Are you Lean, becoming Lean, doing Lean or thinking Lean?
Almost the entire province of Saskatchewan has gone Lean.
On the surface Lean offers everything front line workers should want. It is a system that addresses work process and reduces waste. It looks at the appropriate use of tools, including us humans. It allows for continual process improvement with a focus on quality. It involves and values front line workers in process design. Some managers claim it even saves money that can be reallocated elsewhere.
So why is it we hate it so much?
Lean is a system of continuous process improvement that originated at Japan’s Toyota in the 1930s (sometimes misidentified as the Toyota Productions System – TPS), although founder Taiichi Ohno admits that he generously ripped off Henry Ford for many of his process ideas. Others say the origins go back thousands of years to Africa. The term Lean itself came from a 1988 article on Toyota’s management system by an MIT student.
While initially geared to assembly line manufacturing, Lean has expanded in recent years to include the service sector.
It’s everywhere, including health care, and yes there is even a Lean for Dummies book. You can even buy software to do nifty Lean process maps.
At a recent Insight Conference in Toronto some health care managers were more than happy to give case studies of how Lean improved quality service delivery at their hospitals. The case studies usually finished with a photo of a smiling “Kaizen” team. Kaizen’s are process committees.
While Lean is promoted as “transformative,” most examples were much more modest in nature. For some, it was hard to tell what the actual improvement was.
Rather than delivering major change, some were critical that relative to the labour expended, the results were less than impressive. Being labour intensive, many complain that it is difficult keeping Lean going over the long haul. Many hospitals may simply tick off the check mark – yup, we’ve been Leaned. Now back to work.
The Lean groupies insist that the process needs to be expanded up to scale to get the results they think can be gained, but the examples are elusive.
Working in health care is not for sissies these days. Ontario Hospitals are experiencing their first core funding freeze since the Harris era. Other sectors are not doing much better. Everyone is complaining about workload.
It is understandable in this environment that seconding a group of workers to take Lean training and work on a project to figure out where, for example, the lab equipment gets moved in order to save a few steps, can generate a fair amount of internal resentment.
The experts say the opposite of Lean is not fat. Implementing Lean in a hospital system that is operating on funding well below the national average still risks the perception that we are going from Lean to Anorexic.
The other common thread is that most health care environments really don’t have the culture or trust to make Lean possible.
It’s nice to see front line workers on committees, but are they really being listened to? In some cases, the Lean Kaizen team has simply by-passed those who have a front line perspective. Others have gone to the other extreme by bringing community members into the process. One doctor lamented that leaving out the support staff in his hospital was a big mistake. Choosing who goes on the team can be a choice fraught with peril.
Hospitals often blunder by leaving the union out of the process. Did anyone not think this would raise suspicion about motives?
One former CEO suggested to us that Lean was simply a way of co-opting our members into finding ways to eliminate their own jobs. More cunning Lean promoters will talk about quality improvement; the less savvy will focus on how much money they can save.
Let’s face it; all those chirpy Lean terms can be really annoying. One of our members was told recently that a Kaizen team leader had a green belt in Lean. The member replied she had a black belt in filing grievances.
Professions often invent complicated language as a way of distinguishing themselves. If nobody knows what you are talking about, you are probably really smart. Talking to an auto mechanic can make you feel like a complete idiot. Yet Lean uses the same kind of language blocks while at the same time expecting a culture of openness and buy-in from all.
Lean reminds us of the old joke, how many psychiatrists does it take to change a light bulb? The answer is one, but the light bulb has to really want to change. Executives and managers are like anyone else – they find change scary. Unlike everyone else, they have the power to make change or stop change. Hospitals and other health care providers are not democracies. For middle managers, having front line workers drive change can also be a little unempowering.
We note that there is intense pressure to adopt Lean even if the leadership doesn’t believe in it. It wouldn’t be the first time we heard a middle manager say, ‘ let’s just get through this until the next fad comes along.’ Anybody still remember Total Quality Management?
If you are one of those people who have a lot of ideas and oppose prevalent thinking, chances are your Lean team is going to shun you. Then you become an official naysayer and get to undermine the whole effort among your colleagues. The Toyota system puts much emphasis on respect for people. That’s a huge obstacle in many health care environments.
In a European study on psychosocial hazards at work, Lean production is actually listed among the top 10 stressors along with work intensification, outsourcing and poor work-life balance. That should stop anybody in their tracks who believes in evidence-based decision-making.
Henry Ford and Taiichi Ohno really didn’t design their systems for us. They designed them to make cars.
In a perfect world, with enlightened executives open to real process change, this might have a ghost of chance of working. Then again, it could also be a huge distraction at a time when we really do need to keep focused on the challenges ahead.
Have you been Leaned? Tell us your experience by commenting below.