Giving Lean Healthcare a Bad Name

I appreciate your response and the willingness to promote lean. From the nurse’s perspective, patient care is not an assembly line process and while lean has and can offer worthwhile suggestions to elevate the quality of care at a reasonable price, your logic is flawed on several issues. Lean and its cadre failed to recognize those practices in place that were good. Many acts are established through practice as a better way to do things because they evolved as the practice of nursing as evolved with its own set of standards for nursing care. Instead, we were made to feel that people from the outside, who have their own power issues, were brought into make radical changes because they know more about patient care than nurses do. The reason healthcare costs are out of control is not because were are sloppy in our routines. It is because managemnt is not only top heavy and narcisistic, it is consumed by profit and not really involved in nursing. If lean really wanted to eliminate waste and start reducing health care costs , it might question and examine the extraordinary amount of plastics and paper products that are used by manufacturers of medical products. The nonrecyclable waste is staggering. We all share the guilt in this country addicted to oil and the medical vendors who suck up these resources in the name of pretty packaging. Lastly, our hospital failed to recognize the value of input from the most common worker on up who toil daily at a task and can tell anyone who asks how it can be done cheaper and faster with little change. And while you distance your self from the bad lean enforcers and well paid consultants who have a mortgage payment due, you fail to realize that you all wear the same uniform. How well are you hired consultants screened?

I feel compelled to respond here, because I have witnessed a couple of lean efforts at hospitals from afar. I am not in healthcare, but in engineering and manufacturing. However, my wife is an MD and my sister is an RN, and I watch the lean healthcare efforts carefully, because I am trying to learn more about implementation in such a complex environment.
One thing I noticed in Jean’s comment is typical of lean efforts in most hospitals and most other companies. That is, when lean is introduced, nearly every party/group denies ownership of the “big” problems, and then points to other groups who “need more improvement than we do”. That may or may not be true, and I cannot judge Jean’s situation. However, it is imperative that each individual and each group accept the fact that they can improve, and work from there. Each group needs to get their “house” in order before addressing the problems of other groups.
The successful lean implementations (especially in hospitals) have put as a priority to bring all of the groups together toward a common goal, and have been successful because the leaders have carefully and inoffensively removed the “blame culture.”

Any consultant, whether they come from manufacturing or not, should understand the lean/TPS concept of “respect for people.” Any consultant who doesn’t understand that should be thrown out on their ear, from a factory or a hospital.
When I do work in hospitals, we emphasize that lean is about improving things for patients and employees. It’s about reducing waste and solving the problems that plague nurses each and every day, finding real root cause solutions to put those fires out for good. Lean, done right, gives nurses more time to provide direct patient care, to “let nurses be nurses” and they love it.

The situation is not unique to lean healthcare. Mark and I have both written about companies that have done pretty crappy things in the name of lean. Sometimes it is the product of a self proclaimed lean expert/consultant who is wholly unqualified.
More often it is the result of senior management using a few lean tools to do the same nonsense they has always done – namely, to put pressure on front line people to do more work in less time, rather than to eliminte legitimate waste.
Whenever this happens, it leaves the people in the organization with a sour taste for lean and sets lean back. Jean’s experience has nothing to do with lean’s applicability to healthcare or anything esle. It is just another example of poor management.
Jean wrote “If lean really wanted to eliminate waste and start reducing health care costs …” Jean, lean really does want to do precisely that. It is your management that has a different agenda.

Dear Jean, I was distressed to read about your experience at the hands of the “mean lean” brigade. This is a salutary warning for those in healthcare who desperately want the golden eggs but don’t understand how to get them. Six years ago I started a service improvement initiative based on three goals – what I call the Three Wins. First, the quality of care that the patient gets; second the quality of life of the dedicated professionals (like you and me) who convert cash into care; and lastly the performance. What we found was that focussing on improving the working environment and job satisfaction were critical – get that right and quality improves and get both those right and the savings start flowing. This is how Toyota did it and this is how we did it. What is interesting is we didn’t hear about “lean” until after we had done it. I don’t use the term “lean” – I use the term value stream design because that is what we did. If what you have said is the general feeling of the majority of staff in your organisation then the “lean” transformation will fail – just as many others have failed before if they have been driven top down and by executives who have not changed their mindset from “slash and burn” thinking. Value stream design is a mindset change and a set of methods and tools; you need both – either alone will not work.

I found Lean to be a transformation of spirit, one of focus on our patients and doing all that we can to see they receive good value. Successful lean implementations see that 30% to 40% of health care processes are wasteful and that time with the patient can be improved by thoughtful Kaizen events that allow the employees to improve the workplace by eliminating that waste. It sounds to me that Lean was imposed on Jean, not brought to her in a caring and compassionate way. In a successful lean implementation, she should be gaining more time to spend with patients. Please don’t let one bad experience sour you against a tool that values patients if implemented correctly. Jean, do a search for Lean Virginia Mason or Lean Park Nicollet and see what successful implementations mean for patients. Nurses are one valuable part of a huge process that patients find themselves in.