Let the Process Experts Decide


Leading article: Infected by political calculation

This isn't a “Lean” story, per se, but it still caught my eye. Hospital-acquired infections are a major problem throughout the world. As this commentary from The Independent points out:

Britain has the worst record of hospital infections in Europe, and patient surveys reveal that superbugs have overtaken waiting times as their prime source of concern. The situation could not go unchallenged.

Fair enough — it's a serious problem and it demands attention. The “solution” reminded me a of a recent rant from a specialist physician I saw back in the U.S. a month ago or so. He started complaining about all of the government interference in healthcare and he said “Every time there's legislation about medicine, they make it worse. They need to let doctors make the decisions, not the politicians.”

To be a cynic, a politician's job is to get re-elected. Are they always making decisions that are right for the community or for patients? Back to the article, where the Prime Minister got involved:

But as so often with this administration, new rules have been accompanied with a heavy dose of politically-motivated and unhelpful meddling. Last September, Gordon Brown announced that the 1,500 NHS hospitals in England would be subjected to a “deep clean”. It sounded good. This would involve clearing wards, washing walls and scrubbing behind radiators.

But there was a problem. There was no clinical evidence to suggest this was where effort ought to be directed. According to infection control experts, superbugs were being spread not by bacteria multiplying in neglected corners of wards, but by sloppy daily cleaning procedures and the failure of many medical staff to wash their hands properly. Yet the Prime Minister ploughed on anyway because the idea of a deep clean was deemed a way of communicating to the typical voter how seriously he was taking the problem of superbug infections. Most hospitals finished their deep clean three months ago and, as we can see from these latest figures, it has made very little difference to the standards of cleanliness in our wards.

Millions are being spent on efforts that “sound good” or “feel good” instead of doing what really works. Pretty lousy, huh? How do we get local hospitals to manage their “Standardized Work?” — That's the challenge. It's not a great revelation that hand hygiene is critical. How do we get people to follow good daily processes (for hand hygiene and room/equipment cleaning) instead of taking big splashy efforts that might not make a difference. Did the politicians ASK hospitals, executives or physicians, how to solve this problem or did they mandate a “solution?” Sounds like they should have done more asking.

The column concluded:

This is a lesson on how little is achieved and how much is wasted when politicians put the chase for favourable headlines above expert advice. It is not only our hospitals that urgently need to clean up their act.

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. I have a bit of an axe to grind here.

    Over the last 5 years the single biggest concern of patients entering hospitals has been cleanliness and this has in instances taken precedence over the actual health care provided.

    Organizations have FAILED to respond to the concerns of patients and one just has to look at the Health Care Commissions reports on this to see that hospitals have done little if anything to address it.

    So the government intervenes and whilst it may be misguided it seems ridiculous that the Colleges of Nurses and Clinicians have to be told by politicians that patients are concerned about this and need to do something about it.

    Doctors, RN’s and every other member of staff have known about hand washing for years and still routinely fail to comply. Executives have known that patients are dying of preventable infections and continually fail to respond.

    So the government in a slightly misguided way intervenes with both the deep clean and “no sleeves below the elbow” policies and attempts to do something.

    I am not government apologist but the Doctors, RN’s and Executives have continually failed to address these issues and listen to patients but when the government does it they accuse them of being ineffectual and misguided.

    In spite of plenty of evidence and years of opportunity these people have done little or nothing to improve the situation so I think that the governments intervention was almost inevitable.

    Its really interesting that the only people that have actually listened to patients on this issue in this country over the last 5 years are the government. There is little to no evidence at all that Executives, MD’s or RN’s have changed their behavior at all in spite of the patients concerns.

  2. Sounds like Paul Levy, CEO of the Beth Israel Deaconess Medical Center in Boston is saying in a speech at MIT (http://mitworld.mit.edu/video/504/).

    Despite the great communication tools there is not yet a sustainable way to connect the knowledge that lais cleary in front of us.

    Lean is also about getting this knowledge together not to start all over again with the same stupid mistakes (instead you should make new ones to really learn:-)).



  3. Interesting enough there is the mentioning of an article on the same topic (bothering the English health system) in Paul Levy`s blog. Here the quote:

    “Article on Hospital Attire in UK from Wash. Post:

    U.K. Hospitals Issue Doctors’ Dress Code

    The Associated Press
    Monday, September 17, 2007; 11:30 PM

    LONDON — British hospitals are banning neckties, long sleeves and jewelry for doctors _ and their traditional white coats _ in an effort to stop the spread of deadly hospital-borne infections, according to new rules published Monday.

    Hospital dress codes typically urge doctors to look professional, which, for male practitioners, has usually meant wearing a tie. But as concern over hospital-borne infections has intensified, doctors are taking a closer look at their clothing.

    “Ties are rarely laundered but worn daily,” the Department of Health said in a statement. “They perform no beneficial function in patient care and have been shown to be colonized by pathogens.”

    The new regulations taking effect next year mean an end to doctors’ traditional long-sleeved white coats, Health Secretary Alan Johnson said. Fake nails, jewelry and watches, which the department warned could harbor germs, are also out.

    Johnson said the “bare below the elbows” dress code would help prevent the spread of Methicillin-resistant Staphylococcus aureus, or MRSA, the deadly bacteria resistant to nearly every available antibiotic.

    Popularly known as a “superbug,” MRSA accounts for more than 40 percent of in-hospital blood infections in Britain. Because the bacteria is so hard to kill, health care workers have instead focused on containing its spread through improvements to hospital hygiene.

    A 2004 study of doctors’ neckties at a New York hospital found nearly half of them carried at least one species of infectious microbe. In 2006, the British Medical Association urged doctors to go without the accessories, calling them “functionless clothing items.”

    Infection control societies in the U.S. don’t recommend similar dress restrictions because there is no strong evidence that health care workers who don’t wear ties or jewelry reduce the risk of infection, said Dr. James Steinberg, an Emory University infectious disease specialist.

    Steinberg said that doctors and nurses who don’t adequately wash their hands pose a far bigger risk to patients and that hand-washing should be the focus of infection control efforts in hospitals.

    The federal Centers for Disease Control and Prevention does have guidelines advising doctors and nurses against wearing artificial nails in operating rooms and around high-risk patients. It says there is evidence that health care workers who wear fake nails have more germs on their fingertips both before and after hand-washing than those with natural nails.


    June 12, 2008 4:26 PM

    My comment a few minutes earlier is ever so true;-(

    How can we change the silo-thinking and silo-knowing? This would be a huge step forward in LEAN THINKING:-))



  4. Ties, stopping the wearing of ties is a little like re-arranging the deck chairs on the titanic. These people (government) have lost sight of the real issue and are pandering to the patients whims and the belief that stopping ties will reduce infections.

    The reality is that stopping ties simply reassures patients although it has little to no benefit.

    On the other hand the MD’s, RN’s and Executives have done nothing substantial to help so in one sense whilst the government might be silly at least they are a) listening to patients and b) trying to do something even if it is wrong as opposed to the other groups who are doing nothing………..


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