I have spent the last couple of months banging my head against a wall trying to figure out why one group of employees at one of my implementations just can’t align with a Lean way of life. Each time we 5S an area, it gets changed. Each time we try to implement standard work, it gets delayed by management. Each time we try to implement Kanban, we get no where. Why are these people fighting this implementation so much? Most importantly, why are they being allowed to resist this implementation? They seem to have a complete disregard for authority. Above all else, they can’t seem to wrap their minds around the fact that if we don’t cut costs and improve efficiency, we will cease to exist as a healthcare facility.
I’ve been over it thousands of times, and I came to a realization just the other day – healthcare is made up of a myriad of individual thinkers. It makes sense, the culture of healthcare has allowed for autonomy to prevail for so many years. Caregivers are encouraged to “create the wheel” with each and every patient. Because an inidividual’s anatomy and physiology are so unique, it is sometimes necessary to treat using non-conventional ways. With that said, it makes sense to me that healthcare workers can’t grasp on to something as simple as Lean Thinking. It’s ironic that something so simple is so difficult. As someone pointed out to me the other day, “Lean just makes sense; it’s easy to do, and we probably do it already in our private lives.” I couldn’t agree more with this. Lean is simple, and that is why it is hard to accept in such a complex system. Simplifying our lives seems like an injustice to the patient. However, if we boil it down, it is what is best the patient. A process that operates free of variation does decrease error, which does increase the quality of care.
The problem is, how do I get the employees to realize this? You can give them real world examples and you can play little games to show them how efficient a process is when you cut the waste from it, but they still come back to the ideology that the real world is different than healthcare. “In healthcare, we’re different.” Really? If I were a patron of a fast food restaurant, I don’t want to wait for a burger with no pickles for 15 minutes and receive it cold. As a buyer of a new automobile, I don’t want to wait an extra six weeks to get leather seats instead of the standard fabric interior. As an airline passenger, I don’t want to pay for first class and have to sit in coach. As a patient, I don’t want to pay a premium to wait and ultimately receive poor care. That’s the point, it’s not about the employee, it’s about the patient. That is what everyone in healthcare must realize in order for Lean to sustain. Treat the patient like you were treating yourself. Would you feel comfortable walking into a treatment room that was filthy, unorganized, and where no two rooms looked alike? Would you want to sit and wait for 3 hours before you’re seen by anyone? When we realize this is when we begin to live in a Lean world.
Unfortunately, the complexity of healthcare, combined with its autonomy is what is keeping healthcare from changing its attitude from “we’re as good as we can be” to “we must be even better.” Further, management must be willing to take a stand and promote continuous improvement as a way of life. The autonomy that healthcare workers have had for so long is just not going to work. As the saying goes, “if you do what you’ve always done, you’ll get what you’ve always got.” It’s time the delivery of care catches up to the 21st century.