LEAN management - status of healthcare in Sask

[hitops]

So they are forcing us all to get LEAN management training in the health district. Gov looked at rising costs, rising needs in healthcare and decided to hire very expensive consultants to......what exactly?, nobody is really sure.

We are paying $40M for this program, so far LEAN looks like a huge waste of time. The seminars are ridiculous, we make paper airplanes and talk about how we should be efficient like Toyota. Putting aside the sheer stupidity of comparing car manufacturing outcomes to patient satisfaction, it's interfering in patient care. The number of people taken away from work to listen to the propaganda alone is hugely wasteful. The fact that we are supposed to get excited about it is embarrassing and almost cult-like.

To me it looks like classic avoidance of dealing with the real problems in health care. If you make a fuss and put a glossy cover story on it, you don't actually have to tell anyone the truth about health care financing realities. You can just point to LEAN and pretend you're doing something about it.

I am all for changing gov operations to be more business-like. But LEAN doesn't deal with any of the core issues. While unions protect the worst and laziest nurses and support staff, and patients can eat unlimited dollars of health care and not change their behavior at all, no amount of idiot seminars will ever really make any difference.

But I understand Ontario had to tolerate this s__t for a few years. Anyone have an experiences to share from out east?

Edited March 21, 2014 by hitops

[Michael Hardner]

It's hard to imagine a more context-free post. What is LEAN ? What does it stand for ? What are its objectives ? What is your role ? How are you expected to adopt it ? What are the expected costs and benefits ?

For the record, my experience with healthcare, government, and pretty much everything else is that it's badly managed.

[hitops]

It's hard to imagine a more context-free post. What is LEAN ? What does it stand for ? What are its objectives ? What is your role ? How are you expected to adopt it ? What are the expected costs and benefits ?

For the record, my experience with healthcare, government, and pretty much everything else is that it's badly managed.

All good questions, none of which are clearly answered by any of our managers or consultants.

Here's allegedly the basic idea: http://en.wikipedia.org/wiki/Lean_management

[Michael Hardner]

Well, it sounds pretty bad. The Wiki identifies a way to set up programs, did they talk about those steps ? Probably not.

[Michael Hardner]

I can't express the contempt I have for behind-the-times management. I hesitate to use 'bad' now because I have already overused it. When I go to a hospital, there's no end to the paper, paper signed everywhere, paper taped up in the examination rooms.... giving notice to all: "We don't manage our communication in this place."

And you give all of the information to every single person every time you see them, just before they give you a piece of paper and pen to WRITE DOWN what you just told them, so that they can disappear with the paper only for another person to arrive and engage in the same silly game.

[Topaz]

First of all, I've never heard of a "lazy nurse" burnt out maybe but lazy? I think every province and territory is struggling with health care and until we find out what the feds and the provinces agree on, we are struck with what we have but it could become worse depending of those upcoming province/federal talks. One thing I sure of is ever Canadians hates are the wait times either in the hospitals or the doctor offices we made. Giving 3 people appointment the same time, every 15 minutes, makes people wait up to a hour or more and then the dr. runs behind.

[Michael Hardner]

First of all, I've never heard of a "lazy nurse" burnt out maybe but lazy?

Scapegoating is a hallmark of wrong thinking around improvement. Here's a hint: look at the communication first - if they're doing something new and fresh with that, it's a good first sign. It sounds basic, until you realize that most initiatives fail this basic test.

I think every province and territory is struggling with health care and until we find out what the feds and the provinces agree on, we are struck with what we have but it could become worse depending of those upcoming province/federal talks.

I think the government should fund new initiatives now, based on the LEAN objectives stated above.

One thing I sure of is ever Canadians hates are the wait times either in the hospitals or the doctor offices we made. Giving 3 people appointment the same time, every 15 minutes, makes people wait up to a hour or more and then the dr. runs behind.

That's up to the local office. I almost never wait more than 5 mins in my doctor's office. ER wait times are 'hated' maybe, but most Canadians don't take an active interest in the issue and the mainstream "press" is asleep at the switch.

[eyeball]

All good questions, none of which are clearly answered by any of our managers or consultants.

Here's allegedly the basic idea: http://en.wikipedia.org/wiki/Lean_management

Sounds like a problem that starts at the top and trickles down through the rest . I don't know why you'd pick on unions and patients, and I doubt if even the managers and consultants are the issue. They're all taking their cue from higher up the food chain which is where you need to go to root out the real cause of the problem.

