More Online Criticism of Lean Healthcare
In the new story about CEO David Wessner's retirement, one of the listed accomplishments is their use of Lean methods:
Wessner, the first non-physician CEO at Park Nicollet, also brought Japanese-style lean manufacturing techniques to health care, adopting productivity principles later adopted by a number of other health care organizations. He declined to quantify how much the strategy saved Park Nicollet, saying only it has reaped more than what was invested into it. “It's not a short-term initiative,” he said.
It could be that the retirement is tied to recent financial difficulties and layoffs, events that led to some criticism of Lean (as discussed on my blog here).
As often happens with these stories, the newspaper's reader comments section brings out some vitriol from people who might be staff members (or just from the community).
The link to view all comments is here. Part of me hates to give these comments a wider audience, but I think we can try to respond constructively as a Lean community both here and maybe on the newspaper website.
One comment reads:
The idiots who run PN think treating sick people is like making cars – thus the kaizen system – total quality management for medicine – has been implemented. PN has spent millions – to no effect – on this huge boondoggle. Thus PN has implemented a “production” model on doctors, treating patients like cars on an assembly line. Note to PN management: Treating patients is almost NOTHING like making cars. Do cars live and breath, have thoughts and consciousness? No? Then why treat patients like cars? Because the process of medical care has been turned over to MBA morons who don't understand that everything is not a “business.”
You're right, working with patients *is* very different than building cars. I'm sure everyone at PN realizes that. You have to look at what Lean is — it's not a system for “building cars”, it's a management and quality improvement system.
So people might say they don't want to be like Toyota. What's wrong with:
- Investigating the root causes of problems (looking for systems and processes instead of blaming individuals) and preventing those problems from occurring again?
- Making the workplace run more smoothly by eliminating waste, improving processes, and
- changing the physical layout of the space?
- Making sure that quality is improved (improvements that always lead to productivity improvements as well)
- Listening to employees and staff and getting them involved in the improvement process (instead of being told to “check their brains at the door.”)
When you rant and rave and say “this isn't about building cars”, that misses the point. The four bullet points above can and DO apply to a factory or a hospital.
When Lean is done properly, the hospital employees should be DEMANDING more Lean instead of calling people idiots. So I wonder what the root cause of this person calling PN management “idiots” is? Lack of education about Lean? Are the managers not really living and practicing Lean as a daily mindset? Are the employees not being involved? Or it's probably a side effect of the layoffs and the anxiety created there?
Another interesting reader comment defends Lean but still points a finger of accusation against Park Nicollet:
Kaizen is not an improvement process with limited application to the automobile industry. Those who make such comments only demonstrate their lack of knowledge on the matter and thus demonstrate they are incompetent to comment. PNC is guilty of misguided application of Lean principals and kaizen techniques. My team successfully applies both in the construction industry daily. I watch PNC “fumble the ball” daily in the dysfunction generated in my spouse's workplace.
I have no first hand working experience with Park Nicollet — in what way are their Lean efforts misguided, I wonder? Is it the focus on “how many pencils we have at the nursing station” as the previous blog post highlighted? Are they running a lot of “kaizen events” without the proper follow up and proper focus on the management system? If so, that's a common dysfunction in the Lean world, the over-reliance on event-driven Lean.
Another reader comment further explained and defended Lean (highlighting is mine).
The Kaizen efforts do NOT treat patient's like cars. The make the work that staff does more efficient so that more time can be spent treating the patient. Without Kaizen at Park Nicollet, nurses would still be WASTING several minutes per hour walking back and forth to poorly placed printers, float receptionists would still be fumbling to find basic paperwork every time they sit down at a new desk, business office staff would be spending/wasting many valuable minutes an hour on hold with insurance companies. Everyone always thinks that because Kaizen was developed by a car company that it can't be applied across the board. MANY MANY MANY companies use it.
The point about printers being in the wrong location rings true because I see it everywhere. One reader asked why you need a million-dollar consultant to figure that out? The answer to that is very complex — why do people not see systemic waste (maybe someone suboptimized IS/IT costs by having fewer printers)? Or, if they see the waste, why are people powerless to make changes? Or why do they feel powerless? That's the important question, ultimately — why is there waste and why are things not fixed, not “why are the printers set up badly?”
While I cringe at reading criticism of Lean online, it doesn't do anything to shake my belief (a belief that comes from experience and evidence) in Lean working in healthcare. Does that mean “Lean” always succceeds? Well, no, because people and organizations are imperfect. Changing to a Lean culture is very difficult. I hope these are just bumps in the road for Park Nicollet, a starting point for a better Lean program in the future.
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