Labor Day Reflections for a Safer Week (and Years) Ahead


United States stamp: Labor DayI didn't have a post yesterday because it was the Labor Day holiday here in the U.S. While I'm not a “worker,” in the sense of an hourly employee or union worker anymore, I still enjoyed the day off with family. Managers and consultants and white-collar professionals are certainly hard working… but the spirit of the day is to honor and remember those who have suffered under unsafe, unfair, or unjust working conditions… conditions we should all strive to eliminate for any number of reasons related to lean.

  1. It's keeping with the philosophy, from Toyota, of  “respect for people” – it's the right thing to do
  2. It's also good for the long-term financial good of our organizations – it's practical, not  philanthropic

So, what are some things we can do this week to best celebrate this day, other than enjoy one last summer cookout? (Actually, it might finally start cooling off enough to START cooking out here in San Antonio).

What can leaders, managers, consultants, etc. do?

First, make sure employee safety is at the forefront of everything that we do. As great leaders like Paul O'Neill, John Toussaint, and others say – nobody deserves to get hurt at work. It's a moral obligation for leaders to make sure we have a safe environment (and for healthcare, this extends to patients).

While CEO at Alcoa, O'Neill make it the top priority to improve workers safety (because it's the right, moral thing to do) and profits followed. It's good for the workers (not getting killed) and good for the company and shareholders. Win/Win.

Dr. Toussaint discovered data that showed workers were more likely to get hurt working at ThedaCare (a health system) than at the paper mill in town. He made it a top goal to improve safety for all stakeholders.

Far too many people still get injured working in hospitals.

Leaders need to do more than put up posters or spout slogans about safety (as Dr. W. Edwards Deming taught us). Safety can't just be tacked onto 5S so that it's part of some program. Responsibility starts at the top and it must be practiced daily.

Lean principles like “going to the gemba” and “kaizen”  can be a daily priority.

Leaders at all levels can go to the “gemba” (a Japanese word for “the actual place” or the place where the work is done) and look for safety problems or risks. Do you see people not using proper safety equipment or methods? Are people forced to cut corners due to lack of time? Are they cutting corners due to problems out of their control, such as broken or missing safety equipment (or things that are just too hard to get to?).

If the  hospital CEO or plant manager comes out and seriously asks these questions, the other leaders below them will get the message that safety is paramount. The leaders shouldn't blame people or chew them out… nor do they need to have all the answers. But, workers notice what you're asking questions about and paying attention to.

Leaders can ask employees what safety risks they have noticed. This is part of the daily Lean management practices at ThedaCare – I think it's the first question asked during any leader rounding. Leaders need to create an environment where people can speak freely about risks, near misses, or problems. ThedaCare has made great strides in this area, as has Virginia Mason (getting more people to report Patient Safety Alerts instead of covering up problems).

How do we create this environment? Dr. Deming said we have to eliminate fear and substitute leadership.

Leaders can also honor workers by fully engaging them in “kaizen,” or “change for the better,” as it's often translated from Japanese. If a nurse notices that doctors aren't using automatically-retracting safety needles because some certain kits have old-school needles, don't let the purchasing department say, “Well, those are the standard product for our system.” If people have identified real risks and leaders haven't listened, the problem is with management. It's probably not enough to say, “Well, don't recap the needles, just put them in the box.”

If staffers say “these new security lanyards create the risk of a mental patient strangling us,” then leaders should listen instead of just reacting after the fact (recent true story, from California).

The lanyards with alarm buttons were a countermeasure to a previous strangulation incident where a staff member died… but, ironically, the security alert buttons hanging around people's necks created a NEW risk. Some people pointed this out and asked to wear them on a belt loop instead of around their necks … management finally said yes to SOME (in a “pilot program”) after a patient indeed tried strangling somebody with the security lanyard. It's hard to make stuff like this up.

Not to get too sidetracked, but you might ask why it wasn't a “breakaway” lanyard… well, it was.

