaning procedures for a health care facility. They were not able to meet the increased demand for environmental cleaning that is required to control an outbreak of CDI.”

If you don’t have enough staff to get the job done properly (due to underhiring or just having too much waste to deal with during the day) and you haven’t trained them well enough, that’s a serious problem. It’s a management problem. It’s also pretty easily fixable (better training, reduce waste and improve processes, and add staff if you have to).

Bonnie agrees with me, as she writes:

Let’s get on with the solution. Hire enough people to do the job. Equip them with the training and tools they need to do it. Give them the time required to clean properly.

But, Bonnie then proposes this additional countermeasure:

And let’s make them hospital employees again.

And that would likely make them union employees. Bonnie has a clear conflict of interest here (which was, again, disclosed at the end of the story).

I’m not “anti-union” in a way of simplistic labels. But I am “pro” effective problem solving. These problems could be fixed through outsourced staff and making them hospital employees might not necessarily solve the staffing, process, and training issues.


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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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6 Comments on "Blame Outsourcing or Bad Processes & Bad Management?"

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  1. Rob Worth
    Twitter:
    says:

    She might have a conflict of interest, I couldn’t possibly say, or she might see that a hospital employee would be more aligned with the needs of the hospital.

    Outsourcers get contracts, mostly, on the promise that they will be cheaper. Cheaper to many outsourcers, means fewer staff, cheaper kit and consumables and cutting corners. If a hospital became enlightened and saw that the cost of better cleaning would be massively outweighed by the savings that come from fewer infections, then they would ensure their own cleaning staff had the personnel, equipment and materials to do a better job.

    Now we both know that a better job doesn’t necessarily mean more people, but having the people more closely managed by the entity (the hospital) that requires the outcome (better cleaning) means that outcome can more easily be produced. Having outsourcers means that the management is at one remove with the outsourcers own goals in the way which makes the levers even more rubbery and ineffective.

    So having the hospital employ the staff sounds like a good idea to me.

    • Mark Graban
      Twitter:
      says:

      Rob – thanks for your comment (love your blog and your work).

      I agree that outsourcing isn’t usually good problem solving, as it’s often motivated by “cheaper” instead of “better.”

      Yes, a hospital employee might feel better alignment, but they might also face the internal pressure (due to budgets and traditional management practices) to be cheaper instead of better. My point is that insourcing as a blanket solution doesn’t necessarily fix the underlying problem anymore than outsourcing did.

      I agree that the hospital needs to look at the overall goals — the best patient care and saving money by reducing infections (a bigger picture system measure) rather than reducing costs in a silo, like housekeeping.

  2. Jayadeep Purushothaman says:

    You definitely can take better care of the cleaners yourself if they are your employees. Isn’t that a “lean” enough reason? Outsourcing does point to the thinking that the job is not important for them – and cleanliness is really important for a hospital !

    • Mark Graban
      Twitter:
      says:

      Yes, I agree that outsourcing is too often used as cheap and easy “fix” by management. It does send a loud message that these jobs aren’t important. I’m not advocating outsourcing, but arguing that insourcing doesn’t automatically fix anything.

  3. Joe Dager
    Twitter:
    says:

    I’m not an advocate of outsourcing either but it is difficult to believe that it would be considered the “fix”. I do not agree with the statement that outsourcing sends a message that it is not important. It may have sent the message that it was not getting done right and it may have improved the process from where it was.

    Outsourcing or in-sourcing are just alternatives, neither addresses root cause.

    • Rob Worth
      Twitter:
      says:

      Outsourcing or insourcing are alternatives but they are not just alternatives; i.e. they are not equivalent.

      I agree that with either structure, if root causes are not addressed then nothing good will happen.

      However, everything else being equal, it is still easier to manage a system with insourcing because your system is smaller and levels of management are fewer.

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