Applicability of Lean Management in Nursing

Nurses also bring added advantages to the role of Lean leader-an uncompromising commitment to patient care and the natural ability to view hospital yester through the lens of the patient. The second literature "Lean Management in Med/Surge" By Barbara Mercer talks about the pros and cons of lean Management as Tracy Galilee, MBA, URN, has developed a professional and personal investment in the success of the organization- one aftercare's lean facilitators.

Lean management principles are derived from the manufacturing industry, specifically from Toyota Motor Corporation, which espouses continuous improvement and respect for people. Sounds like a great idea to incorporate into healthcare, wouldn't you think? The Institute for Healthcare Improvement (III) agreed. The 'His 2005 White Paper Going Lean in Healthcare was based on expert presentations from the 'HI Calls to Action Series.

Among the experts was John Toasting, MD, president and CEO at Teacher, who was integral to bringing lean management to the organization. The white paper's executive summary briefly explained the purpose and goals of lean management as they would relate to healthcare: "The Institute for Healthcare Improvement believes that lean principles can be - indeed, already are being - successfully applied to the delivery of health care. Lean thinking begins with driving out waste so that all work adds value and reverse the customer's needs.

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For those unfamiliar with lean management practices, Galilee did not take over as a dietary counselor; instead, she assisted nursing staff to cut the fat from daily processes that stand in the way of the most efficient practices and the best possible outcomes for patients. Now the business unit manager of the med/surge unit, Galilee continues to assist staff in employing lean principles in a developing community of empowered problem-solvers. (2) The last literature to be reviewed is an article that spoke against the implementation of Lean Management

Don't 'Lean' on Me, Hospital Workers Say' by Alexandra Bradbury [August 1 5, 2013. Part of the lean ethos is getting workers to participate in their own exploitation. Some hospitals offer nurses a boost of pay and status for championing a lean project. "Hospitals are very often successful at co-opting natural leaders," Mencken said. What can the union do? First is to educate members to see through management's hype-?what labor educator Charley Richardson called the "tricks and traps" designed to lull you into believing you and management have the same concerns at heart.

These include Joint brainstorming, win-win rhetoric, and trust exercises. One strategy is to try to get your people onto the lean team-?but they probably won't be picked, and it's a "slippery slope," Sheridan-Gonzalez said. Union members on Joint committees should treat every meeting as if it were a bargaining session, with two opposing sides. They can say, "We don't accept your framing. We see this as a potential for harm," Mencken recommends. And the usual union tactics can be used against lean, too: petitions, forms that document unsafe staffing, button/ sticker days, and marches on the boss to resist speed-up. 3) Study Population Nurses have served as leaders of 2 very successful Lean initiatives at the Robert Wood Johnson University Hospital (RUSH). Founded in 1884, RUSH is a Magnet hospital that is the principal teaching hospital of the University of Medicine and Dentistry of New Jersey's Robert Wood Johnson Medical School. Each year Rush's 1300 physicians and 1500 nurses care for more than 200 000 patients. The first case study-"OR Lean"-details the Lean transformation of Rush's operating room (OR).

The second case study describes the remodeling of Rush's emergency department (DEED) with Lean principles and practices. Monsoons et al,2012) While nurses in Interiors Medical Center, New York and California Pacific Medical Center have iced out the disadvantages of Lean Management in their respective hospitals. Sources of Data A primary source data was utilized in this study. Lean management as cited in journals, articles and blobs and are mostly Internet based were used and acknowledged.

Some of these Journals and articles are: "From Toyota to the Bedside: Nurses Can Lead the Lean Way in Health Care Reform" by Joyce E. Johnson, Amy L. Smith and Kari A. Master (Nursing Administration Quarterly,September 2012 ,Volume 36 Number 3 ,Pages 234 - 242), "Lean Management in Med/Surge" By Barbara Mercer, and "Lean Management Don't 'Lean' on Me, Hospital Workers Say' by Alexandra Bradbury 'August 1 5, 2013 among others. Data Analysis As stated in the research's sources 2 data clearly evolved and both stating favor and opposition towards lean management.

The 2 cases in RUSH that favor lean management has the following results from their studies: case study 1 : OR LEAN The need for improved efficiency in OR scheduling has been although the number of Lean interventions in the OR reported in the literature is relatively small when compared with interventions in other hospital departments. Most recently in 2011, Violence reported a 20% increase in OR productivity and capacity n a Canadian hospital that adopted Lean methods.