Though they have a breakaway clip in the back, staff members explained to management that a savvy assailant could still grab the lanyard from the rear and use it as a choking tool….  “It's a flawed design. It doesn't take much to see that.”

So even after the incident, some are being asked to continue following a risky practice.

Those not enrolled in the carabiner pilot program, however, have been ordered to wear their lanyards by management and hospital police who work at the facility entrance.

On Thursday, many refused.  “I carried it in my hand, showed it to them and put it around my waist,” said psychiatrist Nader Wassef, who said he previously worked at two psychiatric facilities in Missouri where lanyards, ties, earrings and other items that could cause staff members harm were prohibited. “I told them, ‘Take my name down and report me.' I can lose my job, but I'm not going to lose my life.”

Management really seemed to try to downplay the risk.

Kathy Gaither, deputy director of the Department of State Hospitals, said in a morning statement on the assault that the lanyard had broken as intended, the “new alarm system worked as designed and staff responded consistent with the training received.” The lanyard, she said in a follow-up interview, “represents a minor risk, but the improvement in safety is so vast that it more than makes up for that risk.”

It seems like wearing it on the belt loop eliminates that minor risk… so why not do it? Out of  stubbornness? Because it's a battle with the union? Management finally caved in and ordered carabiners for the rest of the employees.

If risks have been identified, leaders need to listen. If people have ideas, we need to let them initiate and test small changes that will improve their safety and ergonomics. Leaders need to listen and take action when it's a suggestion that requires support be given to front-line staff.

I know it's budget season for many organizations, but… in the spirit of Labor Day, can we make employee safety the top priority this week, if not every week? If we can't make a major dent in the employee safety and patient safety problems, why else are we “doing Lean”?

See also my Labor Day piece from 2010.

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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. Hi Mark

    Great message this morning, safety shoukld always be a top priority and it does in the end always lead to increased profits. Here for those that do not think so are a few reasons i have found.

    1. It lowers the cost of using temporary help because you actually have your trained staff doing it. This alos means higher quality is maintained, temps are never as good, as well as higher productivity, for the same reason.

    2. It lowers the cost of both health care and injury compensation, injuries drive both cost up and the higher your injury rate the more these insurance programs cost.

    3. It lowers the cost of training new people simply because you are keeping your workforce for the longhaul. Just plan lower turnover.

    4. It imporoves morale in an organization, at all levels, if leaders care about the safety of the lowest level worker, than everyone else will feel that the leaders also care about them. Happy workers do a better job.

    5. It will improve the consumers opinion of your organization. The higher a consumer holds you in their opinion the more likely they will become loyal consumers. More than half the problems facing the auto industries North American big three is that they have ruin consumer loyalty chasing after nothing but a quick buck.

    No one single thing maybe huge, but a lot of little things add up.

    • Thanks for that great elaboration, Robert.

      I would love to see a survey that shows:

      1) How many hospital departments are doing a stand up huddle meeting today, with safety (patient and employee) being the first agenda item.

      2) How many senior leadership team meetings start with safety

      3) How many hospital board meetings start with safety this month

      I wonder how that compares (I would guess unfavorably, at least for #1 and #2) to manufacturing companies?

  2. Great post this morning. I do wince when I hear about how we’re going to deploy and experiment with our new idea–and it involves, “Let’s use a light-duty nurse.”
    Why this ready pool of light-duty nurses? Because they’ve been injured on the job and aren’t ready to return to a full load yet.

  3. Very nice message – I do believe that often times in healthcare when we talk about minimizing risk and safety that management often is thinking about sentinel events only. When we talk about safety it is about the everyday safety risks (any dangerous activity) and not just those that cause high risk. What I like about today’s posting is – first ask about safety…….that I believe is a good message about everyday management Actions and how we should approach safety. Safety should be discussed everyday and not just in the event of a safety risk as unsafe practices everyday can be improved.


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