NEJM and Lean – something’s missing

It’s been said many times over that’s what old is new again. If’ you’ve been around for any length of time, you’ve no doubt seen this phenomenon play out in everything from fashion to toys. So, it’s with some disappointment that I have to admit that Lean is not immune to this same trend.

nejm1Lately, for whatever reason, there seems to be a ground-swell against Lean, claiming that it is to blame for sterile work environments, devoid of any character or culture in lieu of efficiency and cost controls. A couple days ago, and article in the New England Journal of Medicine sparked some amount of outrage within the Lean community, as Pamela Hartzband, M.D., and Jerome Groopman, M.D. penned an article entitled “Medical Taylorism” (read it here). These doctors make some rather disturbing claims as they paint an overly-simplified picture that patient-doctor visits have regressed into little more than quickie oil-change appointments driven by the clock and not by patient satisfaction. If their claims are true (and I have no doubt that they are), then I would propose that they fire whatever consultant they hired, because he/she/they don’t know what Lean is really all about.

An outcome of Lean is often cost savings; that is true. But it’s just that – an OUTCOME. It’s not the focus – it never was, nor was supposed to be. There are Lean “experts” out there that are hocking that spin, promising big gains in efficiency and savings to land jobs and accounts. But they are perverting our craft, and conclusions like the ones drawn in the NEJM article are the inevitable outcome. Plant managers, business owners, doctors, engineers… they are all smart people, and they’ll draw conclusions based upon information given to them. So, if they see (or hear about) people being measured by a stopwatch, they will believe that that is the metric they are measured to. A company I once worked at unsuccessfully implemented hour-by-hour charts in an effort to understand how to maximize production lines’ ability to flow product. The mistakes in rolling them out were many, and the charts eventually became known as “pee-pee charts”, since managers told associates to make sure that they wrote what time they went to and came back from the bathroom on the chart to account for the line being down. A great tool fell by the wayside because the people trying to implement it bungled the engagement of the workforce in its use. Instead, it was regarded as simply one more way that management kept associates under their thumb.

Above all else, Lean is about delivering value to the customer through a properly trained and engaged workforce. That’s it. When employees care about their jobs beyond just getting a paycheck, that’s when Lean transformations really start to take effect. In Zeynep Ton’s “The Good Jobs Strategy”, she cites several examples of just how powerful this can be for organizations beyond simply enjoying work. Employees who are engaged help build businesses – they produce better quality, enjoy higher profits and lower turnover than their competition. All of these things support the bottom lines of what it takes to run a business by creating a better customer experience and not incurring avoidable costs.

For those, like Dr. Hartzband and Dr. Groopman, who say that Lean has no place in their industry because their industry is “different”, I say “Tell me something I haven’t heard before” . 1 out of 4 potential clients I talk to have some deviant view of what Lean is and why it’ll never work for them. Their product mix is too unique; their batch sizes too big/too small; their equipment is too finicky… I could list 50 excuses I’ve heard over the years. None of them accounted for anything more than that – an excuse.

Value is defined by your customer. In the case of healthcare, that’s your patient. If a doctor is telling a patient that he doesn’t have time for her questions because of time, then that’s not Lean – it’s garbage. Lean Healthcare seeks to standardize those things that should be to allow for a better patient experience. Having the proper amount of supplies readily available in a clearly marked and obvious location so nurses can care for patients- that’s Lean. Standardizing lab processes to eliminate mix-ups and reduce test turn-around time so doctors get the data they need faster – that’s Lean. It’s not about hitting a queue time for each visit. It’s about removing waste from processes to allow your people to do what you hired them to do; what they went to school for and ultimately what they want to do – provide the best patient care that they can.

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