By December 10, 2015 5 Comments Read More →

“If the Employees are Upset, it’s Not Really Lean”

Medical/Surgical Operative PhotographyHow is it that we have two realities out there in healthcare… in parallel, Lean is awesome and Lean is horrible. It depends on where you are, unfortunately.

I had an amazing day yesterday with a major health system… I’ll blog more about them later. I was their guest to see their progress with Lean and continuous improvement (Kaizen).

I saw staff members enthusiastically explaining their continuous improvement approach. Nurses in multiple departments, environmental services, patient transporters. They’re doing A3s and structured problem solving. They’re identifying problems and implementing staff ideas in visual ways.

Staff members are telling management what problems they want or need to fix and they’re being given time to work on things, with the support of coaches. These coaches are their managers and continuous improvement professionals.

The staff members demonstrated a high level of mastery of not just the tools and methodology, but the mindsets, saying things like:

  • We’re pointing fingers less and looking at the process
  • We’re testing countermeasures to see if they work
  • We’re looking for root causes instead of being happy with workarounds
  • We might not totally solve the problem, but we’ll make it better and come back to try another improvement
  • We thought we were good until we started studying the process and then we saw how much opportunity we have

They are getting results – shorter patient waiting times, faster call light response, higher patient satisfaction, lower cost… and they’re working to demonstrate and measure the impact on quality and safety.

I think any Lean skeptic would be blown away by the smiles, the enthusiasm, the empowerment, and the patient-centered-ness of this.

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So, it was heartbreaking to once again read about the complaints about Lean in the Saskatchewan healthcare system (read previous posts about their problems and controversy).

It’s so confusing, trying to figure out this Saskatchewan situation from afar.

I saw this headline:

Impossible to say if Lean program working: Provincial auditor

I haven’t read the whole report yet, but the CBC article says:

“While some aspects of the government’s multimillion-dollar Lean efficiency program are effective, the provincial auditor says she’s still not getting an answer to her big question — does it work?”

For one, I hope calling Lean an “efficiency program” is the media’s mistake. Lean is about improving flow and quality (just ask Toyota)… better efficiency and lower cost would be end results of meeting those goals.

“Ferguson said there’s evidence that the program is being effectively co-ordinated — but not whether it’s leading to better service, improving things, or getting good value for the money spent.

They’re unable to show us whether or not Lean is achieving what they’re hoping it’s achieving,” Ferguson told reporters.

The auditor had come to similar conclusions in a previous report that looked at Lean in health care.”

Internet reader comments sometimes have to be taken with a grain of salt… and this Saskatchewan situation has becoming a partisan political fight, but look at the comments:

lol…and you wonder why there are high sick days?

lean=stressed out employees, cuts and overworked staff. period

And

Doc here. Can confirm, LEAN is a ridiculous joke. I do not know a single staff member of any level who I have asked, who thinks it doing anything, but it has universally wasted our time and made working more difficult.

And

Does Lean work? Just ask any front line health care worker affected by it, they’re the ones that have to put up with it day in and day out. All those this poster knows of all say it’s a complete wa$te that’s made their all ready difficult jobs (due to the epidemic of under staffing) even more difficult.

And

Most staff were never consulted before the gov’t brought in this private consultant, and if they had it would have been pointed out that many lean-type initiatives that help the workplace run more efficiently were already in place, developed organically through common sense as well as prior continuous improvement initiatives undertaken by management. The consultant never came and said “oh i see you are already doing such and such parts that are already fit into lean”, rather he just said “this is how you do it” and our gov’t and healthcare administrators forced it into hospitals with no regard for the daily effort that staff have already been putting in to making sure their jobs went as smooth as possible.

And

LEAN is just like the ShamWow, big on hype short on results. Obviously the government needs to hire more Vince-like ShamWow communications staff to hype it up. The alternative would be to show these LEAN leach consultants the door and hire some competent managers.

And

LEAN is the only program I have heard of that spends $100 MILLION to save $30 million.

John Black and Associates sure proved that there is a sucker born every minute and that Brad is one of them.

So, how can be it that the hospital I visited yesterday is using Lean (engaging staff) to make work EASIER, while people in Saskatchewan (and some other hospitals, unfortunately) claim that Lean has increased stress and is making work more difficult.

Why are there so many complaints?

Saskatchewan has taken the wrong approach to Lean? It’s too top down? They tried to do too much too fast? Didn’t engage the staff like I saw yesterday?

Does Saskatchewan have a communication problem?  They are doing good things, but not communicating it internally or externally?

When Lean is done well, properly, you don’t hear those complaints.

Recently, I heard a Toyota executive say, “If the employees are upset, it’s not really Lean.”


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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.

5 Comments on "“If the Employees are Upset, it’s Not Really Lean”"

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  1. Mark Graban
    Twitter:
    says:

    Interesting point on Twitter:

    Yes, Lean and improvement can push people out of their comfort zone. But they shouldn’t be completely upset and disengaged, either.
    Mark Graban recently posted..MDs Can Earn a CME Credit from AMA, Learning about LeanMy Profile

  2. Sab
    Twitter:
    says:

    Totally agree with you Mark.

    And it’s often the same root cause : only “tools” deployment…

    Instead of this ToolsOfFakeLeanMania, they can choose the right way : Develop people.

    Sab

  3. Bart says:

    It’s unrealistic to expect that every Lean implementation is going to be equally effective or that every consulting group is equally competent. Add to that that healthcare is different from where many consultants earned their stripes. There’s also a wide spectrum of entry points for healthcare organizations. As pointed out by you and Sab, ultimately it comes down to the effectiveness of the leader. More recently, much has been written on this topic but still not widely understood on how to be an effective Lean leader. It is also unrealistic to expect every healthcare leader can be an effective Lean leader.

  4. Mark Graban
    Twitter:
    says:

    What puzzles me about Saskatchewan is that they appear to have some success stories with Lean:

    Yet some say Lean is not working there or that Lean is upsetting and alienating people…
    Mark Graban recently posted..The Lean Force Awakens: Star Wars Memes & A Gemba Walk with YodaMy Profile

  5. Mark Graban
    Twitter:
    says:

    And this sounds positive:

    I would like to respond to the recent coverage of the Provincial Auditor’s report on our government’s efforts to use lean outside the health sector.

    The auditor concluded that the co-ordination processes used by the government to manage lean across ministries and the educational sector were effective. However, additional work was required in certain areas, including the measurement of results. We accept those recommendations and are working to address those shortcomings.

    The government spends about $2.5 million a year on lean in ministries and agencies that have a cumulative annual budget of $7.1 billion. This means we are spending less than one-tenth of one per cent of those expenditures on lean. And the return has been significant. Thanks to lean, we have saved $30 million to date. We expect those savings to grow in the future.

    Lean is helping the government’s bottom line. But more importantly, it is helping people across Saskatchewan by reducing wait times for speech language pathology, occupational therapy and student loan applications. These improvements to services have come because the people who deliver them — the front line — have been empowered to identify weaknesses in programs and make them better.

    Don McMorris, Minister Responsible for Lean Initiative

    Mark Graban recently posted..Lean Leadership and Progress at Mary Greeley Medical Center [Webinar Recording]My Profile

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