How a Non-Lean Culture Can Harm Patients
Sometimes people ask me, “how does Lean apply in a hospital?” The critical issues in a hospital are more often about culture and environment (although using technical lean methods for improving processes and flow are important also).
Many hospitals, unfortunately, have “current state” cultures where people (particularly nurses or technologists) are afraid to speak up in the name of safety or quality. They are often afraid to speak up because they're intimidated by administrators or physicians or surgeons.
If somebody knows something unsafe has happened or is about to happen, they might keep quiet because:
- They are too busy to speak up
- They are too scared to speak up
- Speaking up didn't get anything fixed last time, it just brought them grief, so why bother
This reminds me of my time in the GM factory, circa 1995. There was nothing “lean” about that environment (until we got new leadership).
It's sad that hospitals are often this way. The employees deserve better and patients certainly deserve better.
The Lean approach and the Toyota Way philosophy are very different than this. People are supposed to speak up, to “stop the line” when there is a quality or safety concern. Thankfully some hospitals are working on improving this culture (like Virginia Mason and ThedaCare).
Tracing this back to Deming, employees are supposed to be able to have pride in their work. Not letting them speak up, knowing something bad might happen destroys that. It's also not very customer/patient focused. As Deming said, we have to eliminate fear from the workplace if we want quality, and that includes hospitals. Especially hospitals. It requires leadership. People preaching about “this is what a lean culture should be” won't be enough.
I'm curious to read more about the aviation concept of “Crew Resource Management” and how it is being applied in medicine. Many airline crashes were traced back to a root cause of subordinates not being willing to question or challenge the pilot who was “in command” and infallible. But guess what, pilots (and doctors) are human and therefore fallible. It seems intuitive that applying CRM methods and coaching could potentially help change hospital or O.R. cultures (if people are willing to admit there's a problem with the current culture). Physician, heal thyself, eh?.