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The Ergonomics of Compliance


Mark's Note: Today's guest post is by Ryan Leach on a topic that I think is important, especially for hospitals — the idea of ALWAYS being ready for accreditation visits, surveys, or audits. Organizations should be ready every single day, rather than jumping through hoops and relying on heroic and special efforts to “get ready” every few years.

By Ryan Leach

leachMany industries face the compliance conundrum. The compliance conundrum occurs when staying in regulatory compliance interferes with business as usual operations. In highly regulated industries, where regulating bodies conduct periodic audits, the strain of the compliance conundrum is even more apparent.

Audits are unpredictable by nature. This unpredictability can lead to underprepared, or ‘knee-jerk', reactions to return us to a state of compliance when an audit is approaching. We try to minimize these knee-jerk reactions by operating in a state that is audit ready at all times. However, a lot of times this means periodically returning to a state of compliance rather than engineering a state of compliance.

Typically, ergonomics focuses on safety issues, where our interactions with systems and tools are studied and manipulated to reduce the strain on our bodies. The goal is to remove repetitive strain injuries, which are caused from exerting too much force or awkwardly positioning ourselves to complete tasks. We've all been told to lift with our legs, rather than our arms.

We see ergonomics applied to commercial products, such as gardening tools. We might see shovels or rakes that are marketed as more ergonomic, where the shapes of these tools are made to reduce the strain from using them.

Why not look at the strain of staying in compliance as an ergonomic issue?

The International Ergonomics Association breaks down the study of ergonomics into three areas: physical, cognitive, and organizational.

Physical aspects involve systems and procedures.

Cognitive aspects involve education and participation.

Organizational aspects involve management and teamwork.

In each area, we want to reduce strain.

For physical aspects, strain may be caused by additional time and effort needed to stay compliant. When the only tool you don't have is a hammer, every other tool starts to look like one. However, in regulated processes, the end doesn't justify the out-of-compliance means.

Many times, when we find ourselves trying to cut corners, we're doing it as a way to compensate for an inefficient or disorganized system. 5S can be used to organize an area, so that we have what we need, when we need it. SMED can be used to engineer the corner-cutting in a way that is compliant. Poka-Yoke can be used to corner-cut-proof a process.

For cognitive aspects, the strain may be caused by any additional mental processing needed to stay compliant. It takes less time to guess than to research an answer.

Visual Management can be used to show states of compliance vs. non-compliance to remove the guesswork. This also improves participation, as it creates a cognitive pressure when a system shows an out of compliance state. Good compliance engineering also removes the cognitive stresses of knee-jerk reactions.

For organizational aspects, the strain may be caused by unassigned ownership in areas of compliance. Plausible deniability is a quick way to avoid responsibility.

When compliance is built upon organized teamwork, the stress of compensating for others is removed. The success or failure happens as a team.

A lot of times, operating out of compliance is a result of short-term thinking. The stresses of an audit may not happen frequently enough to outweigh the short-term satisfaction of cutting corners. When it becomes less strenuous to stay compliant, we have successfully engineered compliance ergonomics.

ryan2About Ryan LeachRyan has a degree in Chemical Engineering and is the author of the ebook, The Mistake Economy. He explores the fundamentals of business and personal improvements at You can find him on Twitter as @simplecimprove.

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Mark Graban is an internationally-recognized consultant, author, and speaker who has worked in healthcare, manufacturing, and startups. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. His most recent book is the anthology Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also the VP of Improvement & Innovation Services for the technology company KaiNexus. He is currently writing his next book, tentatively titled Measures of Success.

  1. Susan Muscat via LinkedIn says

    Wow… this entire article and concept, never thought of the “strain” of continued survey readiness in conjunction with ergonomics, but it makes since!!! Especially with 5S. This has opened my mind!!! Thank you for posting.

    1. Mark Graban says

      Yeah, that’s way too true even for a satire news story…

      “For 2-3 days I can’t eat at the nurses’ station, but once they are gone we all bring the food right on out,” said charge nurse Kenny Waterson. “Typically we have a post-JC potluck feast at the nurses’ station in honor of passing the inspection.”

      Why hasn’t Joint Commission caught on to this? Or maybe that have and this whole accreditation thing is just a bunch of theatre…

  2. Rodrigo Bernal says

    Nice topic. I think this happens cause the organization doesn’t perceive the benefit of a certification and just see it as a requirement. Therefore, is not something built into the process. In a lean organization, one piece flow or a kanban system is common and everybody understands the importance. If an audit comes, wil find that employees see it as something normal not because of the audit itself, but because everybody see the benefits of it and how better the process is with it.

  3. Abid Shah via LinkedIn says

    Especially in healthcare industry it is very important. Most organization may not even realize how much FTE resources they waste when they prepare for audit every few years.

  4. John Carter says

    Unique perspective on ergonomics from a compliance perspective. Came here while researching for a new article and this gave me something new to ponder.

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