In the past week, I found two articles about hospitals that are engaging staff members through suggestion programs. Employee suggestions are a core part of Lean and the Toyota Production System. There's so much wasted potential when hospitals don't get people engaged in improving their work and improving processes. This is wasted potential in terms of patient care not being better and hospitals not saving money, but also wasted potential in terms of not letting people feel good about improving their workplace (an example of the “waste of human potential” that's often talked about as one of the “Eight Types of Waste.”
I've heard staff members at many hospitals complain that they're expected to just show up and do their job — don't try to make things better, don't make waves, or you might get branded a “troublemaker.” Sad.
Toyota teaches their employees they have two jobs:
- Do their work (follow the standardized work)
- Improve their work (“kaizen”)
Do hospital staff and physicians have the same expectation? When you are expected to help improve how work is done, that's your outlet for creativity and problem solving, even if your work is being done in a more standardized way. Let's not be creative in figuring out how to insert a central line — let's do it in a standardized way and be creative in finding ways that work better and lead to further reductions of infections.
A Newton hospital has been recognized for cutting costs after a series of staff suggestions helped save the facility $1.7 million over the past year.
The baseline number that Norman Bodek often cites for companies like Toyota or Canon is that the company saves $4,000 per employee based on employee kaizen suggestions.
If you have a hospital of 2,000 employees — that's $8 million a year in savings.
The article doesn't mention Lean, but Newton Medical Center has the right idea about how to encourage suggestions:
Hospital spokesman Barrick Wilson said the ideas allowed them to save money, protect patient care and “protect the integrity of the work force by not having to have any layoffs.”
No layoff pledges or no layoff philosophies are becoming more common in the Lean healthcare movement. This is critical – if kaizen leads to layoffs, who would participate?
Gleason said hospital staff submitted 121 ideas and officials used 62 of those, some quickly and others as the year progressed.
That's a 50 percent implementation rate. Toyota often gets cited as having a 90%+ rate — not that every suggestion is necessarily implementable, but the submitted suggestion is the starting point for a discussion between staffer and supervisor. If you define the problem (and not just make a suggestion), you can talk about alternatives and find SOMETHING to implement, even if it wasn't the original idea.
The ideas included surgeons and operating room staff reviewing the supplies routinely kept on hand and finding they were wasting several thousand dollars with redundant items.
Gleason said other workers suggested switching to cheaper alternatives of products the hospital used. Some of those changes saved only a few hundred dollars but others saved thousands.
Lots of little ideas — they don't all have to be a million dollar idea. We tend to focus too much on finding a few small ideas with HUGE cost savings. I'm sure there are more than 121 ideas… $1.7 million savings sounds great, but why didn't they get more than 121? Was the systemic too bureaucratic?
From Ontario, Canada:
This article DOES mention Lean specifically. And they also have a “no layoffs due to lean” committment, although they are looking to reduce 85 positions through attrition (not backfilling). The hospital is losing millions — they have to choice but to find cost savings. What better way than asking the staff?
Cambridge Memorial's workers are eager to offer cost-saving ideas while maintaining and improving patient care, Martin said. More than 200 ideas have been received; many have already been adopted to allow the hospital to face a freeze in provincial funding at the same time facing increased staff costs from union contracts and operating expenses.
Martin was adamant care will not suffer at Cambridge Memorial. In fact, he said the staff-inspired ideas will improve care throughout the hospital.
“I think the community should be very pleased with what the (hospital improvement plan) has accomplished,” Martin said.
Hospitals are late to the cost-saving, “lean-process” mindset that private industry long ago adopted to operate more efficiently, Martin said.
Staff offered more than 200 ideas since September that helped find $3 million in annual savings. These include work-schedule changes, smarter ways to offer care, and more efficient ordering of supplies.
Protecting staff members is key. Also important is making sure that you're eliminating waste, not just blindly slashing costs in ways that negatively impact patient care. Finding ways to improve quality will lead to cost savings.
How are things at your hospital? Are you encouraged to submit and help implement ideas? How is this working for you?
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