As Mark Graban stated in a recent post, “People fear or assume that a factory is…mindless, monotonous, repetitive…” These sentiments may come from observation of one aspect of lean and manufacturing: rules and related rewards.
There is the common (mis-)perception that all manufacturing work is like an assembly-line; the work is all standardized and people are rewarded for following rules. By following rules in such an environment, one's autonomy is lower. If there is one thing that knowledge workers (like doctors and nurses) don't want to lose, it's their autonomy. Therefore, some may think that lean = loss of ALL my autonomy = bad!
Of course, this isn't the case in all situations. The rules and rewards that can be implemented as a part of lean healthcare have been found to be very beneficial in the right situations. One of the most common examples of the appropriate use of standardization is using 5S for managing supplies. The average person would likely be able to recognize, “Having a usual place to put things makes them easier to find.” Not having autonomy here makes work easier and more effective.
However, let's imagine that there are standards set for patient care, but there is a situation that requires a different action. Strictly following the standard may have an adverse effect on patient outcomes. Here, the provider needs a certain level of autonomy to do the right thing.
It is important to communicate the PROPER conditions under which rules and rewards positively impact performance and patient outcomes. This is true for lean in any industry, from manufacturing to healthcare.
Of course, these examples just scratch the surface of this very important topic. Two talks by Dan Pink (who Mark interviewed in December) via a cool new animated video by RSA and Barry Schwartz provide more details that I think you'll enjoy and will hopefully spark some discussion.
And the second video:
How do you communicate and determine when TO USE and NOT USE rules and rewards?
Dr. Wiljeana Glover is currently a Postdoctoral Research Associate at the MIT Lean Advancement Initiative. Her current research interests include healthcare systems, improvement sustainability, and management innovation.
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