SUNBurst | Distributed March 27, 2014 @ 2:30 pm
I want to thank you for taking the time to voice your concerns and support regarding our communication on the lean process in healthcare. I really do value and respect every member’s opinion. Also, I want to say, that for months we have heard the concerns of members regarding the process, so when we [SUN] receive positive feedback about instances where Lean is working, I feel hopeful and encouraged that the positive aspects (and there are many) can be translated in practical benefits for patients. Thank you for joining the conversation about lean and bringing both the pros and cons of the process to the surface for discussion.
There has been so much public debate these days about the value of Lean and its apparent failures and successes, especially on a political level, that I fear SUN’s messaging has been lost in the mix.
I would like to clarify that the partisan back and forth between government and the opposition over the past few weeks has largely missed the key issue for SUN members, and that while the NDP has aligned SUN’s position with theirs it is far from the case. We did not pursue any planned, joint messaging with either of the political parties. We have made it clear, and will go on record again, that there is absolutely no doubt Lean has helped identify waste and make improvements and we will support our member’s continued engagement in this work.
SUN members have, however, flagged many concerns. These largely centre on Lean’s impact on the nursing process. All too often we are hearing from members that registered nurse care planning has been simplified to a series of check-boxes and their ability to assess, plan and implement has been reduced. For example, members are reporting that the utilization of time and motion studies with the creation of “buckets of work” has undermined the knowledge application of registered nursing. Assessment, critical thinking, decision making, teaching, monitoring and discharge planning cannot be controlled by a stop watch. These important elements, that help clients understand their condition and help them prepare to leave the health care facility and successfully maintain their plan of care at home, are being eliminated.
We are hearing about instances where hemodialysis patients have been put at risk and harmed, or hospitals have run out of linens or wound dressings, because the margin for error or uncertainty has been “Leaned” out of supply chains. We have also heard about rushed discharges to increase patient flow, leading to poor outcomes and costly readmissions from members who work in both emergency and homecare. Efficiencies, found by scaling back high-touch surface cleaning in operating and emergency rooms, have resulted in rising hospital-acquired infection rates in some regions. Furthermore, untested model of care changes under the cover of Lean have reduced the capacity of registered nurses to adequately assess and monitor patients, safely in many areas across the continuum of care.
These are just a few examples of how Lean, model of care changes and care delivery redesign initiatives are impacting our members’ ability to provide safe patient care. Registered nurses are in a tough spot in raising the alarm about patient safety. They are exempt from whistleblower protections, are concerned with patient confidentiality, and fear repercussions in their workplace. SUN has moved forward to government close to one hundred specific member-documented instances of risk and harm to patients along with 860 work situation reports for 2013 alone only to have the plug pulled on a joint safety review when health regions proved unable or unwilling to provide data. This has only heightened concerns we are not properly measuring and evaluating outcomes.
I know many have suggested SUN has suddenly changed our position and withdrawn support for Lean. I want to assure you, this is not the case. We will continue to be engaged in the process and will always support our members in their Lean work. Members are however, having doubts about its wholesale application to aspects of the system, especially direct patient care. All SUN is saying, is that Lean, like anything else, shouldn’t be uncritically accepted as the catchall answer to addressing every healthcare challenges. Engaging providers and patients must include being open to rethinking what we are doing along the way.
Sincerely,
Tracy Zambory, RN
President, Saskatchewan Union of Nurses
