This Cost Cutting Move Will Kill Doctors, Nurses, Patients

You can not cost cut your way to quality healthcare, only cheaper healthcare.

Where are all of the staff? Those who deliver healthcare have already been stretched beyond the breaking point. LEAN will only serve to increase the tension.

Where are all of the staff? Those who deliver healthcare have already been stretched beyond the breaking point. LEAN will only serve to increase the tension.

Of all of the cost cutting measures to come barreling down the pike in healthcare, this latest one has to be the worst and most ominous. If fully implemented, I believe the individuals pushing this new workplace redesign concept will be at least partially responsible for the deaths of not only patients but the persons who care for them, namely physicians and nurses. I’m referring to LEAN Staffing.

If you aren’t familiar with the LEAN concept, allow me introduce it to you. The LEAN process, sometimes simply referred to as lean,  is borrowed from the manufacturing sector. Lean production or lean manufacturing is a systematic method of identifying and eliminating waste within a manufacturing process. Well, that doesn’t sound so bad.

In essence, lean seeks to amplify or make obvious that which adds value to a product by reducing everything else which does not. This management philosophy was developed and utilized by the car manufacturer Toyota. So, how does this apply to humans? It doesn’t. That’s what makes it a bad idea for healthcare.

The actual application of this process to clinic or hospital staffing involves taking a process in healthcare, i.e. triage in the Emergency Department or nursing in a critical care unit, and breaking the entire process down into its constituent parts. Any duplication of effort or redundancy (in who’s eyes) is removed. Similar actions are combined (yet another loss of control). Shortcomings in personnel are either improved or removed (she/he is let go). Time allowances are shortened (you must work faster). Approved tools are prescribed then utilized and improper ones are discarded (by whom?). Waste (again, according to whom?) is eliminated.

The concise, but no less accurate, description for LEAN Staffing is “someone requiring someone else to do more with less.” 

This may work very well for manufacturing automobiles, flat screen TV’s or widgets of one form or another, but the problem as I see it lies with applying this process to the healthcare needs of humans. In manufacturing, the individual product doesn’t change. The product line or product model may change from time to time, but each unit within a product line is identical to the next. This makes control over the entire manufacturing  process much easier to streamline.

The LEAN process has no direct comparison, application or translation to the healthcare of humans. All humans may be people, but we are all different. LEAN assumes we are all the same. 

I do harbor one certainty concerning LEAN. Whomever the wizard of smart was that brought this process over from manufacturing to healthcare knows next to nothing about taking care of patients.

You can take identical twins, each with an acute asthma flare, presenting at the same moment to the Emergency Department and both would likely be triage’d differently based on level of acuity and a host of other patient specific factors. This would not be the case with LEAN which seeks to combine similarities, forgetting the fact that similar still means different when it comes to people. 

You can’t cookbook the practice of medicine and retain any sense of humanity. It is a violation of our solemn oath to “first do no harm.” 

The deliverers of healthcare have already been stretched beyond the breaking point. LEAN will only serve to increase the tension. For the past several decades now, physicians and nurses have been asked to do ever more with less — increasing numbers of mandates, new sets of guidelines, a growing list of performance benchmarks, increases in patient workload, a maniacal focus on coding and record keeping, all of which have negatively impacted the provider/patient relationship, decreased the quality of healthcare, increased error rates, forced physicians into early retirement, created doctor and nurse shortages and put patient’s lives at risk. And for what, a questionable and unproven notion all of this activity improves the quality of healthcare?

The sad truth is it’s not just patients who’ve been put at risk by today’s healthcare system. Our nation’s caregivers, the physicians and nurses who provide the care, are at risk as never before. Last year alone, over four hundred physicians committed suicide and the rates are rising. The rate of suicide among physicians and residents is six times higher than the general population. The industries response to this is now LEAN.

How much more blood can you wring from this turnip in the name of cost cutting? You can not cost cut your way to quality healthcare, only cheaper healthcare. If anything, we should be adding to the staff of ED’s and hospitals, not reducing staff or continuously increasing work demands. Work overload is one of the major mismatches which causes employee burnout which in turn increases employee turnover. You want to reduce costs? Reduce employee turnover and increase employee job satisfaction. LEAN will accomplish neither. 

As with LEAN, the usual decision makers aren’t the one’s caring for patients. The current healthcare systems wrests increasing amounts of control and decision making from the providers. Lack of control is just another of the six major mismatches which lead to job related burnout.

To the purveyors of LEAN within the healthcare industry I would ask, what would be your council when the staff of Emergency Departments and hospitals all across America are all “leaned out” and the next disaster strikes? How would you advise a hospital administrator or physician who was just asked to explain the concept of LEAN to a plaintiff’s attorney seeking damages for their client due to an untoward event in the hospital because of short staffing? What would you say to a patient who sits needlessly in a full ED waiting room because the staff is LEAN but several staff have called in sick, themselves victims of the latest epidemic?

Applying the LEAN process to healthcare is a horrible, ill conceived, dangerous and even lethal notion. More harm will come form this than good. Harm to patients. Harm to providers. Any implementation of LEAN in the healthcare setting should be abandoned immediately.

Had you heard of LEAN before now? Has your facility been through LEAN training? How has it impacted the way you deliver healthcare? If you would like to discuss this issue one-on-one, just click the CONTACT button below and I’ll soon be in touch.

Contact Dr. Brunout

Please note: I reserve the right to delete comments that are offensive or off-topic.

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2 thoughts on “This Cost Cutting Move Will Kill Doctors, Nurses, Patients

  1. Right on. It goes right back several years when the government was telling us how long a patient could stay in the hospital for certain conditions. I t didn’t matter if the patient had a set back or another condition arose while in the hospital. The patient had to go home and stay a specific amount of time before they could go back in the hospital. Remember?? I argued with insurance companies many, many times. Any way, I hope you are doing good. I think about our days together often with good memories. Miss you.