March 2014 - The Real Story About Lean

The Real Story About Lean #nursing #skpoli #ptsafety

SUN was hopeful at the outset that Lean concepts would be effective - it's very disappointing this is turning out not to be the case in practice. We are progressively hearing more from the front-lines about how Lean does not fit with the registered nursing process. The leadership shown by engaging registered nurses in Lean must now extend to listening to the numerous concerns being raised and then responding to these concerns.

Now that Lean is being put into practice we are seeing the primary focus is on creating efficiencies, waste reduction and budgetary savings only, it fails to take into account patient acuity and complexity and is unfortunately proving to have little impact on direct care at the bedside and patient outcomes. We are constantly hearing this from our members and it is concerning.

When we look at what changes are already happening under the umbrella of Lean we should be worried. The Ministry-directed review of patient safety across the Regional Health Authorities (RHA)s under the pause on abolishment of registered nurses was as a direct result of serious front-line patient safety concerns raised with government.  RHAs were instructed to supply safety data relating to issues such as medicine errors and falls in order to track whether changes being implemented were in fact improving patient care. Unfortunately, only four (4) RHAs complied with the Ministry of Health’s directive and the data supplied showed some concerning trends of declining patient safety. When coupled with sky-rocketing province-wide and individual RHA critical incidents - 27% increase provincially and a doubling in the past four years for Regina Qu'Appelle Health Region (RQHR) - these findings should have been enough to reinstate the full provincial safety data review.

The fact is we are finding that Lean does not fit with the registered nursing process, safe nursing practice, registered nurse decision-making or the formulation of nursing diagnoses. Lean is viewing important knowledge-based aspects of registered nursing, such as consultations, as wasted time. The linear, production-line approach to creating efficiencies does not take into account the flexibility needed to deal with increasing and evolving complexities and acuities of patients we are seeing today.

There is no shame in acknowledging Lean is not entirely transferable to Saskatchewan’s health system. I think we are proving that as we go. It is not the single “catch-all”, this government or SUN and our members were hoping for.

Naturally SUN and front-line registered nurses shared government’s initial optimism that Lean would be the answer to improving patient care in our province. Sadly, this has not been the case. We are now at the point where we must look at whether we should be proceeding with Lean or changing course. This is not the time to steam-roll ahead regardless of the major red flags we are seeing along the way.

It’s not always easy admitting a mistake, especially for governments, who are at the mercy of their voters and constituents. But, when it comes to healthcare and the very safety and well-being of those who have entrusted us to lead, we must put political motivations, ideologies and rhetoric aside and work together.

That’s what Lean was about – engaging everyone, listening to everyone and then making truly positive transformative changes based on their feedback. Lean is supposed to be an inclusive process and when the largest provider of direct patient care says it’s not working we have to go back to the drawing board, and we have to do this together. It’s time to put patients first.