No Michael Scott, Hospitals and Manufacturing Are Not the Same

September 24, 2014

I loved the TV show, “The Office.” It starred Michael Scott (played by Steve Carrell), a bumbling boss of a paper company who continuously and hilariously shared is inane “wisdom” with others. In one of my favorite episodes, Michael was invited to be a guest lecturer at a business school. He was trying to teach the students about business when he uttered the following line:

“There are four kinds of business:  tourism, food service, railroads and sales. And hospitals slash manufacturing. And air travel.”

If you count more than four types of businesses in that sentence, you are really “with it.” Today is going to be a good day for you! If you find the grouping of hospitals/manufacturing into one business type to be odd, then I am right there with you. But I wonder if sometimes, in our efforts to improve the patient experience, we might act as if hospitals and manufacturing are more alike than they really are.

One of the biggest goals in manufacturing is to get to as close as zero defects as possible. In assembly line-type manufacturing, that means you take the work from the previous station, which should look exactly the same every time, then apply the same manufacturing process to it…every time. If everyone along the assembly line does their work exactly the way they are supposed to without fail, then you should have virtually zero products that don’t meet standards by the end. But what if the products put out by Station B in our assembly line varies each time? If you are working in Station C and you follow your scripted work process and don’t adapt to what you receive, then the errors in those products will continue to be passed along.

The big reason health care is not and never will be like manufacturing is that our patients come in with different needs, different expectations, different experiences, different behaviors, different levels of knowledge…you get the gist. The only thing consistent in service is patient variability. The healthcare organizations that will “produce” the most satisfied patients in the future won’t be known for their consistency in using a particular script or best practice, but for their front-line staff’s freedom and ability to adapt to whatever physical, mental, social, emotional, or spiritual condition the patient arrives in.

The future leading organizations of the patient experience will reject the task-based manufacturing approach to improvement and move toward a goal-oriented, principle-based method of improvement. Scripts like AIDET will be replaced with specific goals like reducing patient anxiety and others. For patient anxiety as an example, staff will receive training that helps them to identify the variety of reasons patients get anxious. Staff will learn tools and ideas that emphasize adaptability over consistency, empowerment over conformity, and reflection over auditing. They will be masters at meeting patients where they are and finding the right solution for their particular circumstances. The best organizations for the patient experience will learn from others’ best practices, but will insist that they can do it better. And they will do it better than any “manufacturing” hospital out there.

Sorry Michael Scott, hospitals and manufacturing just aren’t the same.


Always Reinvent the Wheel

April 30, 2014

One of the most enjoyable parts of my work is getting paid to do a hobby of mine–thinking of new ways to address old problems. Even as a child, I would happily spend two hours thinking about how to do a one hour homework project in 45 minutes. I know that doesn’t make sense, but it was something I enjoyed doing just for creativity’s sake.

Now I realize what valuable learning opportunities those moments were as a child. Through trial and error, I was learning how to think about problems from multiple perspectives. The biggest lesson I learned is that there are multiple ways to accomplish goals, and there is always a better way to do it if you spent the time to think about it.

So…ALWAYS TAKE TIME TO REINVENT THE WHEEL. In my experience, no statement kills innovation, fun, and creativity more quickly than someone in a workgroup uttering the phrase, “Well, let’s not reinvent the wheel.” There are so many reasons to reinvent the wheel. Even when you don’t come across a better solution for the time being, you have planted the seeds for a further innovation. Here are a few additional reasons why reinvention is worth the effort:

  • Today’s best practices won’t be tomorrow’s – The words “best practice” is a misnomer. The more accurate name would be “better practices, for right now.” Every current “best practice” will be replaced with something else in the future. You should probably get started on its replacement!
  • The context of your problem is always different – Details matter. Most solutions require some resource mix which includes time, energy, skills, culture, products, processes, and so on. If your resource mix differs, even slightly, from someone who has implemented a best practice successfully, your solution will also need to be different.
  • If you build it, you’ll know how to fix it – Every effective best practice makes assumptions. When you take the time to reinvent the wheel, you will list your assumptions as a matter of diagnosing the problem. If your solution doesn’t work the way you imagined it would, it will be more apparent what assumptions were incorrect.
  • Innovation is only as good as people’s desire to use it – So you have a solution, now what? You have to implement it. In service industries in particular, how you implement something requires a great deal of innovative thought itself. We are often trying to change the way staff interact with customers. It is one thing for you to tell staff you want them to greet customers with the phrase, “It is my pleasure to serve you today.” It is quite another to get them to do it with a smile, especially when there are no cameras around or a supervisor to observe!
  • The wheel itself has been reinvented many times over – There is a reason you don’t see wagon wheels much anymore.


Curiosity: A Most Curious Trait of Caregivers

April 28, 2014


The most patient-centered caregivers are, by nature or learning, very curious people.

Imagine there are two nurses, Amber and LeSean. These two nurses are the same in nearly every respect. They work on the same unit. They have the same number years’ experience. They have the same level of clinical skill. The one thing that is really different between the two is that Amber is very curious about the world around her. LeSean is not. What difference does that make in providing care?

Imagine that both are presented with a patient who resists taking the medication she was prescribed. If we could hear each of their thoughts, it might sound something like this…

Amber: “I wonder why this patient is resisting this medication. Why is this patient anxious at the moment? Does this patient understand how this medication will help her? Is there something I did or didn’t do that makes her not want to cooperate with her care plan?