[Spiderfish]

So they are forcing us all to get LEAN management training in the health district. Gov looked at rising costs, rising needs in healthcare and decided to hire very expensive consultants to......what exactly?, nobody is really sure.

This may shed some light on the objectives of the program:

http://www.leanadvisors.com/lean-success-stories/government/province-of-saskatchewan-adopt-a-culture-of-lean

In summary, the Ministry’s focus is on providing value and the elimination of waste to:

• support our primary objective to create and maintain an unwavering focus on the patient;
• improve quality of care and safety of patients and staff;
• increase the effectiveness of our processes;
• increase customer satisfaction with our processes and the experiences of care;
• raise employee morale;
• increase productivity;
• lower costs; and,
• lead by example and share the journey with the entire provincial health sector.

We are paying $40M for this program, so far LEAN looks like a huge waste of time.

It may take awhile to see the full benefit, however efforts to date include:

• Over 1400 safety defects have been removed from the health system.
• The Children's Hospital of Saskatchewan Lean design process helped teams find more efficient ways of providing services, while improving the design and hospital experience for patients and families. The result was a 15.6% reduction of space required at a cost savings of approximately $30M.
• $4M has been saved this year through Lean improvements in inventory management of the provincial blood and plasma supply (a total of $14M since 2008).
• 3S Health provincial laundry services achieved 61% reduction of returned unused linen, 73% reduction of filling cart for delivery and several thousands in rewash savings.
• Through a staff scheduling improvement event, the Saskatoon Health Region anticipates annual savings of at least $4.4M once fully implemented.
• Operational efficiencies of $85 - $160M over 20 years will be obtained at the Moose Jaw Regional Hospital replacement by using Lean design.

It's hard to know for sure at this point exactly how much benefit and efficiency the LEAN program will create, but it's nice to see a province taking a fresh approach in trying to increase efficiency within the health system. It's pretty obvious that provinces have had poor results increasing efficiency and satisfaction in the sytem using the standard old methods and approaches. Deloitte has summarized their perpsective of LEAN program as: "LEAN cannot be looked upon as another cost cutting initiative - instead it must be embraced as a fundamental shift in thinking that will allow an organization to more efficiently and effectively provide patient-centered care". I think a fundamental shift in thinking may be what is needed, established perspectives don't seem to be getting us anywhere with regards to gaining efficiencies in the system.

Edited March 23, 2014 by Spiderfish

[hitops]

Sounds like a problem that starts at the top and trickles down through the rest . I don't know why you'd pick on unions and patients, and I doubt if even the managers and consultants are the issue. They're all taking their cue from higher up the food chain which is where you need to go to root out the real cause of the problem.

You're definitely right it comes from the top and everyone is forced to play along. But it's also circular, the public demands better services, the top needs to point to something to show they are listening. A new name, fresh coat of paint and a few cherry-picked numbers are the political answer.

Meanwhile wait times do not improve, drs offices still run behind, and the patient experience is no better. So then the next government some out with a new repackaged slogan to once again make it sound like they are listening. Rinse, and repeat with next government.

The real issues are not being address. They are:

1) Free health care for all with all the latest and greatest drugs and gadgets, delivered quickly and on demand, is a myth. Government should grow a spine and find out what people want, and clearly tell them the consequences. If free, good and fast, that will mean user fees, or dramatically increased taxes. If you settle for 2 of the 3, you need to tell people honestly that you can't have the 3rd one.

2) You will never deal with efficiency problems when the majority of your workforce is protected by unions. One of the unions fundamental functions to avoid becoming LEAN, almost by definition.

Until those two points get addressed, it's nothing but papering over until you get through the next election. LEAN cannot deal with either.

Edited March 24, 2014 by hitops

[Michael Hardner]

Hitops, I guess you missed Spiderfish's most excellent post.

Spiderfish, the one qualm I have with the results is that they need to be linked to other areas that show indeed that the savings have happened, ie. budgets were reduced, efficiencies were found etc. Otherwise, this is just self-reporting and should be looked at with a healthy dose of skepticism

[hitops]

• Over 1400 safety defects have been removed from the health system.
• The Children's Hospital of Saskatchewan Lean design process helped teams find more efficient ways of providing services, while improving the design and hospital experience for patients and families. The result was a 15.6% reduction of space required at a cost savings of approximately $30M.
• $4M has been saved this year through Lean improvements in inventory management of the provincial blood and plasma supply (a total of $14M since 2008).
• 3S Health provincial laundry services achieved 61% reduction of returned unused linen, 73% reduction of filling cart for delivery and several thousands in rewash savings.
• Through a staff scheduling improvement event, the Saskatoon Health Region anticipates annual savings of at least $4.4M once fully implemented.
• Operational efficiencies of $85 - $160M over 20 years will be obtained at the Moose Jaw Regional Hospital replacement by using Lean design.

