Criticism of Lean at Park Nicollet Hospital
Minnesota's Park Nicollet health system is often held up as one of the leading “lean healthcare” examples in the U.S. As I mentioned in my book, Lean Hospitals, they claimed $7.5 million in savings from lean improvement events in 2004, reinvesting the savings back into patient care.
The linked article talks about current financial problems, including layoffs of of 7% of their workforce. Initial questions that might come up might include:
- Were these layoffs because of Lean?
- Why didn't a Lean strategy help prevent the layoffs?
- Would things have been worse without Lean?
I have no idea – those are legitimate and honest questions and I claim no inside knowledge. There are people asking “Why didn't Lean save Toyota” from a financial loss. The world isn't that simple. Lean isn't a cure all or silver bullet, for a manufacturer or a hospital.
Some details do emerge from the Park Nicollet news story.
Park Nicollet Health Services is the Twin Cities' smallest hospital and clinic group.
But its ambitions were big.
During health care's boom years over the past decade, Park Nicollet invested heavily to compete with its far-bigger rivals, Allina and Fairview. It sent executives to Japan to learn Toyota's “Lean” production process, adopting productivity techniques that would later spread to the rest of health care. It installed not one but two electronic medical record systems, one after the other, and borrowed millions to build new specialty centers.
Then the recession hit, and hospital groups big and small saw their rosy business projections fall apart.
The article details how their small market share (about 6%) may give them structural disadvantages against two competitors who each have >20% share.
The CEO is given credit for being a strong proponent of Lean:
He also applied business ideas and technology to health care. Among them was the Toyota “Lean” method, which studies work processes to reduce waste and raise quality. Devotees say anything can be “Leaned” — from improving the flow of instruments in operating rooms to assigning pillows to each hospital room so a nurse doesn't have to walk down the hallway to fetch one.
Yes, anything CAN be leaned, but part of the question comes back to “are you ‘leaning' the right things?” Freeing up nursing time is, I agree, one of the most important things you can do in a hospital — for the benefit of patient care and the hospital itself.
Some complaints emerged:
The succession of changes wore down staff. Some believed they had become incidental to the work of caring for patients. “People are kind of tired of management fads,” said Kent Searl, a nurse in the intensive care unit who joined Methodist Hospital in 1992. “We were offering suggestions and getting pushback on safe staffing, yet being told to reduce the number of pens and pencils.”
I can see where this would be frustrating. If you're not addressing the core issues for the hospital, for patients, and staff – say, you're dabbling around the edges with a kanban system for pens at the nurse's station – people might see Lean as a distraction or a bit of foolishness.
If you're focusing on the right things, the important things, staff members won't feel this way.
That said, if staff members are always saying “we need more staff, we need more staff” and that is just an old habit (as opposed to being supported by data), then hospital administrators might be right in not approving the increases – and it might be true that current staffing levels are not “unsafe” (safety can be a staff excuse for forcing staff increases… if management says no, you accuse them of not caring about safety).
Either way, when conflicts like this come up, communication and leadership are key. Even if it is the right decision to NOT increase staff, you have to communicate “why” and gain buy-in with the staff. Otherwise they might be resentful and morale can/will suffer.
I hope things are going well with Lean at Park Nicollet. The news article, in keeping with the “things are going badly” theme of the article, may have just focused on the negative aspects of Lean. Are they still saving $7.5 million a year or more through their Lean events?? Maybe not, but maybe that just went unsaid in the article.