Why clinical staff has been labeled resistant to change

“Why is it every time I ask for a pair of hands, they come with a brain attached?”
— Henry Ford

This not so famous quote from Henry Ford illustrates why manufacturing operational proven methods don't work very well in a hospital.  For the past 15 years I've been watching hospitals struggle with improvement methodologies like Lean and Six Sigma and their application to ED wait times, medication administration, OR TAT, and even sepsis.

The weak results are not for lack of investment, training, or time.  The reason why these approaches seem to fail us is that we are forcing change.  It's always boiled down to a change management problem: "they are resistant to change".  After decades of trying we are just not getting the results from what I call manufacturing oriented operational improvement methodologies.  And the reason is simply that a hospital is not a factory.  

There are three things that are true in factories that are not true in hospital: 

1. The people that work in hospitals are brains attached to hands; they are not robots.   At three o'clock in the morning in the ER the doctors and nurses your hospital ought to be doing what's best for the patient.

 As far as the processes concerned, all bets are off.  The education and training of clinical people is incompatible with the manufacturing mindset.  Moreover, as a customer of a hospital I would prefer it stay that way.  Most people, I dare say, would prefer that doctors and nurses work based on their education and experience supported by a process rather than dictated by a process.  

Now I am not saying that people in factories don't have brains, however, they work within a process differently.  They deliver high quality products according to a specification.  It is expected that people in factories will throw out product that doesn't meet that specification.   It is called scrap.

2.  There is no scrap in hospitals.  The entire manufacturing process is built on the notion that we build to specification and try to minimize scrap.  Scrap must not reach the customer.  The notion of scrap doesn't exist in a hospital.  Hospitals are processes that cannot tolerate even the notion of scrap.  It is a fundamental difference and reality in a hospital.

3. Management of randomness.  We all know hospitals like factories are filled with random events and random behavior.   From machine downtime to surges in demand, manufacturing works to protect its operation from randomness.  

An entire discipline exists to deal with the logistics of randomness: supply chain management.   Manufacturing protects itself against randomness with buffers and inventory.  It builds a little bit extra at various points along the way to protect each individual step from and unplanned disruption.    

It is critically important to understand that here again the manufacturing engineers anticipate this capability. The issue isn't "do I have inventory?", it is "how do I minimize inventory?". Hospitals can't store up physician care and nursing time and protect itself against surges in demand or random events. The processes themselves have to be able to deal with randomness in real time, without compromise to patient demand or safety.

These are only three of the many fundamental aspects of factory life that are without mirror in hospitals.  They help explain why techniques to improve a manufacturing operation don't work very well in a hospital. They just don't fit. 

It is possible to get the performance break through that you need.  It starts with a collaborative approach that embraces the people, resources and culture unique to your hospital.  Not to change what you do necessarily, but to give it a boost to a new level of capability.  We would love to show you how.