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?

Posted by: jean - June 6, 2006 08:01 AM

Hello Jean,

I meant no disrespect to your profession or to anyone working in healthcare by the term "assembly line healthcare". I was merely trying to call attention to the good work being done with eye surgery in India.

Your point that nursing is not where the focus of cost reduction in healthcare should be is a valuable insight. As consultants, we are sometimes guilty of relying on our "tried and true" approach instead of taking time to fully grasp the situation based on the big picture.

Most Lean consultants in healthcare today are coming from a manufacturing background, so this is understandable though not excusable.

We're a small company and we grow only as fast as we can find the best people possible. We screen very carefully. With all due respect, we at Gemba are not bad enforcers. We really don't wear the same uniform as the consultants at your hospital. You would have to meet us to know.

Thank you for opening our eyes.

Jon

Posted by: Jon Miller - June 6, 2006 08:35 AM

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."

Posted by: Matt - June 6, 2006 10:49 AM

Jean,

As a comment to this posting I would suggest looking into alternatives to Lean consulting. There are a number of Lean training packages that provide a great alternative that allow nurses to use their healthcare experience while getting the Lean consulting tools. I personally think it is a great combination and takes care of the outsider issue.

Best regards,
Jim

Posted by: Jim Sady - June 6, 2006 11:00 AM

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.

Posted by: Mark Graban - June 6, 2006 09:01 PM

Mark,

I agree with you 100% that is why I support using these tools. Again, it comes down to the most appropiate people to deliver this knowledge and this should be within the professional field.

Best regards,
Jim

Posted by: Jim Sady - June 6, 2006 09:20 PM

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.

Posted by: Bill Waddell - June 6, 2006 11:17 PM

Since your kind response in June, my workplace has descended into a kind of black space. Without telling any family secrets, those who did not "heil" lean have found other employment. I think we, as a staff are beginning to feel like chicken pluckers in the Golden Plump Place where Faster is always better. The morale in our place of work has been sliding down and has recently picked up speed as the true depth of lean is being revealed to us. I do not know what Toyota does to halt the subliminal disconnect of hearts and body that is happening in our place. Last week a co-worker said she felt like an evil black vapor was loosed upon our place. We are all good nurses and are dedicated to the healing arts. We cannot figure out what we did to warrant the pattern of abuse, in the classic description, that mocks what we have spent our lives preserving. Yes, it is pitty pat to say that malcontents focus blame on sometning else rather than face up to the challenge of lean. I say that they simply do not understand what is happening. We all now would like lean to go away. As it is failing in our place, the pressure to make it succeed lest the venders of lean lose business selling the "concept", the pressure to "do it" has increased so many fold that a day at work is like that picture "The Scream" for eight hours. There is no joy in the hallways, no laughter (I suppose laughing slows down the Line), no one wants to stay late or do anything extra that use to come just from the joy of working in an Operating Room. I do not know where this will end. I only have three more years until I can retire. It is going to be a long three years.

Posted by: jean - August 12, 2006 04:18 PM

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.

Posted by: Simon - September 24, 2006 04:26 AM

Thank you for the response. I have decided that I no longer want to be a victim grumbling about the oppression, depression and suppression. I just do not know where to start.

Posted by: Jean - October 1, 2006 02:14 PM