This article caught my eye at Becker's Hospital Review:
Even though organizations do formal physician and staff satisfaction surveys, the questions posed here is one that we should ask people frequently (including patients) in the name of improvement.
The questions Becker's asked include:
What do you like most about your organization?
What do you dislike the most?
What do you wish the CEO did differently?
You could answer any of these three questions in a blog post comment below, if you like (and you can use just your first name or say “Anonymous” where prompted).
Some physician answers that stood out to me, in the context of the Lean methodology and management system (edited, in some cases, for length)… I tend to focus on “dislikes” as things that need to be improved. It's also good to celebrate and build upon what is good or “liked” in an organization.
Dislike: “The vast proportion of physician compensation is built around productivity metrics… would like to see the emphasis in compensation shift to value rather than volume.”
Dislike: “Sometimes the administration gets lost in what's involved in day-to-day patient care. They don't understand what people on the frontlines are doing — they don't see the small things we do on a daily basis. Leadership also needs to find a way to be more involved in making sure there is enough staff and making sure they are doing enough to keep the staff happy.”
That's a very widespread problem. In the Lean management system, leaders get out of their offices (“go to gemba”) to try to appreciate what staff are facing… asking them what the problems are, what the staff members' ideas are, and how administrators can be servant leaders. We need not just large projects, but also the daily practice of “Kaizen” to solve problems, keep staff happy, and improve engagement and other results.
Wish the CEO did differently (same respondent as before): “I would like [him/her] to have a more clear understanding of what's involved in taking care of patients every day. The CEO could do more rounds, but the problem is when the CEO walks around, everyone is sure to act ship-shape. But sometimes we have just one nurse for 12 patients — there's not enough staff. There isn't enough help for the acuity of care.”
Rounding, or “gemba walks” need to be done in a way that builds trust. Staff shouldn't be afraid and they shouldn't feel forced to create a false reality. Leaders need to see reality and react in a non-judgmental, helpful way. And a 12-to-1 patient/nurse ratio is a huge problem — something the CEO shouldn't have to see first hand (that shouldn't be happening in the first place).
Dislike: “…unfortunately the focus on profit diverges from the more central focus that I or another clinician would have — on the patient. Every hospital says they are all about patient care, but hospitals practice and subscribe to this pledge to varying degrees.”
A for-profit hospital (or a non-profit health system) needs to realize that profit (or surplus) is the end result of providing value and better patient care… Lean organizations practice what they preach in terms of mission, values, and daily reality (such as truly making patient safety a top priority).
Dislike: “I don't like the authoritarian way the hospital operates. The rules and regulations interfere with patient care and take away physicians' independence. Leadership takes advantage of physicians and makes them do inappropriate things that are adverse to patient care. The hospital hires outside physicians and will terminate contracts if they don't act subservient to leadership.”
Yikes. Lean, of course, is not an “authoritarian” approach to management. Leaders need to work with people, not force them to do things.
Dislike: “The biggest challenge would be — just because my organization is so big — when I want to make changes at the personal level, I can't just do it. It has to go through a big committee. And everything has to be standardized, even putting up a poster to inform patients about a new medication. It becomes harder for physicians to make those changes.”
While Lean focuses a lot on “standardized work” and “standardization,” it doesn't mean change needs to be slow and bureaucratic or that everything has to be 100% the same everywhere. See my blog post on that.
Wish the CEO did differently (different respondent): “Balance the needs of the system with the local needs of different sites. In my humble opinion, there are some decisions and some initiatives that benefit a lot from standardization across sites and there is no reason to have variation. But, there are some local idiosyncrasies that are unique to certain sites. The strength of a CEO is to know how to balance both.”
That's my same point about Lean, standardized work, and variation. Things should be the same when it makes sense (it provides some benefit) and not all variation is harmful or hurts results.
There's lots of interesting stuff in that article if you read the whole thing… including other complaints about bureaucracy and bothersome standardization.
How would you answer those questions? Leave a comment below… or use this Google form if you can access it (responses might be used in a follow-up blog post):
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