The Proper Use of Metrics


I was able to tour a hospital laboratory that had already gone through the lean process.

One metric was a daily tally of “sticks per day” (that's what a Phlebotomist — a person who draws your blood — calls it when the draw your blood…. they “stick” you…. maybe not the most customer-focused term).

Anyway, my first thought is concern over how these metrics are used. Are the metrics some sort of goal or quota that pushes every phlebotomist for “quantity over quality?”

So, I asked what happens when a phlebotomist is “red” for the day, fearing the worst.

“Oh, we use that to identify problems. If a phlebotomist couldn't hit their goal (based on the standard work), we ask what problem might have gotten in the way of them hitting their goal, so we can fix that problem.”

That was absolutely right, the right answer. You can't turn it into a competition, whether it's in manufacturing (which production cell built more) or in patient care. I was very happy that they were using quantitative metrics for a constructive purpose, rather than for punative reasons.

As Deming said:

“The job of a supervisor is not to tell people what to do or punish them, but to lead. Leading consists of helping people do a better job and of learning by objective methods who is in need of individual help.”

One of the problems preventing someone from hitting their daily goal could be a lack of training, or maybe they aren't following the standard work. It's leadership's job to coach them to follow the standard method, if they aren't, so they can get standard results.

By the way, the “red” in the chart refers to the “TAT” (Turn Around Time — cycle time, basically) not the number of draws/sticks.

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Mark Graban is an internationally-recognized consultant, author, and professional speaker who has worked in healthcare, manufacturing, and startups. His latest book is Measures of Success: React Less, Lead Better, Improve More. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. He also published the anthology Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also a Senior Advisor to the technology company KaiNexus.

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