A Nurses Union in Canada Supports Lean


telegraphjournal.com – Lean process, big results

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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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. Mark,

    I appreciate the acronym LAME, and it's entered my lexicon.

    I know from early lean work with Boeing, for years in the early 1990s, that it's really possible to achieve some impressive lean results, but not get the philosophy or take it deep into how to manage the company.

    It might be time to write a book about how *not* to do lean, using examples.

    In the report from New Brunswick I'm struck by how shallow and immediately oppositional many comments can be following an article or post. A year ago when the Washington Post featured lean healthcare on a Sunday front page, in the 200 comments following the article on the web, only *three* used the work "lean."

    I am contradicting myself, but comments are rarely where anyone is listening, or having a genuine conversation.


  2. This is exactly what US health care needs right now, is a process that will cut wasteful spending and maximize doctor patient interaction.
    "The administration of the existing health delivery system is bloated with waste and unnecessary cost. If information was shared by all providers of health services and all insurers by using computerized systems to store all medical records, it would cut costs and reduce errors that would save and improve lives.

    What we need in a health system is uniformity in pricing for procedures and services and modalities of provision of testing and procedures for diagnosis and treatment. By providing coverage to the uninsured, which initially will cost the taxpayer, it eventually will save us hundreds of millions of dollars." Eva Mor http://www.ourblook.com/component/option,com_sectionex/Itemid,200076/id,8/view,category/#catid107
    Eva Mor is the author of Making the Golden Years Golden, and has some very sincere and insightful views on health care from a professional perspective.
    It is a very strong issue, but until we can actually understand that insurance isn't the entire debate, health care will not improve. The clinical side of health care needs as much focus and modification as policy.


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