In my time working with hospitals, I've always been very sympathetic to front-line nurses (and other staff). They are far too often overburdened and undersupported. Work is often more difficult than it needs to be — too much hassle and not enough time with patients. Nurses are forced to jump through hoops, fighting through bad systems, yet they too often get blamed when things go wrong.
It's no wonder that 1 in 5 nurses choose to quit their job in their first year. And, far too many get fed up, leaving this important profession early in their careers.
This article posted anonymously on AllNurses.com has over one million views in the month since it first appeared:
It's an “Open Letter to Hospital Administrators.”
From the letter:
“I have seen staff cut to the minimum, while patient acuity and nurse to patient ratios increase. I have seen support staff break down in tears because they have not been able to do their jobs properly. I have seen staff pushed to their breaking point, all the while administration stays in their offices, or in the meetings, determining yet more ways they can cut our resources.”
This is where Lean management is an alternative to traditional healthcare management styles and approaches. Lean leaders get out of their offices and get to “the gemba,” or the actual workplace. Managers and leaders would see if nurses are stressed out and frustrated and, in a Lean culture, staff would feel supported and everybody would work together to improve systems and processes — to free up time, reduce stress, and improve patient care.
A Lean culture makes sure employees aren't overburdened – whether they are building trucks, writing software, or caring for patients.
The letter continues:
“I see ways in which we are constantly blamed for declining patient satisfaction, increased patient falls, late medication administration, all the while we are asked to do more with less. I have seen you fire experienced staff and hire less experienced, cheaper, staff. I have seen that new staff break down because they have no resources, no experience to draw from and I have seen patients suffer from that inexperience.”
Lean leaders wouldn't blame employees for poor results. Lean leaders take to heart what was taught by W. Edwards Deming — that senior leadership is most responsible for quality and for the systems and processes that lead to quality.
Lean leaders don't get mired in cost cutting mode like traditional hospital management does. Instead of firing people and replacing them with cheaper replacements, Lean leaders would embrace their employees' experience, viewing them as partners instead of seeing them as just a cost.
“I see you develop a culture of fear, where our jobs are at stake, and threatened at every turn. Yet, you still look to me for solutions.”
Lean leaders have also embraced another of Deming's teachings – the idea that management must work to eliminate fear from the workplace. Staff who fear for their jobs or are beaten down from being blamed for the hospital's problems aren't going to be willing to participate in “Kaizen” or continuous improvement.
The author of the letter also complains about being told to “do more with less.” If management means “work harder,” it's hard to see where that's possible. Lean leaders work with staff to reduce waste and make work EASIER, which allows nurses and other staff to focus more on patient care. Lean managers focus on helping people do more (more work that's rewarding instead of frustrating) instead of focusing on “the less” — or fewer resources.
I don't know what organization ever cut their way to greatness.
What does the letter suggest?
“My answer to this is simple. It is time to get real and start valuing your employees.”
Valuing your employees, to a Lean leader, means making sure they have the right staffing levels – for nurses AND for important support staff. Valuing your employees also means respecting them and including them in improvement efforts.
“We need to stop the assembly-line mentality of medicine and return to the service mentality.
Yes we are a business. But any business that has ever done well has not done well by decreasing the services to people or by mistreating its staff.“
While some people associate Lean with “turning the hospital into an assembly line,” Lean has proven to be the best alternative to nurses being frazzled, overworked, overstressed, and not able to deliver quality care. I've seen bad assembly lines where the complaints were the same as these nurses' complaints.
I've also seen Lean assembly lines that represent everything these nurses want – a proper workplace, the ability to do quality work, proper staffing levels, respect, and the opportunity to have their voices heard. Lean organizations have a better leadership style and culture. That's our aim with Lean healthcare… a different culture and management system that better supports the staff so they can provide better patient care. This approach, not traditional cost cutting, leads to better financial results.
I suggest you read the article and the comments, which include a number of nurses who say they warn their management about patient safety risks that result from bare-bones staffing levels, to no avail. Many claim age discrimination and say the hospitals like hiring young nurses at the lowest end of the pay scale because they're less likely to speak up. If that's true, it's shameful.
One comment says:
“The hospital I work at has weekly ‘mandatory' lunch with CEO and HR director, this topic was recently brought up and the response was that it was ‘lazy nursing' that was causing low patient sat scores, it was lazy nurses that were complaining and lazy would not be tolerated…”
Lean leaders would never blame “lazy workers” for the problems in an organization.
What do you think of the article and the situation in hospitals? What hope do we have of creating more Lean leaders and more Lean cultures?
Chasing Lean tools, training front-line staff, and running a few projects here and there is not making enough of a difference. I'm not surprised. We need to do better.