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.


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.


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.