I regularly refer to Quality
Partners, as organizations committed to improving laboratory Quality. At the same time, the single greatest impact
on Quality comes from the public through its agents: the media, the regulators,
and the legislators. The following
describes when the public conspires to kill Quality.
For those outside Canada, Saskatchewan
is a province just west of the true geographic centre of Canada. It is a province big in size, small in
population with a growing economy based largely on agriculture and
resources. It is currently run by a
centre-right party (the Saskatchewan Party) with a substantial majority with a
centre-left party in opposition (49 seats
versus 9 seats). Most would not be
surprised knowing that the government is interested in being financially
efficient through error and cost reduction.
To do that it has turned to
Quality and Lean, with particular attention on Healthcare (that is a good
thing). To accomplish this they decided
to hire an American consultant group (not sure why; there are many Canadian
organizations that could have done equally well) to investigate, advise, implement
and train a team of Lean leaders throughout the province.
One aspect of the implementation
was right out of 5S (as in Sort - Straighten - Shine (clean) – Standardize
– Sustain); they supplied templates
and guides on how to Standardize procedures in Healthcare. So that was what the team of Lean Leaders did. They went through the healthcare system and
wrote “SOPs” to standardize process. To
anyone reading this story on this site, that would all seem to make a lot of
sense; Yes? (of course Yes!).
So now we enter into the
politics. The opposition party (remember
their very weak position) decides to take a swipe at government because they
say the contract with the American consultant was too rich. Well, politicians are politicians and
opposition parties are supposed to say bad things; so I can live with
that. Besides I’m still annoyed by a
decision to go American, when there are lots of good Canadian organizations
that can implement Lean programs.
But then things get
stupid.
First the opposition party
report through the media that they found a standardized procedure for making
coffee. This, the media jump all over. The coffee instruction became a major
scandal. The fact that it was not in a
healthcare facility was irrelevant.
Then they went on to
complain that over the last few months the amount of savings due to Lean was
paltry. Then they complained that the
problem with Lean is that uses too much jargon and is disliked by many
front line health care workers [see: http://www.cbc.ca/news/canada/saskatchewan/sask-nurses-say-they-re-being-intimidated-over-lean-program-1.2610542
]. This too becomes fodder for the
cross-Canada media. Then it is reported
that the Lean program was implemented not only in acute care but also in
nursing homes. Shock upon shock.
To be fair, there were some
stupid things done, like deciding to import Japanese senseis to help in the Lean
training [see: http://www.cbc.ca/news/canada/saskatchewan/wanted-japanese-translators-to-assist-lean-consultants-1.2816341
], and an apparent decision to replace nursing home residents' facilities with
space for health-care bureaucrats [see: http://www.leaderpost.com/news/Mandryk+Wall+must+avoid+another+lean+mess/10704492/story.html
], but by the end of all this, the opposition centre-Left and the hard left
media (the Canadian Broadcasting Corporation – the CBC) have done the province
of Saskatchewan and the Canadian news watching population a great disservice.
The outcome of all this is
that with all the negative media attention, the government decides to back away
from the Lean consultants and terminate the contract early. No mention is made about if they plan to walk
away from the Lean activities they have implemented.
Canadian healthcare is
financially out of control and needs significant action, not only in
Saskatchewan but all across the country.
One of the reasons that Canadian healthcare has so many problems is that
it is controlled by healthcare unions that have no interest in addressing cost
effectiveness, especially if it means reducing positions or union wages. (Gee is it any wonder that these unions would
resist and dislike a program like Lean.)
Recently I wrote that Quality
will inevitably fail when an organization has an endless supply of customers,
with essentially no threat or consequence to counteract indifferent behavior
[see: http://www.medicallaboratoryquality.com/2014/12/competition-and-quality-partner-dynamic.html
]. This is the very definition of Canadian
healthcare system
Going after a government
plan to implement continuous improvement through a program like Lean, is easy,
just blame it on a mean government being hard on those poor front line workers
and point out some trivia like a scandalous instruction about coffee.
But if this Quality
initiative gets killed before it gets started, there will be blood on people
hands, and everyone including the government, the opposition, the unions, and
the media will all have to wear it.
At least that is my opinion.
I realize that Nurses have a totally different mindset than Lab Technologists and other lab staff. They are patient oriented and are not of the mindset of facts and figures. Most Lab Techs are very technical, goal oriented, and organized. MLT'S tend to be thinking of Quality in a different manner than Nurses due to the variance in training, responsibilities and personalities. I think that there is to much of a barrier of knowledge of what each position is responsible for and therefore misunderstanding of how, where and why Quality in processes work. MLT's have more opportunities to be in the Nursing environment but that does not hold true for Nurses or doctors in the Lab environment. A better understanding of each other's responsibilities I believe would enhance the ability to achieve quality.
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