She doesn’t understand that she’s not going to get better if she doesn’t take her meds the right way.  Why do I even bother!?”

Something really interesting is happening in each of these situations. Amber’s curiosity has gained her the power to make things better for herself and the patient. Instead of having a patient that IS a certain way, she has a patient that is temporarily acting a certain way but whose behavior can change for the better. LeSean’s lack of curiosity will put him on the defensive with this patient and all but guarantees that he will make things worse for himself and the patient.

Curiosity is a fantastic trait for caregivers. It helps us to see so many possibilities to improve the care of our patients and gives us the power to make it happen. When you find yourself in a challenging situation with a patient, let your curiosity take the lead. Change the situation into a puzzle to be solved. Realize that you have full control over how you are going to perceive the patient. That perception determines your possibilities.

The Principle of Mandated Health Insurance

October 20, 2011

This issue remains a very contentious issue within “Obamacare.” According to Poll Position , “77% of Republicans believe mandatory health insurance is wrong, 63% of Democrats support required health insurance, and independents oppose it by a 48%-40% margin.”

Let’s forget about the technical aspects of mandated insurance and focus on the principle of it. On principle alone, I’m not sure why the positions of Republicans and Democrats positions on this measure aren’t reversed. At the core of this issue is who should be financially responsible for one’s care: the individual or the state? In the real world, Republicans gravitate toward personal responsibility and Democrats tend to favor the social safety net. In Political Bizarro World, they hold the opposite positions.

In full disclosure, no one is likely to tag me with a liberal label any time soon. As a student of mine said on my Rate My Professors page, “He’s from Texas, need I say more.” That said, I fully support the principle behind mandatory insurance. I liken it to liability insurance on your car. If someone else causes a crash with me, either accidentally or because of poor choices they made, why should I be stuck with the bill? Shouldn’t the other person have to take personal responsibility? The parallels with mandatory health insurance are obvious. If someone gets sick, either accidentally or because they made poor health choices, why should the taxpayer be held financially responsible?

There are certainly important technical and economic issues of mandatory insurance that may sway one’s opinion. However, I find it hard to believe that the majority of the American people know enough about the details of the legislation that technical details are responsible for their opinions overall. This issue seems to show just how strong the influence of political leaders is…as they have convinced their constituents to take positions opposite their own principles.

Accountability: Either, Or

January 26, 2010

Suppose I tell an employee that I am holding him accountable for signing up 40 new people for cable TV services over the next month. I provide him the list of potential customers I want him to use and the script I want him to use as he goes door-to-door. Does he truly bear responsibility for the outcome if I gave him the process he must follow? Who can say definitively it was the employee’s fault and not my instructions or script?

You can hold people accountable for the process or the outcome, but not both.

Employee Satisfaction

April 8, 2009

Organizations often have employee satisfaction as a general goal. The specific goal is to make a number that represents employee satisfaction higher than it was the last year. To me, it’s not how you satisfy your employees, but who you satisfy.

Cookie cutter approaches to addressing employee satisfaction make some routine suggestions such as better compensation, time off, more staffing, etc. However, given the emphasis on diversity in the workplace, why would we think there is one magical type of satisfier that will meet everyone’s needs? Take compensation. Even if everyone receives a little more pay, we know that people often judge their benefits relative to other’s. So even greater compensation is not such a “no brainer” after all. If I perform better than someone else, why should they get as much of a raise as I?

The question we should be asking ourselves is who we want to be happy to work in our organization. I believe it should be a specific goal of organizations to make work as uncomfortable an experience for low performers as possible. The objective is to get such low performers to improve (to be happy) or move on (to be happy). If your low performers are relatively happy, they’ll stay. If they stay, your high performers will be unhappy and they’ll look elsewhere.

Exact practices that differentially impact the two groups of employees depends somewhat on the type of industry. High performers in service industries will desire greater flexibility. High performers in manufacturing might respond better to a more structured environment.

But one thing we should be able to agree on is that high performers aren’t scared of being held accountable for their work. They even thrive on it and desire it. For the unsuccessful, accountability is the arch enemy. You want to make your top performers happy? Find what makes your low performers unhappy.

Psychology of Managing 101

October 24, 2008

No matter how good of sense an initiative makes to you, no plan will succeed without sufficient buy-in from employees. This is where a crash course in psychology can be very important.

It is not what you say, but how you say it. The best ideas for changing work processes often come across as “just another task” when the boss tells you what you are going to do.

What follows is the backdoor way of getting your ideas into your people so that it feels like it is their idea. It may be easier to just tell employees what they should do, but if you don’t want to be looking over their shoulder all the time to see that they are complying, if you want them to internalize the changes, then take the counseling approach:

  1. Ask your employees or representatives from the group for their help.
  2. Define the objective. Ask them why “the old method” didn’t work/isn’t working as we had expected. (Note that it is very important to talk in the plural we/our/us to make it a team effort.)
  3. Work out the new solution together as a puzzle, one piece at a time, even if you think you have the solution. Be sure to follow the throughput process from beginning to end. You may be surprised what kind of effect a seemingly minor inconvenience at the beginning of a process can have by the end.
  4. Highlight the good logic and ideas they have along the way. Let them own those ideas.
  5. When you arrive at the best solution, let them tell you again why “they” think this was the best way to go about reaching that objective.

Another benefit of the process above is that you get to test the waters with your idea without incurring any penalties for demanding something that won’t work. If you are managing to improve rather than managing to control, this counseling style approach will get you there.