Healthcare Culture Can’t Hinder Improvement

Posted on March 16, 2012


AirTran happens to fly where I need to go lately, so I have flown with them quite a bit. On a recent trip, I was watching the ground crew prep us for take-off and saw a very appropriate use of Lean design in action.  I looked on the ground and saw several areas striped off on the concrete apron as ‘no walk’ zones.  The rough outline of the parked plane was also clear.  In addition, accurately sized angled boxes were painted off to the side for all the equipment used to turn the plane over quickly—belt loader, fuel, baggage carts—and the boxes for each were labeled in big block letters.

This obvious use of Lean triggered a story from a book I read recently on Lean:  Norman Bodek’s Kaikaku.  In it Bodek explained how one industrial complex he toured had a workshop where equipment locations were outlined on the floor and every tool in a shop area had its exact shape outlined on the wall, not only so things could be found easily in the future, but also so things could be easily identified as missing.

My next immediate thought was:  why not in a hospital operating room?  Instrument carts, lights, stands, even people could be outlined on the floor.  Sterile packs could have bold lettering and instrument outlines on them so infamous cases of lost equipment inside the patient would never happen because it would be too obvious something was missing.

A recent post highlighted some hospital departments that would benefit immediately from a Lean approach.  Why are hospitals so averse to the visual practicality of it? 

One hypothesis is that each surgeon has his or her own idiosyncracies:  they like to do things ‘their’ way.  I appreciate the sensitivity of the personalities in healthcare, but one of the significant hurdles in hospital improvement (design and operations) is the culture of healthcare itself.

As an architect, I have been in many user meetings where this was apparent. Physicians can be eccentric and not aligned with the business mission of the hospital. Nurses can be entrenched in ‘the way I’ve always done it’ so much that they sound identical to a stubborn subcontractor. I have been told:  “healthcare hates consultants”, as if being confronted with new information, innovation and outside ideas are heresy. And how many times have I heard a worker bee recall “I was promised…” when discussing departmental space programming, leading to a recounting of every favor that was earned but never cashed in—and I’m getting what’s due me, doggone it!

These are not blanket statements; however, they are frequent enough—hubris, me-first, icy bedside manner, resistant to change—to be considered stereotypical for the industry.

The airline industry is not exactly the poster child for being well-run and profitable.  Historically massive losses, consolidation, razor-thin margins, poor customer satisfaction (just to name a few) plague the industry. However, they do some things really right, too:  safe, maximized consumer pricing, strong loyalty programs—and they are not afraid to paint boxes on concrete in the name of Lean to ensure a job well-done.

Healthcare would do well to be more open to the betterment of care and the organization’s operations first, instead of catering to specific scheduling whimsies and OR setups for a select few. In healthcare parlance, this is called “hospital-physician alignment”. In a process of any sort, it is the idiosynchracy that generates waste and introduces variability–anathemas to Lean and Six Sigma, respectively. Waste costs money and variability creates mistakes, and there is no room for either, financially or psychologically, in the designs for our future healthcare.