When Having a Process Improvement Idea Means You’re Weak? — Lean Blog

I guess I’m wired for improvement. Or, it’s just become a habit. Or, it’s both.

I celebrate moments when I can identify an opportunity for improvement in my work. I tend to be pretty transparent about problems and even mistakes (like forgetting my socks).

The Toyota-ism of “No problems is a problem” resonates with me. Identifying a problem shouldn’t bring blame and shame… it’s the first step in improving the way work is done.

I’m fortunate that we’ve built a culture at KaiNexus where problems and opportunities are celebrated. It’s safe for people to speak up and problems lead to improvement, not punishment.

Our book Healthcare Kaizen shares stories and examples from organizations that have built a strong and sustained culture of continuous improvement. I almost take it for granted that improvement is a positive thing.

But, I sometimes get reminders of the challenges that people face when working in an organization that is NOT a culture of continuous improvement.

Twice now, in recent weeks, I’ve heard a similar story from healthcare professionals (one American, one on another continent).

One of them, a nurse, is the type who also seems wired for improvement. She tries speaking up. She aims to be constructive in pointing out ways the work of patient care could be easier.

She gets told:

“Well, this is nursing.”

The implication is that she needs to toughen up and get better at dealing with the waste.

This mindset is really hard for me to wrap my head around. I think nursing should include the opportunity to improve the nursing work.

A small, real example:

A nurse notices that patients ask for ginger ale to drink when nauseous. There is no ginger ale on the unit, so the nurse has to go upstairs to a different unit to get ginger ale… or the patient’s request doesn’t get met if the nurse is too busy (“we don’t have any, sorry”). The nurse points this out to the manager and suggests it would be nice to stock ginger ale on their unit.

A manager could say, “Suck it up… that’s the job… go get the ginger ale even if that means walking. Nurses today want to have it so easy… good grief. And don’t you dare say you’re too busy to do it. It’s part of your job!” But, in a culture of continuous improvement, the manager thanks the nurse for pointing this out (without saying things like “why didn’t you mention that before???”). The manager might contact dietary services to change what beverages are delivered to the unit, or they might teach staff how to contact dietary services as needed.

But, not every organization truly embraces continuous improvement.

It’s sad to hear a healthcare professional have an idea that could be implemented right now, at little cost… only to be told:

“You have to understand, this is how healthcare works.”

But it doesn’t have to work that way. The work could be easier… the culture could be better.

The implications of comments like these from managers include:

  • How dare you point out a problem? That’s offensive.
  • You need to toughen up.
  • You should be more resilient.
  • I dealt with that waste when I was a nurse, so why can’t you handle it?

It almost reminds me of the cycles of hazing that happen in organizations. “I survived this, so I’m going to make the next generation suffer through it too.”

This is all still very puzzling to me. Have you experienced similar situations? How can we help change this?

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Originally published at https://www.leanblog.org on May 31, 2019.