• It's hard to know for sure at this point exactly how much benefit and efficiency the LEAN program will create, but it's nice to see a province taking a fresh approach in trying to increase efficiency within the health system. It's pretty obvious that provinces have had poor results increasing efficiency and satisfaction in the sytem using the standard old methods and approaches. Deloitte has summarized their perpsective of LEAN program as: "LEAN cannot be looked upon as another cost cutting initiative - instead it must be embraced as a fundamental shift in thinking that will allow an organization to more efficiently and effectively provide patient-centered care". I think a fundamental shift in thinking may be what is needed, established perspectives don't seem to be getting us anywhere with regards to gaining efficiencies in the system.

• There is NO independent confirmation of these numbers. This is old hat for government. You pick the numbers where there are improvements, and try to ignore the ones where there is deterioration. Or, you just ignore the un-measurable costs like decreased job satisfaction for employees, staffing shortages, or impacts on patient care. You CAN get better numbers on the money side if you push hard enough. You WILL have to accept that there will be patient-care cost to that. No government will ever be honest enough to admit that.

  I think the government should fund new initiatives now, based on the LEAN objectives stated above.

  In principle I completely agree with you. Working in health and seeing how things work, I can tell you that LEAN will never, and can never actually address the largest and most important inefficiencies in the system.

  A typical example from just this week: We are being told we should have standardized reporting sheets for a certain patient outcome of treatment. This will involve more paperwork, more computer programs, more time for nurses, docs and patients. It's adding FAT, not removing it. The LEAN objectives are in conflict with each other.

• A lot of the public will love the idea of LEAN. What they don't understand is that this will not actually improve anything for them.

Edited March 24, 2014 by hitops

[Michael Hardner]

Job satisfaction is indeed measurable. But you have to measure it. Do they ?

Actually so are staffing shortages, impacts on patient care too. And furthermore these go against the objectives stated.

Is your cynicism justified or are you just griping ?

[hitops]

Job satisfaction is indeed measurable. But you have to measure it. Do they ?

Actually so are staffing shortages, impacts on patient care too. And furthermore these go against the objectives stated.

Is your cynicism justified or are you just griping ?

Always a good question, but I can tell you with full honesty that I love my job and enjoy every day of work. This is partly just personal philosophy towards work attitude.

You can't measure staffing shortages, if your answer is to just making less staff do more work. If you just move the goalposts of what full staffing means, you can reduce staff and increase stress without ever having to acknowledge a shortage on paper. You get more sick calls, more mistakes, worse outcomes when this happens.

Should certain people do a lot more work for the sake of the taxpayer? Yes. Can LEAN deal with this? No. What will happen is that good employees will strain themselves more and result in more risk to patients,while lazy ones will not change. LEAN cannot deal with the unions, so it cannot deal with this problem.

I like the idea of LEAN in principle. It works great in real life in a factory like Toyota. It doesn't work in government delivery of services, because it deal with the inherent problems. Meanwhile, it can certainly make us all jump through a lot of hoops and waste a lot of time. I've had to attend at least 20+ hours of LEAN related meetings and lit. I can't think of a single thing that has benefited any of my patients, saved money, or saved time so far. I can point to a few things that have added complexity, added time and made patients wait longer.

Edited March 24, 2014 by hitops

[Michael Hardner]

Always a good question, but I can tell you with full honesty that I love my job and enjoy every day of work. This is partly just personal philosophy towards work attitude.

Do they measure it though ?

You can't measure staffing shortages, if your answer is to just making less staff do more work.

I misunderstood. I took staffing shortages to mean "we need X more people".

You're talking more about workload, and that too is measurable. You can't just pile work onto someone forever.

You get more sick calls, more mistakes, worse outcomes when this happens.

All of which are measurable.

Should certain people do a lot more work for the sake of the taxpayer? Yes. Can LEAN deal with this? No. What will happen is that good employees will strain themselves more and result in more risk to patients,while lazy ones will not change. LEAN cannot deal with the unions, so it cannot deal with this problem.

You're black to blaming individuals, which is just not a smart way to respond to these challenges. You have staff that can do a certain amount of work. Benchmark it and move on.

