Over the years, as a result of my advocacy for Lean in healthcare, I've been both:
- Attacked by labor leaders in the U.S. and Canada because I supposedly put “profits over patients”
- Labeled by someone at the Texas Hospital Association as “a labor union supporter” because of my criticism of a DFW-area hospital during the Ebola crisis.
I must be doing something right if I'm bothering people on both sides of the labor / management divide?
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Like many people who came into healthcare as a second career, I remain idealistic and I'm not worn down by healthcare. To me, patient safety and healthcare quality need to be the top priorities (and Lean can contribute positively to these goals in many ways). I know somebody who recently withdrew from a Lean hospital job possibility because he wanted to talk about safety and quality in the interviewing and he said the hiring managers only wanted to talk about cost.
I certainly get frustrated with hospitals whose daily activities don't seem to line up with the lip service about “patient safety is always our top priority.” I get frustrated when hospitals are staffed below their stated staffing plan, yet they don't turn away patients, thereby creating overburden for nurses, which harms patient care and puts everybody at risk.
A retired labor leader from the automotive industry (who reads this blog) sent me a link to this article:
The article isn't from a newspaper; it's from a site that provides “independent and incisive coverage of the labor movement and the struggles of workers to obtain safe, healthy and just workplaces.”
Again, for the record, I'm all in favor of “safe, healthy, and just workplaces.” That's what Lean management aims to deliver.
But, far too often, business leaders (including some in healthcare) confuse Lean with traditional cost cutting. When their lens and priority has been cost cutting, it's natural (if not frustrating) that they'll view or frame Lean as a better way to do cost cutting.
In the Lean mindset, lower cost is the end result of doing everything else well. Improve safety, quality, and patient flow and you'll end up with better bottom-line results. Your cost might be higher to deliver better patient flow, but (in the American system) your revenue might be higher to make up for it. And, not to mention that safety and quality are moral imperatives. Healthcare likes to say, “We're not just cranking out widgets, this is life or death.” OK, then you need to act like that.
What stood out to me in the article about nurses going on a two-day strike in Vermont?
“In addition to low wages, the UVMMC employs lean production methods that put both nurses and patients at risk.”
How would “lean production methods” put nurses and patients at risk?
As I've written about in my books Lean Hospitals and Healthcare Kaizen, Lean is a solution to the existing problem of risk to nurses and patients. Before Lean (or without Lean), hospitals are workplaces with very high rates of employee injury and burnout. Lean helps address both of those issues. Before Lean (or without Lean), various estimates suggest that between 200,000 and 400,000 Americans die each year due to medical error. Lean can address that serious problem.
In a Lean workplace, staff aren't overburdened. A Lean workplace has the right number of staff in the right positions so we can take care of patients the right way. A Lean workplace is more ergonomically designed, to reduce injuries. Reducing waste through Lean (improving processes and systems) mean that nurses have more time for patients. When staff aren't short on time, preventable problems like bed sores, infections, and falls drop.
The problem is that any organization can label anything as “Lean” even if that's not really the right description to use.
Again, from the article:
“The union claims that the hospital has frequent shortages of support staff, including nurses' aides and orderlies.”
Being understaffed is NOT Lean. A Lean environment would have the right number of staff, including the right number of support staff so that nurses can focus on being nurses. This all ties into the Lean principle of “respect for people.”
Again, from the article:
“According to Tristin Adie, a nurse practitioner and member of the bargaining committee, nurses in the rehabilitation unit routinely do laundry for up to an hour a day, while nurses in the oncology unit are consistently tasked with billing and coding duties, and nurses across the board are forced to regularly clean rooms and accompany patients to far off places in the building.”
Those problems sound like they are caused by an understaffing of support staff. That's not Lean. That's just bad management.
“Adie says that such practices directly contribute to an unsafe working environment: nurses cannot adequately care for patients when they are forced to do the work of support staff in addition to their primary duties.”
I agree with what Adie says.
As I've written about before, a truly “Lean” management system would be the best thing that ever happened to nurses and patients.
Here is a blog post from 2009 that talks about a nurse's union supporting Lean:
In the case of this article from New Brunswick, the hospital in question gets it right:
“The goal is to deliver process improvements that allow provincial nurses to spend more time with patients and less on administration or wasted effort.”
That sounds like Lean to me.
But, here is another blog post from 2016 about a union being opposed to Lean:
Lean is a good thing. I can understand a union being opposed to bad management and practices that bring risk or harm to patients or staff. Unfortunately, too many people have had bad experiences, seeing or living through something that is labeled as “Lean” but doesn't really sound like Lean.