Don’t Speed Up or Improve a Workaround Process – Fix the System
Hospitals are full of workarounds and fire fighting, it's a pretty common problem. That's one reason cost is so high and quality is often so poor.
One of the key insights that comes from introducing healthcare professionals to Lean concepts, even in the first few days, is that they:
- Start seeing the difference between being busy and adding value for the patient
- Start recognizing that many of their daily activities are “workarounds” disguised as necessary work
Let me share an example that you might see in a hospital:
At the start of, or during a surgical procedure, a needed instrument might be missing. As part of the fire-fighting, the team might call the sterile processing department, asking them to expedite an instrument to the O.R., possibly using something called a “flash sterilization” process.
It's not the full, regular sterilization process – “flash sterilization” is something that hospitals try to minimize as it's not considered as effective as regular sterilization. But it's faster — in a pinch.
Let's say, also, that the flash sterilization process is taking too long, or longer than the surgical team would want.
I'd propose it wouldn't be the best use of Lean principles to try to improve the “flash sterilization” value stream — doing THAT process faster, the process and method that's not ideal for the patient, misses the point of the true opportunity for improvement…
We should step back and ask why instruments are sometimes missing from the tray — how do we ensure the right instrument is always there at the right time? Fixing that process defect (missing instrument) would do far more to reduce waste than improving the workaround (flash sterilization).
It's not enough to use a specific Lean method properly, such as a value stream map or a kaizen event. We have to make sure we're solving the core, fundamental problem instead of doing the wrong thing faster.
In recent discussions with one hospital, we talked about how a workaround (such as flash sterilization or fixing an incorrect medication order) often gets viewed as “normal.” It's something that happens every day and people get used to it. Therefore, the focus might be on improving the workaround instead of eliminating the need for the workaround. I think this is a core principle of Lean thinking, getting to the root cause.
Think of a workplace workaround, perhaps, like a drug prescription. A doctor typically doesn't give you a prescription to use forever. For example, I used to take a statin drug to control my cholesterol. This drug, while effective, was really a workaround for not eating and exercising properly (something I was trying to fix, in addition to just popping a pill forever).
My doctor regularly checked my lab results and I was eventually taken off of the drug when my cholesterol was well into the safe range.
When we instill a process workaround, do we, as an organization, give that workaround a limited 30-day prescription that requires a figurative call to the doctor to get a refill??
Maybe workarounds need to have a specific expiration date to help us from thinking of the workaround as the new normal that will be around forever??
Waste hides in workarounds – it eventually appears like normal work, especially when new people are taught the workaround as the normal process, as opposed to a temporary workaround…
Do you see examples of this in your organization? Have you been able to battle that workplace disease successfully?
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