Let's talk more about nursing.

“Turn up your hearing aid, Curmudge. I’m going to teach you more about nursing, and I don’t want you to miss anything.”

“Don’t you offer a senior discount, Jaded Julie, that will allow me to not hear 10% of your words? Well anyway, I recall from our discussion two weeks ago that when you were a new nurse you considered your profession a calling and your daily work a mission. Apparently your feelings have become tempered by the realities of experience. Tell me more.”

“Curmudge, hospital nursing is the ultimate ‘in-the-middle’ occupation. Despite being licensed professionals, we have an almost infinite number of bosses—each patient that we care for, his or her physician and the physician’s PA, and the hospital administration. Of course the heart of the job is to meet the needs of the patients:
· to experience minimal pain and discomfort,
· to receive the best possible treatment and care,
· to be kept safe from errors, infections, or falls,
· and, in general, to be delighted with their stay at an Affinity hospital.
While doing the above, we try to meet our own needs for professional and personal fulfillment. Nursing is always demanding and sometimes frustrating.”

“That’s an imposing list, Julie. Indeed, nurses are special people. When I meet a nurse in the stairway, I feel like saying, ‘Thank you.’ But as Lean zealots, you and I feel that in all of the above there are processes that contain waste and efforts that add no value from the patients’ or physicians’ perspective. With less waste, nursing would be more rewarding. Getting rid of this waste will be a big job. How will we do it?”

“You know better than that, Curmudge. It’s not going to be we; it’s going to be they, the nurses working in teams to 5S their areas and take waste out of their processes. Nurses excel in working on teams; think of how well they do in the OR or the ED when a trauma patient rolls in.”

“On the other hand, Lean practiced by nurses will be somewhat different from Lean in manufacturing. In manufacturing the workers gain a measure of participative management. But despite having many bosses, hospital nurses already enjoy significant professional autonomy. Their autonomy may be reduced by Lean when processes become more standardized and efficient.”

“Let’s put off autonomy and nursing practice issues for awhile, Curmudge. We need to score some early wins in areas that are not controversial. I believe you quality guys call that ‘picking the low-hanging fruit’. For example, if we train people in 5S and immediately put them to work using it, they will gain a feeling of accomplishment and be able to see the evidence of their good work. There aren’t many storage areas in the hospital that couldn’t profit from a good 5S’ing.”

“Not so fast, Julie. Before we do lots of rapid improvement events, or what my colleagues call ‘drive-by kaizens,’ we need to understand the ‘big picture’. As someone said, ‘Before the bus leaves, it must have a destination.’ Recall our discussions about hoshin kanri planning back in September and October of 2007. Then on January 18 we mentioned Pascal Dennis’s emphasis on strategy deployment to focus Lean tools on business needs. It’s important for people with discretionary time, as we discussed on 10/12/07, to work on hoshins and the projects that support them.”

“That’s not me, Curmudge. As a staff nurse, virtually all of my time is what you Lean folks call ready-to-serve. Is there some sort of big picture that guides the Lean efforts that I can squeeze into my ready-to-serve time?”

“I think so, Julie. I found a very insightful article that we’ll talk about next time. Although the paper is from France, it is written in English.”

“If it weren’t, Curmudge, you would find me taking ‘French leave’ from our discussion.”

“Au revoir, Julie.”

Affinity’s Kaizen Curmudgeon