I like the idea of LEAN in principle. It works great in real life in a factory like Toyota.

They just paid the biggest fine in history for unsafe practices, so everybody has their limits. Plus Japan was the toast of the management world 30 years ago or so, so it's telling that Sask Health is getting around to it just now.

It doesn't work in government delivery of services, because it deal with the inherent problems. Meanwhile, it can certainly make us all jump through a lot of hoops and waste a lot of time.

What you're saying is "we're not like other operations". Trust me, every business I have worked with thinks this.

I've had to attend at least 20+ hours of LEAN related meetings and lit. I can't think of a single thing that has benefited any of my patients, saved money, or saved time so far. I can point to a few things that have added complexity, added time and made patients wait longer.

Again, you seem to have missed the post above. If it's self-reporting then fine, but they are reporting some benefits. You strike me as somebody who likes the status quo.

[hitops]

You're talking more about workload, and that too is measurable. You can't just pile work onto someone forever.

Ok I admit you can measure some aspects of workload, but not really the subjective ones. The perception of workload can vary drastically between individuals with the same workload.

You're black to blaming individuals, which is just not a smart way to respond to these challenges. You have staff that can do a certain amount of work. Benchmark it and move on.

No I don't believe 'just accept mediocrity' and move on makes sense at all. In companies that have used the lean model successfully, they certainly don't. They LEAN up by caning useless people. We have zero ability to do that, in the most critical areas.

What you're saying is "we're not like other operations". Trust me, every business I have worked with thinks this.

That's because they are businesses. We are not, we are a bureaucratic, government institution. We have interests that have leverage to make sure it can't touch them. What's left over is irrelevant minutia.

Again, you seem to have missed the post above. If it's self-reporting then fine, but they are reporting some benefits. You strike me as somebody who likes the status quo.

I would probably be the first to argue against the status quo here. I think you're missing my point, I favor a large disruption in how we do things. I just know LEAN can't accomplish this because of the walled-off protection of the areas it would make the biggest difference.

Let me give you an example: I am given x number of patient to see. My colleagues also often see the same patients, and we offer treatment in coordination. We are a very rural province, so many patient must travel 4-5 hours each way to see me, and then again to see my colleague. It is easier for me, and I have every right, to just insist patients see me only on scheduled days, which may be a different day than my colleagues. But I don't insist on that, I adjust my schedule instead so that I see the patient on the same day as my colleague, and save them the extra trip. This is a big time and cost saver to the patient.

Not only does this happen without LEAN, if it didn't happen, because of the entrenched unions and protections, there's nothing LEAN could do to make it happen. In the areas LEAN can affect, it seems to just add pointless paper-pushing. LEAN is the subject of jokes, and a source of frustrating to everyone I've asked who would much rather just get to work accomplishing something.

Nobody is helped, when I sit through 8 hours of hearing the story of Toyota. A bunch of people are helped, if I use that time to see a bunch of patients or do some actual work. A rural patient is helped, if I go out of my routine to fit them in the same day they see my colleague. Nobody is helped, if I have to review yet another piece of paper and perform a redundant documentation task.

The most efficient people I meet, are often nurses of the older generation who have the ability to use old-fashioned common sense in how they approach problems. LEAN makes these people less effective, and favors people who buy into the LEAN message over people who accomplish work.

Full disclosure: I am 100% paid by the provincial government. I would gladly work privately, but I am not legally allowed to offer my service to anyone else but gov.

Edited March 24, 2014 by hitops

[Michael Hardner]

Ok I admit you can measure some aspects of workload, but not really the subjective ones. The perception of workload can vary drastically between individuals with the same workload.

Perception of workload, yes for sure, but workload measurement is something management has to do. It will impact other numbers, too, such as worker satisfaction. If we're at the point where we're physically loading workers with more work than they can do then maybe it's time for worker representatives to get involved.

No I don't believe 'just accept mediocrity' and move on makes sense at all. In companies that have used the lean model successfully, they certainly don't. They LEAN up by caning useless people. We have zero ability to do that, in the most critical areas.

That's right, you can't fire people. So move on. Finger pointing isn't helpful, and results in negative attitudes.

That's because they are businesses. We are not, we are a bureaucratic, government institution. We have interests that have leverage to make sure it can't touch them. What's left over is irrelevant minutia.

Operations are operations. There are constraints that you don't have that businesses do. These are things that you work around. Whatever these 'interests' are, they don't seem to be able to stop the workload from piling up incessantly.

Communication isn't minutia[sic] and that's definitely an area that can be improved.

