WHEN “LEAN” IS FAT!

The buzz word in today’s management circles is “LEAN” — not as against a lamppost, but as trimmed back to basics and making the most of computerized technology to produce a measure of quality efficiency. This is a fantastic concept that works in manufacturing (such as with Swiss Screw precision parts, and with automated equipment operations).

Unquestionably, implementing LEAN can make a difference. The problem is that –as with MBWA and Quality Circles and Theory X and Theory Y and JIT and scores of other management and leadership approaches– too many leaders desperate to make a name for themselves by shaking up their organizations tend to latch on to the latest fad, and expect nirvana.

With LEAN, too many advocates of quality leadership in management are attempting to put this square LEAN peg in a round ultimate consumer hole. The result for many of these forced marriages — especially in healthcare (doctors, hospitals, and facilities of every description)– is that they can end up victimizing themselves by a rush to “leanness.”

It’s not unlike cutting back food consumption to lose weight, then ending up dizzy and disoriented. In other words, too much reliance on streamlining the process can easily overshadow the basic thrust of an organization’s purpose.

Consider for example, what the last few letters (hint: Not “EHR” or “EMR”) in healthcare, are all about. All the cost efficiencies and lightning record retrieval systems in the world cannot come close to the only thing that –in the end– really matters:  care.

Of course a LEAN approach in healthcare can mean more accurate, more efficient, more rapidly delivered patient care. But buying into LEAN as if it were the end-all, be-all, ultimate solution to healthcare is like saying that the process of flying the plane is more important than the pilot. And that may well be the case some day but, for now, reality dictates that computer technology apps are simply tools to afford providers the opportunities to provide better quality patient care.

Use LEAN. But give careful budget and strategic planning consideration to the kinds of staff training and practice development avenues that far override the values of LEAN, such as:

1) Staff, patient and patient family communication. [A world-leading hospital I am intimately familiar with has robots delivering meds to patient rooms, but staff physicians who file endless numbers of computer reports don’t read one another’s reports, or communicate with each other. Few even have direct contact with the nurses dispensing the drugs!]   

2) Staff, patient, and patient family stress management [Did you know that the more relaxed a patient is, the more accurate the diagnosis can be and the better the response will generally be to treatment? The better the odds for reimbursement too, not incidentally! Patients and their families seek trust and  reassurance. LEAN may set that table, but only physicians, nurses and professional staffs can deliver the meal.] 

Target your budget and your process emphasis behind the kinds of communication skills and stress management training that providers and provider support staffs most need and least often get if you really want LEAN to work. Diets are great if you stick to them, and success often reduces itself to maintaining an ongoing dialogue about it with someone who supports your pursuits.

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Healthcare Management Problems

Go Far Beyond Technology Tangles

Thanks to what many doctors regard as excessive and medically-uninformed government intervention, and excessive and medically-uninformed insurance company intrusion, America’s private and hospital-based medical practices are suffering from excessive and medically-unacknowledged stress.

They find themselves having to be caught up in blood-curdling power play control battles instead of with innovating and nurturing methodologies for improved case management and patient care. This is not a condemnation of medical technology advances by any means. It is in fact an endorsement for more tech exploration while simultaneously getting back to basics.

Positive stress enables healthcare managers to answer the wake-up call for effective practice management to realistically occur on two fronts at the same time. EMR and EHR systems and skills represent focal point one. Case management, patient care, and patient family care, focal point two. But negative stress (or “dis-stress”) surfaces when one of these enslaves the other.

Relentless interruptions of non medically-trained government and insurance regulators seeking to satisfy their self-importance at the expense of doctor, staff, and patient stress levels, has the same effect as throwing gas on a fire. Whether rulings require doctors to spend just 12 minutes per patient, or to conduct patient gun ownership surveys, the result is negative stress.

Negative stress feeds medical errors, and takes its toll on the lives of trained professionals and their families. Often, patients and patient families suffer needlessly because of mixed or contradictory signals lost in busy day-to-day clouds of smoke.

Even monster teaching hospitals, including the highest-rated in the country, fail miserably at basic communication skill levels. Doctors don’t talk with one another. They are too pressured to take the time to advocate on behalf of the very patients they serve.  And –worst of all– they fail to communicate with their patients and patient families meaningfully and consistently.

Practice managers get the short end of the stick. My guess is that most end up absorbing 3/4 of all the stress generated by the mad rush for maintaining Herculean time schedules, by catering to the administrative needs of the doctors they serve, and by managing the daily barrage of staff, task and insurance management issues, plus catering to patient and family requests.

There are solutions, but they are not one-dimensional. Healthcare can never have universal value unless those charged as providers can have the freedom they need to function without constant government interference and insurance company strangleholds.

The first step to fixing a leak is to stop the leak. This means making extraordinary efforts to channel stress productively and to commit to implementing improved personal communications.  CHECK OUT  Medical Practice Managers

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Hal@Businessworks.US    302.933.0911

Mind Over Undermine

     At some time or another, every business and professional practice boss discovers a hired or inherited employee or group of employees whose sole mission appears to be to undermine operations—from manufacturing to customer service/patient care to administration to sales.

     Sometimes it’s vindictiveness, jealousy, bitterness, resentment…all good stuff, right? Sometimes, though, it’s naivety, ignorance, immaturity, misplaced loyalties, or just plain stupidity. While the reason might be important to uncover, what’s most important is to act on the discovery before it has chance to fester.

     If it’s too late to contain the infection from spreading out and affecting others in your organization, it may require you to rise to the confrontative occasion and call for all the cards to be put on the table. This, however, is not always the best solution.

     Why? Someone who may have been undermining you or your business or practice may be truly innocent of premeditation, or was perhaps unwarily acting out someone else’s issues. In that situation, you could be pulling the plug on someone who is a valuable potential asset to your operations or reputation.

     This may be the right point, instead, to pull in a professional to facilitate differences and/or re-train problem employees, or to counsel you on how to do it, or to force the situation to a head on your behalf. At any rate, it’s certainly worth the time to discuss the circumstances with an outside consultant before making that decision. 

     Prepare a short bullet list of issues and individuals involved with your own assessments of how effectively each performs in the roles for which they/he/she were/was hired. Try to keep your comments as objective as possible so as not to prejudice an outsider’s opinions, but articulate your issues and concerns clearly.

     Make your mission clear, and make your goals for each position that’s involved clear ones. In the process, look to your self as well, and question what (if any) contribution your own statements or behaviors may have contributed. Ask your consultant for a straightforward, unvarnished opinion and recommendation.

     Decide when, where and how to act, and what to say. Be receptive to whatever responses you provoke, and assess those in private. In the end, you will have given enough time and energy to the situation to justify moving forward from the point of implementing your decision. Then move forward.     

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Hal@Businessworks.US   302.933.0116 

 Open minds open doors.

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