L.A.M.E.: Not Involving Key Stakeholders
Got this story during an email exchange, used with express permission:
I saw my doctor yesterday and told him I was doing a lean publication, and he immediately started complaining about well-intended but impractical top-down measures being taken in the name of lean, there at [major university] Health System. Interesting.
The example he gave me was a new form for requesting a test from the radiology lab. He pulled out both the old and new forms for me: the old form was short, with two spaces on it: one for the physician write in the name of the test he or she wants done, and a second space to write the reason for the test. The new form is physically much larger and ostensibly lists all the relevant tests; the physician just checks off the one needed. However, none of the choices include nuclear medicine-related tests, and there is no choice of “other,” where such a test could be written in. (I'm not familiar with the terminology.)
When asked why those tests were not included, the response was that the form would be too complicated. So, from my doctor's point of view, a form that was simple at his end, and that allowed him to name whatever tests he needed, including the nuclear medicine tests, has been replaced with a form that is less flexible. Because, he opined, some small group at the main hospital decided that the new form would be an improvement. Obviously, this isn't how lean is supposed to work: my doc feels totally disconnected from the process of making improvements and feels imposed upon from above. The whole exchange between my doctor and I on this was probably under two minutes: the main topic was rotator cuff tendinitis.
This is a shame. Lean improvements aren't something that should be imposed “top down.” We have to work to get input from those actually working in the system. Experts can't be expected to design perfect processes or Standard Work the first time through, without input from people. This is true if it's assembly workers, medical technologists, or physicians. The newly designed form should have been considered a “first draft” that should have then accepted input from the doctors. If the form needed an “other” category, that input should have been accepted, it seems reasonable enough. It seems like an important item was left out in the name of standardization and intended improvement.
It's a shame that some hospitals are making the same mistakes that some factories made — having “Lean” improvements antagonize the value-added workers instead of being something that helps them do their jobs in an easier way. If Lean isn't helping people, it ‘s going to give Lean a bad name and it might just be Lean As Mistakenly Executed.