By Murray Mandryk, The Starphoenix
July 26, 2014 6:40 AM
SOURCE: http://www.leaderpost.com/health/lean+stopwatches+woes/10065419/story.html
The easiest way to measure what's gone wrong with lean implementation in Saskatchewan health isn't by counting the number of Japanese words health care providers were told to learn, or the number of paper airplanes they made in a training exercise.
What's gone so very wrong with the Saskatchewan Party government's lean implementation can best be measured by a stopwatch.
Yes, a stopwatch - the very device that many believe should be credited with the term "going postal" because of the way its use amped up the stress of assembly-line U.S. postal workers in an effort to get more productivity out of them.
Yet the Saskatchewan Union of Nurses (SUN) says stopwatch toting lean administrators have been following operating room nurses to monitor their performance.
Does this really contribute to the improved patient care that lean is supposedly about?
"When we followed up, we asked (why stopwatches were required)," said Amber Alecxe, SUN's director of Patients and Family First and Government Relations. "We were told it was about charting flow."
SUN president Tracy Zambory said such incidents say much about how lean seems more about positive statistics on "costsavings" and wait-time reduction than patient safety and well-being.
"Lean works to some extent as an administrative tool," Zambory said. "But we need to leave the relationship between registered nurses and patients alone."
According to a Praxis Analytics survey of 1,500 nurses last April commissioned by SUN, lean has had no impact or a negative one in both nurse morale and their ability to do their jobs.
Asked about lean's impact on "staff morale and engagement," 58.2 per cent of nurses surveyed said it has declined compared with only 7.8 per cent who said it improved (and the remainder saw no change). On the issue of "workload and stress" 49.5 per cent of nurses surveyed claimed it has worsened and only 7.9 per cent said it has improved.
On the issue of "time and opportunity for clinical education," 35 per cent said things have become worse compared with only 7.5 per cent who thought things are better.
Meanwhile, when it came to "time available for direct patient care," 41.4 per cent of nurses claimed it declined, compared with only 10.4 per cent saying they had more time. And that led 31 per cent of nurses to conclude patient safety had worsened, compared with 10.6 per cent who said it improved and a majority (54.4 per cent) who said lean accomplished nothing.
Of course, some will argue SUN is either simply resisting change or exercising its own political agenda. But that may also be little more than a convenient excuse to ignore the legitimate concerns nurses are raising.
For starters, SUN's concerns mirror similar studies by health regions that have explored the morale of their entire workforce emerging out of lean and have found that virtually everyone - from doctors to cleaning staff - views the exercise as a top-down morale-destroyer that may be worsening communication and grassroots input rather than improving it.
It is for this reason that we now see the Sask. Party government backing off on the more-resented elements of lean implementation that have involved the $40-million contract with Seattle-based John Black and Associates, learning Japanese terminology and flying in Japanese senseis (instructors).
Second, many of the concerns raised in the SUN survey are less about arbitrary issues of nurses' feelings and more about tangible measures. For instance, 42.2 per cent of nurses feel the quality of supplies has declined while only 9.9 per cent say they have improved. Meanwhile, 50.5 per cent said there are fewer supplies available while only 17.9 per cent thought the supply issue had improved.
Third, such numbers seem to support the anecdotal stories.
Besides the aforementioned stopwatch story, Zambory and Alecxe say the survey and general discussion with their nurses is producing stories of supplies being "leaned" out - vital respiratory equipment removed from emergency carts, catheters for nursing home patients that are cheaper, but more painful to insert, vaccines running out and more paperwork - not less.
And when nurses have brought up such concerns, some have been told by administration to "shut up" and stop complaining, Zambory said. The SUN president added the declining relations have really been more evident in the last year or so as the Sask. Party pushed its lean implementation.
It is this disregard for patient safety and well-being that lean implementation seems to inadvertently be causing that's most bothersome for nurses, Zambory said.
Better patient care can't be measured by just a stopwatch.
SOURCE: http://www.leaderpost.com/health/lean+stopwatches+woes/10065419/story.html
PREVIOUS LEAN COVERAGE: [Editorial] The Leader-Post March 24, 2014 - Zambory: Lean is useful, but not a cure-all
