Thursday, September 08, 2011

Becker's shows how Lean fights the Nut Island Effect

I wrote an article in the Harvard Business Review a while back called "The Nut Island Effect: When Good Teams Go Wrong."  It was about a group of folks at a sewage treatment plant in Quincy, MA: A team of skilled and dedicated employees became isolated from distracted top managers, resulting in a catastrophic loss of the ability of the team to perform an important mission. The irony was that most people viewing the team would say that it had all the attributes of an ideal working group -- dedication, collaboration, a strong sense of integrity and values, and indefatigable energy with regard to doing the job. It is probably no coincidence that many of the staff members had served in the military, where those virtues were highly valued.

Over the years, many people have noticed the same phenomenon in other industries.  Bob Herman, with Becker's Hospital Review, has picked up on that fact, with an article focusing on the presence of this syndrome in hospitals.  He cites my experience after entering this field:

[H]e found that the "us versus them" behavior was rampant in healthcare. "We have a team of people that's motivated by the best possible values — physicians, nurses, operating room staff, people in the pathology lab — and they get isolated the same way the guys at Nut Island did," he says. "You can go into any hospital in the world, and I bet if you described this syndrome to five or 10 people, they'd look at each other and say, 'That happens all the time.'"
Bob relates how the use of Lean process improvement in the hospital setting can help reduce the likelihood of this pattern occurring.

Once frontline staff members are trained to report setbacks and managers act on those calls, hospital leadership can map out the processes in question, diagnose the problems and reduce the waste that is bogging down production.... [T]here is a bevy of benefits from this type of systematic hospital improvement based on Lean principles: Employees are not as tired; employees are less likely to make a medication error because they are not as rushed; staff morale improves as more people get to know each other; there is less staff turnover; there is an improvement in overall quality of care; and money is saved as the waste in all processes gets weeded out.

Thanks to Bob for such a clear exposition of these points.


Anonymous said...

That article goes a long way toward explaining why you had such success running things in a variety of fields, Paul - and gives the lie to hospitals which whine about lack of resources. The solution is sitting right there in front of them and doesn't cost a cent - proper leadership.

nonlocal MD

Victoria said...

From Facebook:

Par for the course in the education field; management that not only doesn't know what's going on, but absolutely does not want to know what's going on -- they'd have to admit to flaws and then try to change things, both anathema to education administrators.

I worked for a while in a college tutoring center where our manager, a good guy who had designed a good system, was promoted to dean. We worked for six months with no manager at all and kept a good system running pretty well. Then somebody decided that this would not do, that we must have a boss, but to save money they promoted a secretary with no degree, no math courses, and no teaching experience to run a college math tutoring center. She was all about her position and rules and rituals; chaos ensued and most of the qualified tutors left.

Richard Zarbo said...

Good post. I can reaffirm that of the many challenges to adopting and sustaining a Lean management culture of work in and throughout an organization, rather than in established pockets, as can be currently seen in healthcare and many other industries, is the overarching challenge of horizontal integration. This means not just within divisions but also across business units, along the horizontal value stream as perceived by the "customer". This is likely the most important but also the most difficult work for senior leaders in standing up a successful culture of worker empowered, continuous process improvement that is not vertically silo-ed. Leaders must create that structure for effective communication of empowered, well meaning employees who follow the established rules of change and improvement described as the so-called Toyota kata.

Anonymous said...

I think managers need to work a few days each month in the shoes of the people they manage.

Two decades ago, at five o"clock in the afternoon, a 600 lb woman came to the OR in respiratory distress. She could not be intubated.

We were running on a short staff. We had to put two OR tables together and then after that the ET surgeon was able to do a tracheotomy.

The trach tubes were too short and we had to insert a oral endotracheal tube and suture it to the skin.

We truly saved this womans life that evening. The next day the CRNA manager wrote us up because we put two OR tables together !!!!

No kudos for being resourceful and using what we had just criticism.

Richard Zarbo said...

You bring up the perfect example of a typical Western manager hunting heads and blaming those who don't follow the rules. In a Lean, or more correctly, a Deming management structure, the manager would see this staff creativity to fix a defect as a system flaw that she was responsible for. Rather, she would assemble the team and help brainstorm ideas for redesigning the workplace to eliminate this unsafe practice of pulling 2 beds together so that all are better prepared for the next similar scenario. In this supersized America, that will happen again :)

Sicilian said...

I just wanted to tell you that I have been following you for a long time. I enjoy your comments and your ability to pin point key issues that nobody wants to discuss.
I often want to make comments on your posts, but have fear since I work in health care.
Just know that many people are reading your posts, and are probably just like me, not a doctor, not a nurse, just a support person that makes things happen in a healthcare setting
Keep up the good work sir! Your knowledge in the health care arena is priceless.

Unknown said...

I always say that there is a void between all facets of medicine. It is one of those moments where right does not know where left is.

Also the culture of black and white. Whenever someone finds a fault, it is counted as a strike rather then an educational opportunity.

I hope we can somehow bring a paradigm shift in this culture. Though I must confess we could be part of the problem.

Take care.

Paul Levy said...

Some of us has been fortunate enough to work in a place where the culture shift has occurred. It is a marvelous thing.