I would probably be the first to argue against the status quo here.

Maybe, but you're making the case for special consideration because it's government - which sounds to outsiders, like consultants, like you're digging in your heels for the status quo.

I think you're missing my point, I favor a large disruption in how we do things. I just know LEAN can't accomplish this because of the walled-off protection of the areas it would make the biggest difference.

Let me give you an example: I am given x number of patient to see. My colleagues also often see the same patients, and we offer treatment in coordination. We are a very rural province, so many patient must travel 4-5 hours each way to see me, and then again to see my colleague. It is easier for me, and I have every right, to just insist patients see me only on scheduled days, which may be a different day than my colleagues. But I don't insist on that, I adjust my schedule instead so that I see the patient on the same day as my colleague, and save them the extra trip. This is a big time and cost saver to the patient.

Why is it even an option for you and your colleague to schedule on the different days ?

Not only does this happen without LEAN, if it didn't happen, because of the entrenched unions and protections, there's nothing LEAN could do to make it happen. In the areas LEAN can affect, it seems to just add pointless paper-pushing. LEAN is the subject of jokes, and a source of frustrating to everyone I've asked who would much rather just get to work accomplishing something.

Why couldn't LEAN make it happen ? I think it's sad that people in such an environment make jokes about improvement. It's disgusting actually.

Nobody is helped, when I sit through 8 hours of hearing the story of Toyota. A bunch of people are helped, if I use that time to see a bunch of patients or do some actual work. A rural patient is helped, if I go out of my routine to fit them in the same day they see my colleague. Nobody is helped, if I have to review yet another piece of paper and perform a redundant documentation task.

I guess I'd need to know the details of the program as implemented in your area. If LEAN isn't addressing poor service, then it's not serving the stated objectives.

Did you ask about the situation that you're talking about here ?

Full disclosure: I am 100% paid by the provincial government. I would gladly work privately, but I am not legally allowed to offer my service to anyone else but gov.

Are you unionized ?

[hitops]

That's right, you can't fire people. So move on. Finger pointing isn't helpful, and results in negative attitudes.

So why are we doing LEAN then, if it can't touch the problems that really make us....fat?

Operations are operations. There are constraints that you don't have that businesses do. These are things that you work around. Whatever these 'interests' are, they don't seem to be able to stop the workload from piling up incessantly.

You can't stop people from getting sick.

Communication isn't minutia[sic] and that's definitely an area that can be improved.

One would have to show how this would make a difference. We already naturally communicate in way to get our work done as efficiently as possible. We could add 2x more communication, but to what end? In fact we could communicate all day and do nothing as a result.

Maybe, but you're making the case for special consideration because it's government - which sounds to outsiders, like consultants, like you're digging in your heels for the status quo.

Status quo is not a bad word. The point is optimal patient care, not 'do stuff different'. I mean what? What's the point if it doesn't help?

Why is it even an option for you and your colleague to schedule on the different days ?

Because we have different wait times. Welcome to government health care.

Why couldn't LEAN make it happen ? I think it's sad that people in such an environment make jokes about improvement. It's disgusting actually.

Courtesy of your friendly neighborhood union. Now in my department, I'm fortunate to work with good people. We make jokes about LEAN, not about improvement. Improvement was happening before LEAN, and will continue after it, so long as LEAN doesn't sabotage too much along the way.

Did you ask about the situation that you're talking about here ?

Yes, but one has to be delicate. Our superiors are expected to push this, so that they can tell their superiors they are with the program, and they can tell theirs, up to Brad. Then Brad can tell the voters he's doing something about it. Meanwhile nothing changes for the patient, except maybe more waiting for staff to do the extra paperwork.

Are you unionized ?

Not me specifically, but nearly every other type of health care worker.

[Michael Hardner]

Pretty frustrating - and it sounds like a mess that you're not interested in cleaning up.

[carepov]

In companies that have used the lean model successfully, they certainly don't. They LEAN up by caning useless people.

Not only does this happen without LEAN, if it didn't happen, because of the entrenched unions and protections, there's nothing LEAN could do to make it happen. In the areas LEAN can affect, it seems to just add pointless paper-pushing.

The most efficient people I meet, are often nurses of the older generation who have the ability to use old-fashioned common sense in how they approach problems. LEAN makes these people less effective, and favors people who buy into the LEAN message over people who accomplish work.

Forst of all I somewhat agree with you that LEAN can be a useless waste of time, LEAN is often over-hyped by its proponents and most training intiatives fail.

