Waste & Respect for People in Hospice or a Dell Factory


I've recently had an email exchange with a retiree who is volunteering in a non-profit hospice care facility. I'm sharing this thoughts with his permission. It sounds like there's often nothing for the volunteers to do and the leaders aren't very keen in listening to ideas that the correspondent or their fellow volunteers have for making their work easier or more interesting. A “kaizen culture,” it is not, apparently. The complaints in the email are recurring themes, not just one bad day.

 From a recent email, emphasis mine.

In regard to hospice and lean, my time was pretty much wasted sitting there waiting to see if I was needed (I wasn't). I've emailed the volunteer coordinator (she is looking for topics for the next volunteer meeting) – it is value added when I am with patients, even if it is just sitting there with a patient – once, I had to keep a patient who was in the active dying stage from getting out of bed and falling and hurting himself – it was tough keeping him down; he passed away within 24 hours of when I was with him.

The volunteer has the right idea – he wants to contribute and add value to patients. As a volunteer, the things he can do are somewhat limited, but he should be able to contribute. It's part of the Toyota “respect for people” principle that people shouldn't be made to sit around bored or underutilized. It seems like it would be especially true if you want to keep good volunteers.

The correspondent has written previously that he and the other volunteers have attempted to do basic 5S organization so, for example, it's easier for them to put away supplies in areas that are “behind the scenes.” They asked to label the outside of cabinets and they were told “no” because it would look bad, per the director. Again, this was in a private area that patients and families would not see.

More from the recent email:

If they had something I could do while I was waiting for a call, it would be better. I guess these days, this is a problem primarily with volunteers, but if they want me to be there, they need to respect my time so that it's meaningful and productive. I guess I could just sit there and read and socialize with the employees and other volunteers, but that isn't the purpose.

Several times, I kept myself busy by stocking supplies that were received in boxes – it is not obvious where they go, and I didn't stock some because I didn't want to put them in the wrong place where they might not be found. I have also stocked rooms after they've been cleaned before the arrival of a new patient. Again, it's not obvious what goes into the room, and the supplies are in many places – it seems that all the supplies that go into a patient room should be organized together.

Once I got criticized by one of the hospice managers for leaving the book opened to the cheat sheet on supplies for the patient room out on the reception desk while I was hunting and stocking. The manager didn't tell me herself, but told one of the nurses to admonish me not to leave confidential information out in view (the list of what goes into patient rooms? The rest of the book was procedures and phone numbers). They also complained about the clutter / disorganization of leaving the book out.

How ironic that they aren't allowed to take action to help organize things… then when a workaround, a cheat sheet, is created, they get scolded or admonished for not having a binder out on the desk because, again, it looks bad.

It almost makes you wonder why somebody would volunteer in an environment like this, yet alone work there…

When I worked for Dell Inc. back in 1999 and 2000, it was common to refer to the production associates as “volunteers.” They were paid, but many of them (and you couldn't tell who) had been there from the beginning and had made a fortune on stock options. There was a common joke that “the guy popping open cardboard boxes at the end of the line could be driving a Porsche Boxter.” In some cases, it was true.

Some of the employees clearly had the financial ability to retire, but they continued coming to work because it was a decent work environment and they had friends they enjoyed being around. The management concept (not universally practiced there) was that you should treat all employees with respect, because if they were unhappy, they could up and quit tomorrow. The same could have been true for somebody in IT or other departments, if they had been at Dell for five or more years.

There were many things I disliked about the culture at Dell, but this idea of treating employees like volunteers stuck with me. It's unfortunate that, as shown above, volunteers aren't always treated like volunteers… people who could easily walk out at any time.


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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. To elaborate on today’s post (since nobody commented), I think the reason volunteers don’t quit in situations like this is because the work is so important and so meaningful. People will put up with a lot when the work is important. If you’re building and boxing up computers, there’s probably a lower threshold for BS than if you are working in hospice or a hospital.

    Ironically, perhaps, it’s exactly because the work in healthcare IS so meaningful and important that managers should especially listen to and engage their employees and volunteers in improvement efforts.

  2. Great story about how people come to work either in a paying position or as a volunteer and are highly motivated. The key is to allow them to work and not to de-motivate them. Most organizations aren’t good at this and set up rules and systems that constrict people and wonder why they can’t engage the hearts and minds of their people.
    Wouldn’t a better way be to point people in the direction we want them to go in and then get out of their way with the occasional checking in to allow for teaching and problem solving.


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