I'll write more on this topic of unions and Lean tomorrow, but I wanted to share this story from Canada.
The New Brunswick provincial health system is going to start working with the Lean methodology. This earlier article says the pilot will start at one facility in the near future. Starting with the problem statement:
The provincial government must find ways to manage health care on a sustainable basis. It also must address persistent complaints about waiting times and concerns about hospital working conditions.
Lean is a great way to address both patient needs *and* employee concerns. More satisfied employees lead to happier customers in any service business, especially in healthcare.
I'm not crazy about how the article refers to it as an “efficiency” program, as that ignores the dual quality component of the Lean approach. Better quality and efficiency go hand in hand with Lean.
The one major goal, as with other efforts involving nursing is to use efficiency improvement to create more time for patient care activities. Talk about win-win: better outcomes for patients and more rewarding work for the nurses.
The goal is to deliver process improvements that allow provincial nurses to spend more time with patients and less on administration or wasted effort.
It's also “win” for the hospital because they can get more patient contact time (and better outcomes) in a way other than hiring more nurses (nurses who often aren't available due to shortages in the field). Just to be clear — “process improvement” does not mean cracking the whip and making people work faster. It's about eliminating wasteful motion, effort, and paperwork.
Proof that it's “win/win/win” is that the nurses' union endorses the effort:
The New Brunswick Nurses Union is supportive of the pilot project because Lean process has been used successfully in other health care systems, from the United Kingdom to Saskatchewan. Provided administrators and employees engage in the process with an open mind, it is a time-tested way of finding and eliminating inefficiencies.
The emphasis there is mine… provided administrators (especially) go about it the right way (involving staff and not forcing changes top-down) then Lean certainly can work.
As always, the article's reader comments provide a range of reactions, including this one:
“Processes are not the key to efficiency. Efficiency is due to good management. Bad management are always proposing changes to the system to hide their incompetence. You can bet your last dollar that this so-called lean system will not work in our health care system. The self-interest group whithin our health care system will not let their priviledges be reduced which is where the waste is.”
Hmmm, interesting viewpoint. Wonder what drives their cynicism? Previous “program of the month” fatigue? Another commenter says that you obviously have to add people to fix the problem. That's very common pre-Lean thinking… just give me more money, more people, and more space and everything fixes itself, eh?
The earlier article has an even more negative comment about Lean, including this gem:
The company I used to work for went with the Toyota model – and ended up screwing up so many departments (trying to fit round pegs into square holes )that we lost at least 30% of our customers & a good portion of really good people who did their own jobs really well during the implementation.
Sounds like a case of “L.A.M.E.” (Lean As Mistakenly Explained) that that reader was describing?
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