However when it done right LEAN tools can help to significantly reduce waste. It can work in manufacturing (unionized and non-unionized) in services and even at home. I am an outsider to heath care but I have observed some very LEAN operations in hospitals and clinics. A dermatologist was able to see about 10 patiens an hour, by "working on" 3-4 at a time. Chiropractors have eliminated the waiting time between their adjustments and crack away 20-30 patients an hour. Clinics assign nurses for more and more tasks saving valuable doctor time. And orderlies do more nursing work - less waste. Homecare can be seen as a LEAN initiative.

LEAN is a set of tools. Saying that LEAN is useless is like saying computers are useless - just look at all the time wasted by posting on MLW instead of working...

[hitops]

Pretty frustrating - and it sounds like a mess that you're not interested in cleaning up.

That's not really fair at all. As I've clearly articulated, I am interested in improving things and I've even given you examples of how I have. I think maybe you deal with these kinds of things in your work, and maybe it's just easier for you to blame the workers for lack of buy-in for when it fails, rather than confront the failings of the program.

I can give you a perfect example from just today. I was thinking about this and asked somebody in another department about it. She told me LEAN has been ongoing for a few years. One of the projects started in 2010, and she was told by our boss to start getting it going. It was a project to track the progress of a patient. I started working here last here and started doing it. I have since learned, I am the only one doing it of everyone that does the same job as me. Not only that, but when she started pushing people to get on board with it, she was actually reprimanded by the people who told her to do the project. This is because they gave lip service to it since they were expected to, but had no real interest in doing it day to day.

These kinds of problems will make any LEAN project fail, and LEAN cannot deal with this. If I'm the only one in my entire department doing it, obviously the program has no power to work here. In the meantime, it adds a lot of inefficiencies to our day simply to administer it.

Another example - they just lie. A major change was made 2 years ago for LEAN, and they issued a report saying x, y and z had improved. I asked the people involved, who told me no attempt whatsoever was made to confirm that those improvements actually happened, no attempt was even made to measure them. They just did it, and then claimed it helped. This is exactly the kind of crap I would expect, and exactly why I don't trust any result numbers such as those copied and pasted by spider. LEAN itself has no accountability, and no mechanism to verify whether any result it produces is anything but a made up number.

It actually reminds me a little of reading Soviet history. The top says what should happen, and everyone pretends it's happening. No need for independent verification, just put on paper what the superiors want to see or hear.

Edited March 25, 2014 by hitops

[hitops]

Forst of all I somewhat agree with you that LEAN can be a useless waste of time, LEAN is often over-hyped by its proponents and most training intiatives fail.

However when it done right LEAN tools can help to significantly reduce waste. It can work in manufacturing (unionized and non-unionized) in services and even at home. I am an outsider to heath care but I have observed some very LEAN operations in hospitals and clinics. A dermatologist was able to see about 10 patiens an hour, by "working on" 3-4 at a time. Chiropractors have eliminated the waiting time between their adjustments and crack away 20-30 patients an hour. Clinics assign nurses for more and more tasks saving valuable doctor time. And orderlies do more nursing work - less waste. Homecare can be seen as a LEAN initiative.

LEAN is a set of tools. Saying that LEAN is useless is like saying computers are useless - just look at all the time wasted by posting on MLW instead of working...

I like the analogy. This is kind of like using your computer to wash your face. Until patients become like manufactured products (where LEAN works), I can't see that changing.

Edited March 25, 2014 by hitops

[Michael Hardner]

That's not really fair at all. As I've clearly articulated, I am interested in improving things and I've even given you examples of how I have.

I suppose so. I just personally find it very frustrating to read about bad management, and see its effects on underlings such as yourself. The examples are frustrating.

Good management is like sunlight, once you have worked somewhere that does it. You are actually motivated to work more because you feel like you're listened to. It's just a shame that that it's so rare in the world.

[hitops]

I suppose so. I just personally find it very frustrating to read about bad management, and see its effects on underlings such as yourself. The examples are frustrating.

Good management is like sunlight, once you have worked somewhere that does it. You are actually motivated to work more because you feel like you're listened to. It's just a shame that that it's so rare in the world.

In government institutions, it's by design. There is no other kind that can flourish, almost by definition.

[carepov]

I like the analogy. This is kind of like using your computer to wash your face. Until patients become like manufactured products (where LEAN works), I can't see that changing.

LEAN does not always work in manufacturing. If done right, LEAN can work in any process where there is waste, including health care, accounting, call centers, etc...