Thursday, 25 February 2010

Who’s Got Time for Lean in Healthcare?

If you have navigated to this then there is a fair chance that you are in a leadership position in healthcare and are interested in the application of lean thinking within your organisation. There is also a fair chance that you would agree that lean should be part of the day job, not an addition to it.

This is where the problem lies. We have worked with many health care organisations where the application of lean thinking is indeed an addition to the day job. Sure, these folks know it’s the right thing to do for both the organisation and the patient, but the truth is that they simply have not got the time, the capacity, to adopt lean.

Suspecting this, we have carried out what we call a ‘Diary Exercise’ with many Healthcare execs, senior managers and line managers. It is totally normal when conducting these exercises to find that the genuine demands placed on these individuals can be in excess of 24 hours a day. So, if you were to start in a new job on day one, you would come in to 24 hours worth of work to complete that day. If you were to work a 12 hour day on this first day, then you would come in to 36 hours of work on your second day (24 hours worth of work plus the 12 hours worth of work that was not completed yesterday) and so on. No wonder that inboxes and in trays are always full to overflowing.

This is not down to poor time management. It is the genuine current demand placed upon these people by their bosses right throughout the chain of command. Whilst conducting these diary exercises in one organisation, we were fortunate enough to be invited to assist them in their first steps towards formal strategy deployment.

During this exercise we discovered that this exec team believed that they had 252 targets imposed upon them and then when deployed to the next (General Manager) level, the number had mushroomed to 350. Why?

Upon close investigation, it transpired that the trust only had 36 external targets imposed upon them (6 of which were duplications anyway, so 30 really). It transpired that the trust themselves (or their Performance Dept more like) were generating this impossible amount of work. Hence the crippling 24 hours worth of demand placed upon individuals. So did this organisation have any time to invest in adopting lean?

More recently, whilst working with another health care organisation that are also keen to adopt lean thinking and more importantly the stability that basic lean Operational Management brings, we noticed that the key managers were unable to maintain the routine ‘check’ cadence that good Ops management requires. Again we performed the diary exercises with these folks and again found a very similar story. Digging deeper we helped them uncover the fact that in the medical division alone, these line management, operational folks were jointly working on over 140 improvement projects and initiatives yet no one person could see all 140 in one place or indeed even knew that there were so many. No wonder they didn’t have time to embrace lean thinking.

Whilst it is admirable that these organisations are striving to provide better and safer patient care at a reduced cost, expecting people to work on these vast volumes of work that has been self generated, is not only unrealistic and unsustainable but is unfair on the staff and provides no real benefit to the patient.

Just imagine that you are spinning plates. You have already got too many plates on the go, when somebody comes along and says “by the way, here are another couple of plates for you to spin”. It’s inevitable that they all come crashing down.

Understanding this situation has helped us work with these organisations to funnel down to their biggest problems, the vital few and to focus everybody’s attention on working on just these.

Medical Length of Stay (LoS) appears to be a good place to start, as a reduction in LoS combined with safe effective discharge, obviously, improves quality of care, reduces the risk of hospital acquired infections, assists in achieving emergency and elective targets whilst reducing costs.

It’s only when there is agreement from the top to unearth the ‘vital few’ and allow everybody else in the organisation to work just on these, will staff not only have time to learn and become skilled in lean, but will have the time and capacity for it to become part of their day job.

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