While working in different environments and different industries, I've seen many work requirements that were deemed “non-negotiable” by management – and rightly so. For example, wearing safety glasses in a factory or wearing gloves when handling specimens in a hospital lab. Generally speaking, “standardized work” (the way we do things) should be written by the people who do the work (this idea in Lean traces back to Toyota's Taiichi Ohno).
While I've never been a fan of top-down “command and control” work rules being forced on people (see my recent post on “voluntary standardization“), there's a time and a place to make things required – especially when safety and quality are involved. Good leaders make sure people understand WHY a non-negotiable rule is required, rather than just saying “do this or you're fired.”
But what about when patient safety is involved?
As somebody who is in hospitals a lot, as a consultant or a speaker, I get a flu shot each year. I do this both to protect myself from getting sick and to protect others who might be in a vulnerable position in terms of their own health. I think it's an extension of the “respect for people” principle of Lean for me to do this, beyond the selfish reason of not wanting to get sick.
It's interesting to see that many doctors, nurses, or healthcare professionals choose to NOT get a flu shot. I am often able to get one easily (and for free) at a hospital site or I pay a few bucks to get one at the local drugstore.
Virginia Mason Medical Center is a world leader in the application of Lean and Toyota practices in healthcare (see more posts about their work). Joyce Lammert, MD, the VM Chief of Medicine recently wrote a blog post titled, “Mandatory Flu Shots: A Defining Moment.”
She writes, in part:
A medical assistant on the [Rapid Process Improvement Workshop] team noted many people with the flu are asymptomatic, which meant Virginia Mason staff members could unknowingly spread the flu to vulnerable patients. During a team discussion she asked, “If the patient really came first, shouldn't everyone at Virginia Mason get a flu shot?”
The policy is certainly patient focused and provides an option for those who really don't want the shot:
Within two years of implementing the new policy, VM had reached nearly 100 percent of employees getting flu shots (a few employees requested accommodations and were permitted to wear surgical masks instead).
You may have seen this story in the news over the weekend, from Cincinnati: “TriHealth fires 150 employees for not getting flu shots.”
From that story:
TriHealth offered all of its 10,800 employees free flu shots. Employees had a month to get the flu shot. The deadline was Nov. 16. Employees who did not get the shot were terminated Wednesday, a company spokesperson said.
I tried to find other stories that might have mentioned if the TriHealth employees had the option of wearing a mask, as an alternative.
From the online discussion on the story, there were many people who screamed about the rights of the employees. Well, the U.S. Constitution is designed to protect against the government overstepping its bounds, but private employers like TriHealth have far more leeway in choosing who to hire and fire. Some other organizations, like Cleveland Clinic, take this a step farther, perhaps, by refusing to hire smokers (but that's in the name of keeping health coverage costs down as an employer as opposed to protecting patients).
I'm not a fan of firing people as a first step… I'd prefer to find a “win/win” solution that protects patients while finding a way to not lose my investment in talented employees and staff.
But, there's a big difference between making an intentional choice that puts patients at risk (not getting a free shot that was conveniently offered) and being part of a systematic error. I wouldn't fire a nurse for giving the wrong medication to a patient, since that's almost always a very systemic error and the harm that comes from people covering up errors is a reason to not rush to punitive measures for errors and mistakes. Not taking a flu shot is a choice, not a systemic error, though.
There's a difference maybe that's similar to this situation in a software company:
- I made an honest coding error that led to our site crashing (don't be punitive)
- I intentionally uploaded a virus that was likely to crash our site (that's intentional, so punitive is OK)
What's your take on this situation? I'm curious to hear your comments and, perhaps, about what your organization is doing (or not doing). Remember, you can post a comment under “anonymous” or with a pseudonym.
From a Lean perspective, what's the balance between the needs of the customer (the patient) and the employees? Is it right in this situation, or other circumstances, to force people to follow standardized work, as we see here with flu prevention?
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