Wednesday, June 04, 2014

How quickly it unravels

I am an unabashed proponent of the Lean philosophy in many settings, especially the clinical environment of a hospital. I've seen it work to provide better customer service, improve the work environment for the staff, and save money--a trifecta that's hard to beat!  But Lean quickly goes by the wayside without the enthusiastic support and encouragement and personal involvement of senior management.

A friend unfortunately got to see this transition in action during a recent visit to a primary care practice.  For several years, the Lean philosophy was at work and, while things were not perfect, morale was high and all people felt they were part of a team engaged in constant improvement and mutual support.  Visual clues abounded to provide all parties with a sense of how the work process was flowing. Patients felt that the system was designed to serve them.

With a change in leadership, that has quickly unraveled.

My friend witnessed all the elements of a dysfunctional system.  Lots of people sitting in the waiting room.  Long lines at the front desk.  Some staff people at the front desk were overly busy, while others sat without enough to do.  Waiting over an hour from the order for a simple blood test to when it was drawn.  Patients leaving without the blood test because they had to get back to work.  Front desk staff blaming "those" lab techs for slow service--yes, aloud, for all to hear.  Lab techs blaming "those" front desk staff for overloading them.  A physician reporting that phone calls from patients were taking more than 15 minutes to be answered, resulting in a high call abandonment rate.  And the ultimate sad moment when the patient asked the lab tech how long s/he had worked there: The response, "Six months . . . and that's six months too long."


Kerry O'Connor said...

From Facebook:

Good cautionary real-world story. Organizational atrophy is insidious, and like a loss of one's personal physical conditioning (except for peak athletes) the diminution of skills and abilities is rarely apparent in the early stages. Everyone is victimized, but the patient (customer) takes the hardest hit. In a hospital setting that means you may develop an iatrogenic illness (the odds are about 30% of your developing one during an in-patient hospital stay) meaning you now have an illness you didn't go into the hospital with such as pneumonia or an infection. It greatly increases your likelihood of imminent demise (death).

Mark Graban ‏@MarkGraban said...

From Twitter:

1 of the hospitals I featured in 1st ed of @leanhospitals is NOT in 2nd ed, new CEO, fail

Mark Graban said...

Yes, the hospital brought in a new CEO who was an expert from their success at other hospitals... said that Lean wasn't needed... it unraveled any progress they had made. One leader can have that much of a difference. Lean hadn't fully become "the way they did things" there yet. Lean was too new (4 to 5 years)...

Anonymous said...

I don't mean to be a skeptic of Lean; I know it works when applied properly and stuck to. But these stories point up yet another reason why I believe it has not taken the medical community by storm. If 'too new' is 4-5 years and the average hospital CEO stays 10 or fewer years and a vast minority of CEO's are Lean trained when they arrive.....well it's easy to see why it doesn't stick.
I continue to challenge its cognoscenti to make it easier to implement and maintain in the real world.
Realizing, of course, that my challenge will be answered with all the reasons why that can't be done due to the nature of Lean. But look where you are now - treading water.

nonlocal MD

Paul Levy said...

Wrong conclusion, I think. The real conclusion is that we need boards of trustees, when hiring the "next" CEO, to insist that this be part of the strategic vision for the place.

BTW, your points would hold with virtually any kind of process improvement approach. This is not just about Lean.

Of course, it would help, too, if MDs were trained in this stuff in medical school and residency.

Anonymous said...

Well then, get busy. (training). (:

I would quibble a bit with comparison to any process improvement approach. I think Lean is a particular mindset and set of processes which require 'drinking the Koolaid' (in a good way) more than some other more mechanistic methods. This is both its great strength and its weakness in terms of ease of use.

Good point about the Board and new CEO, but I wonder if many boards are that focused. Certainly they should be.


Anonymous said...

By the way, as I have advocated elsewhere, it's high time we start naming hospital names with these stories. It does no good to tell these stories when the offender can remain anonymous to do the same thing to someone else. Certainly it's no different than a review on Yelp or something, and probably more fact-based. There is evidence that these reviews are having an effect, due to the public exposure.


Anonymous said...

And, I rest my case - written by a former official of Partners, no less.


Don Sharpe said...

After several years of supporting LEAN efforts where I work, it's disheartening to see that once implemented, LEAN could fall by the wayside... and so quickly!
I guess LEAN is really a culture like any other, without active support from it's leaders and participants, it withers and dies.