Wednesday, June 4, 2014

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."


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