Paul Levy: “Lean” Hospitals Save Lives
Monday, March 12, 2012
At my former hospital, Beth Israel Deaconess Medical Center, we were strong adherents to the Lean approach, and it literally helped us save patients' lives. It also made the workplace environment more pleasant and rewarding for nurses, techs, and other staff. It also enabled us to save jobs in the face of strong economic forces that could have weakened our hospital.
What's this about collaborative learning, though? John Shook, the CEO of LEI, explained that learning collaboratively means more than each person learning individually while occupying a shared space. Collaborative learning is two or more partners who actively endeavor to learn together through shared experience. The power of learning collaboratively is that it is a way to achieve economies of scale in learning -- spreading lessons within an organization and beyond.
That sounds a bit technical, but it is an important aspect of Lean thinking. If it is not present, there can be major misunderstandings within an organization that can undermine what should be a positive experience for all.
While it is risky to diagnose from afar, I wonder if a lack of collaborative learning was at the heart of a management-labor misunderstanding I read about a few months ago. Here is a quote from a story written by the Mass. Nurses Association about U. Mass Memorial Hospital.
Behind this "business story" of hospital cost cutting, lies a deeper story about what it means to provide appropriate care by the professionals best equipped to deliver that care. In the parlance of business, what UMass is doing is known as "deskilling," attempting to deliver the same service with lower paid, lesser qualified workers. The approach is a staple of the "lean" factory model production processes being employed by UMass and other health care employers in recent years.
My colleague Mark Graban, a Lean expert, noticed this story and said, "I'm not sure the union has it right when they say Lean is associated strongly with "de-skilling." It's about using the right skill level for the right tasks. The nurses' union has a vested interest in protecting nurse jobs, I get that, but why blame Lean?”
Mark was correct. If anything, Lean is a philosophy that is based on highly respectful treatment of workers, and there are many union shops that are active and pleased participants in the Lean approach. Jon Katz from Industry Week has noted, "While unions may present more challenges for Lean implementations, there are certainly many operations with organized labor that have excelled with Lean. Just look at some of IndustryWeek’s Best Plants from years past. I had the privilege of seeing one for myself last year when I toured Schneider Electric’s Peru, Ind., operations. The plant achieved dramatic productivity improvements from its lean 5S initiatives, even after contentious labor contract negotiations."
As it turns out, some students from Worcester Polytechnic Institute recently published a paper summarizing some of the Lean activities at U. Mass Memorial. The report tends to document the increased satisfaction that can result from a collaborative approach to learning. Here's an excerpt from a section about a team of workers who re-designed the approach to handling pre-operative patient records:
There were several people from different sections of the hospital in the group that focused on Chart Prep. Everyone involved participated in the Lean training, and would be essential to the success of the project.
This change led to a 16.7% reduction in registration time (14.3 minutes), lowering the average time from entering the PSE to completion of registration to 31 minutes. Also the standard work was made straightforward enough that a new PSE staff member was able to learn the process in two days after training from one of our team members. Most importantly, the registration staff has all given positive reviews to the new system, and have 100% adopted the methods as of the 30 day follow-up meeting.
When Lean is done right, people in all job categories learn from one another how to make the work environment a better place. Sure, there will be some hiccups along the way, as this is a new way of thinking. But given the cost pressures facing the health care industry, it will be those hospitals and unions who collaborate to employ Lean that will be most likely to preserve jobs.
Paul Levy, former CEO of Beth Israel Deaconess Medical Center, is an advocate for patient-driven care who writes a blog about health care issues entitled Not Running a Hospital.
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