The electronic paperwork to discharge a patient is "eight pages of clicks," said Betsy Prescott, a leader in the Massachusetts Nurses Association. Muff get spoken to if you miss one thing. '"some of these floors can have 15-19 discharges a day," she said. Mire's not taking care of the patient, you're documenting. " (Bradbury,2013 ) Standardization is a watchword of lean management. Nurses at SST. Charles Medical Center in central Oregon were Justly proud of their Rapid Response Team-?it had saved lives. But that didn't stop the administration from announcing plans to end the team.

The rationale? Other hospitals don't have one. Most hospitals now use computers to set staffing. You enter the number of patients on the unit today, and the software spits out how many nurses and nursing assistants are needed. Employers claim they factor in the severity of patients' conditions-?but Mortally none of them do," Burros said. (Bradbury,2013 ) Strengths and Weaknesses of the Study The strengths of this study can be summarized as the following: lean management was applied to a well known and prestigious hospital Robert Wood Johnson University Hospital (RUSH).

Founded in 1884, RUSH is a Magnet hospital that is the principal teaching hospital of the University of Medicine and Dentistry of New Jersey's Robert Wood Johnson Medical School and with well documented evidences that lean management worked for them. Other credible articles as to the applicability of lean management were also cited and gave a good argument to the promise that lean management can work for the healthcare sector. So in terms of credibility, accurate accumulation and evidence based arguments both for and against lean management were well presented.

On the other hand, it is very clear that the main weakness of the study is its very limited scope and hence the uncertain conclusion as to whether lean management is applicable or not in nursing management. Conclusion It is very clear that the study has a very limited scope but we will summarize below both arguments for and against lean management in regards to its applicability in Nursing management. As shown in the results of the 2 case studies in order for lean management to succeed it must be: Leadership is critical for success

The literature emphasized the central role of committed leadership in the success of Lean work. According to Doss and Orr, leadership is "an integral part of the Lean Operating System, not an afterthought. " The support of leaders, they suggest, can "make the difference between superficial attempts at implementing Lean-where the tools and techniques are evident, but the behaviors haven't changed-and full transformational deployments where the entire organization embraces Lean from the bottom up and the top down. Monsoons et al,2012) Lean work is systems work In their 2010 review, Macho and Litter emphasized that Lean work is a whole yester strategy that cannot be done piecemeal and that no single "silver bullet" solution, such as a new computer system or automated equipment, can achieve the same results. Systems thinking, the discipline of seeing wholes and inter- relationships, is certainly not new. As Sense suggested more than 20 years ago, the systems perspective is badly needed in a world overwhelmed by rapid technological change, changing demographics, shifting borders, and increasing complexity. 5)(6) Monsoons et al,2012) Communication is critical to success From the outset of our Lean work, we knew that communication was the key to the horn-term and long-term success of our work. As we had done with past quality improvement efforts, we regularly reminded the staff to keep the vision of the future state in mind because, as the anticipatory principle suggests, the image of the future is what guides the current behavior within an organization. Monsoon et al,2012) As for the argument of those who are against lean management, the following reasons are cited: Lean management according to critics does not consider human factor for it stresses "no downtime, Just in time staffing, emphasis on the use of technology to monitor staffs performance, among others. Standardization is an emphasis of lean management that also rings alarm bells among employees who do not yet have a holistic appreciation for lean. In lean, first you standardize, then you improve. Improving a non-standard process is like remodeling a house built on quicksand.

It won't do you much good in the long run. "(Bait, 2010 ) If we continue to standardize work in hospitals without accounting for the variety nurses and hospitals get from patients we will make things worse for patients, nurses, doctors and the bottom-line. The system needs to be redesigned around the work by management, ruses, doctors and others working together to improve the system. This all begins by management changing their thinking around the design and management of work. Once management understands by seeing the damage of their thinking in a normative way can real changes impact the work. Bait,2010 ) Now, to answer our query whether lean management is applicable or not in Nursing management, we say it is still remain to be seen. Learning from both sides of the argument of for or against lean, it is safe to conclude that lean management is applicable but not to all types of health care institution and setting. As much as success of lean management s well documented in the ROUGH, we have to remember this is a Magnet accredited hospital and employees are expected to get used to high standard work and compliance to a strong administrative leadership and management.

Lean management is also about culture change and resistance will be expected so those who oppose have some valid points in which management has to seriously consider. After all for any system or management to work, people's satisfaction and cooperation should be addressed foremost and not to be ignored or taken for granted. Otherwise, what is the use of introducing a promising system such as lean management when in he process it will lead to dissatisfied and tired staff?

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