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Bruce Hamilton

Health Care

Unsung Hospital Heroes

Clinicians and administrators dissatisfied with the status quo take a personal risk to heal their health care systems

Published: Thursday, May 19, 2011 - 09:13

About six years ago I was meeting with a clinical team to kick off an early improvement effort at their hospital. We began with a reflection on the problems with traditional business management practices. To break the ice, I played a short clip from an I Love Lucy episode that has now become a staple of lean learning. We watched as Lucy and Ethel struggled to keep pace with an ever-accelerating chocolate packing line, and we watched Lucy stuff about two pounds of unwrapped chocolates into her clothing lest their autocratic supervisor see that they couldn’t keep the pace. (If you haven’t yet watched this clip from Job Switching, you can view it now.)

When the clip finished, I asked the group to describe practices that would not be favorable to continuous improvement. Was the line running too fast, or were there too few wrappers? How could we tell? What did we know about the kitchen or the wrapping line? What problems were Lucy and Ethel experiencing? What about the relationship between employees and supervision?

At one point in the discussion a nurse noted, “Lucy and Ethel are hiding their defects from management.”

An administrator in the group added, “We call them occurrences not defects. The word ‘defects’ is a no-no.”

A doctor seated next to me leaned over and murmured, “We don’t hide our defects; we bury them.”

There is no question in my mind that every person in that cross-section of employees was passionately committed to providing the best possible patient care. But the doctor’s dark humor caught my breath. Six years earlier my mother had been one of those “defects,” a person in reasonably good health who entered a hospital for elective surgery, contracted a hospital-born pathogen, and died of pneumonia. I understood the doctor’s words all too well. My instinctive response to the discussion was a quote attributed to W. Edwards Deming, “A bad system will beat a good man every time.” The group nodded in agreement. I left my personal tragedy out of the discussion. It would have been just one more data point in a larger tragedy of denial.

But there was no denial among this group, just concern. All of the systemic problems that characterize traditionally managed organizations—functional arrangement of processes and resulting “batch processing,” complex ladder structures, convoluted information flow, lack of clear standards—were present in monumental proportions. Yet this group, hesitant and unsure, was taking a risk that it could heal this condition, not in a quantum leap but with small, stepwise improvements. One member of the team, a physicist, expressed doubt that small changes would make a difference, but he too was ready to be part of the experiment. At the conclusion of their early improvement project, this physicist stated with all the authority of a scientific thinker, “Based upon the evidence, I can only assume that the significant improvement that was made occurred as a cumulative result of many small improvements.” This improvement team was the advance guard of a movement which extends today well beyond the operating room and the hospital ward. They committed time to improvement despite frenetic schedules, long days, and scarce resources.

We are accustomed to thinking of hospital heroics as they relate to lifesaving moments in ERs or miraculous surgical outcomes. And of course these are hospital heroics. But thanks are due also to the clinicians and administrators—doctors, nurses, technicians, and support staff—who were sufficiently dissatisfied with the status quo to take a personal risk to heal their health care system. They too are heroes whose actions will save the lives of countless future patients.


About The Author

Bruce Hamilton’s picture

Bruce Hamilton

Bruce Hamilton, president of the Greater Boston Manufacturing Partnership (GBMP), brings hands-on experience as a manager, teacher, and change agent. Prior to GBMP, Hamilton led efforts to transform United Electric Controls Co.’s production from a traditional batch factory to a single-piece-flow environment that has become an international showcase. Hamilton has spoken internationally on lean manufacturing, employee involvement, continuous improvement, and implementing change. Also, he has contributed to numerous texts ranging from visual control to variety reduction. Hamilton’s blog, Old Lean Dude, is an ongoing reflection on lean philosophy and practices, with an emphasis on keeping good jobs close to home.


blaming Lucy and Ethel?

Spot on, Bruce.

One other point I'll raise... interesting that the nurse seemed to blame Lucy and Ethel, saying "“Lucy and Ethel are hiding their defects from management.”

I hope the nurse realized (she probably did) that Lucy and Ethel HAD to hide defects, given the environment they were in!