Mark Graban's leanblog.org - Lean Healthcare, Lean Hospitals, Healthcare Kaizen, Lean Thinking, Lean Manufacturing, Toyota Production System

Making the Numbers

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Freedom from Command & Control: Rethinking Management for Lean Service

Here is a fascinating post from John Seddon at his website www.lean-service.com (link is dead) about ambulances “making their numbers”:

The stupidity of measuring the eight-minute response time has been all over the press recently (you get a tick in the box for getting there in eight minutes even if the patient dies). People working in the ambulance service tell me this is causing some managers to send ‘technicians' who get there on time but can't help the patients (some die) and other managers work on what calls to ‘exclude' from the eight-minute measurement. The latter, of course, leaves them open to making the mistake of treating some events as not time-critical when in fact they are.

Sigh, that's familiar from the manufacturing world and the business world. Donald Wheeler talked about (quoting Brian Joiner, I believe) the three things people can do when pressured to improve the numbers:

  1. Distort the system
  2. Distort the numbers
  3. Improve the system

In the case of the UK ambulances, we have the first two happening. They distort the system by sending SOMEBODY in the 8-minute window. They distort the numbers by looking for cases to exclude for one reason or the other. Neither is a true system improvement, unfortunately. That's what we need more of in this world, actual system improvements, not distortions.

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Here are some BBC stories on the 8-minute goal:

BBC News Story

Article #2

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Mark Graban is an internationally-recognized consultant, author, and speaker who has worked in healthcare, manufacturing, and startups. 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 book is an anthology 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.

1 Comment
  1. […] much as British hospitals cut corners and gaming the system to hit 4-hour A&E targets and 8-minute ambulance targets. Targets and fear-based management will lead to errors… but that management system is rarely […]

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