When we introduce the idea of Lean to healthcare organizations, it's very common for somebody (often a senior physician) to say something like,
“But we don't want assembly line medicine.”
The implication is that assembly lines and factories are cold, rigid, uncaring places that focus on ruthless efficiency and making the numbers at the expense of safety and quality. Do a Google search for the term and the implications of “assembly line medicine” are very negative.
See what I wrote about “assembly line medicine” in 2006.
It's also a bit of a “red herring” (or is it a “straw man”) for them to bring up assembly lines when we're in agreement (I hope) that our goals are to improve safety, quality, waiting times, cost, and staff morale.
When I volunteer to take local healthcare students or leaders to the Toyota truck plant here in San Antonio, I always ask them about who has ever been inside a factory. It's rare that a hand goes up to say yes.
So, there are all sorts of misperceptions about what a factory is like, including people thinking that a factory is a simple technical system instead of being a complex socio-technical organism. This is borne from ignorance and it's not their fault for not understanding factories. Society has often portrayed factories as full of dolts, like Fred Flintstone, Peter Griffin, or Homer Simpson for a long time now.
When the healthcare professionals actually get inside the Toyota factory, they quickly see how workers are respected and listened to as the team members reach up and pull the andon cord frequently, getting a quick response from team leaders, allowing them to put quality first.
Are Healthcare Settings Already a Bad Assembly Line?
The perception of what “assembly line medicine” would be like is, ironically, often the norm in healthcare before Lean concepts are introduced. Safety, for patients and staff, is far worse in hospitals than it is for most manufacturing companies.
GM's CEO Mary Barra and Toyota's CEO Akio Toyoda get called in front of Congress to explain a dozen customer or driver deaths, but hospitals and their leaders somehow avoid scrutiny for all the preventable harm that occurs in their domain. On the flip side, ThedaCare, Virginia Mason Medical Center, and others have demonstrated that applying Lean methods improves quality and safety (while also reducing waiting times and costs).
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My dad sent me this column from the Detroit News: “Let ye who have ears use them,” where Ronnie McBrayer talks about the healthcare system not being good at listening to patients.
“Listening is largely a lost art. Medical professionals run us through their offices like cattle through a chute.”
Since a small minority of doctor's offices and clinics use Lean methods to any significant degree, we can assume he's talking about the traditional, predominant medical system. In this system, appointment slots are being shortened due to pressure from payers and administrators, and patients start to feel like they're on an assembly line. Well, at least an assembly line flows… as a patient, we usually feel like inventory that's just sitting there and waiting.
I had to disagree with a professor in Finland who made comments at a conference about how a Lean doctor's office would have some sort of takt time clock buzzer ring, forcing the patient to leave the room when their time is up. Lean assembly lines are allowed (if not required) to stop, slowing production to put quality first. That would be a good thing in healthcare.
A Lean system would do no such thing. If it took longer than planned to care for a patient, you'd pull the andon cord (or some equivalent) and put the patient and quality first. That's a more caring environment, not a less caring one.Medical professionals run us through their offices like cattle through a chute Click To Tweet
A Lean System Listens Better
If there's a lack of listening in the world, a Lean environment demonstrates “respect for people” by doing a better job of listening. In the factory, production team members are free to speak up with their voices or by pulling an andon cord. Their concerns about falling behind in their work or having a potential quality problem are listened to.
Employees, in a Lean factory or a Lean medical clinic, are listened to when they have “kaizen” improvement ideas. Lean companies, ranging from manufacturing to startups to hospitals, also do a better job of listening to the voice of the customer.
When people say they fear “assembly line medicine,” we need to do a better job of explaining how assembly lines actually work, particularly Lean assembly lines.
We can all do a better job of listening. Friday's post will be about the need for the Lean community to listen to “Lean horror stories” rather than just ignoring them and hoping they'll go away.we need to do a better job of explaining how assembly lines actually work, particularly Lean assembly lines. Click To Tweet
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I agree, Mark. But what I discovered is that the Lean skills I learned in healthcare and administrative processes worked equally as well in manufacturing.
I sat on the board of a Plastic Molding plant. While they were implementing Lean, I had a chance to visit a number of times. I could tell that my skill level was way above the level of the QC staff when they would take me to a process and I could see plenty of improvement and safety opportunities.
When I took a Medical Director for one of my employers to Virginia Mason, she bought into the vision completely.
Listening is important, and no one had listened to her or her staff. My approach was a standard healthcare approach-surround the Doctor with appropriate staff and well run processes so all they literally have to do is see patients. And there are so many ways to add value to a patient visit.
My experience as a patient involves lots of waiting and very little in the way of results. In the organization I was talking about, we had 30 minute appointment slots and patients saw very little of the Doctor because of the extreme waste in the system, among the worst I have ever seen.
Thanks for your comment, Patrick. I agree that “Lean is Lean” regardless of the setting and “good leadership is good leadership.”