Workarounds, Band-Aids and “It works for now” solutions are a common occurrence in any almost environment, but they are especially prevalent in the healthcare arena. While at times we recognize them for what they are, we often find ourselves marveling at the creativity and the ingenuity required to develop these much needed “solutions” to the problem at hand. In almost every facility we visit, there is at least one staff member who has built a reputation for their ability to create workarounds and gained the respect of others for this talent. In the course of Lean implementation, we are challenged to eliminate the waste that is created by these process deviations and create sustainable, high quality, flexible processes. As Lean Healthcare practitioners, we must also resist the urge to create workarounds ourselves in the name of making progress in the short term. Why are workarounds so contrary to Lean principles and what’s so wrong with them? To answer that question, we must first understand the true nature of the beast.
At their core, workarounds are caused by processes and systems that do not support the work that must be completed. While they are typically temporary fixes, workarounds are also testaments to the creativity of staff that are not equipped with the tools needed to accomplish the job at hand. So often we commend these actions as brilliant displays of “out of the box” thinking. In reality, workarounds represent a glaring example of tradeoff thinking. In order to achieve performance in one area, another key element (Satisfaction, Quality/Safety, Time/Utilization, or Financial) is sacrificed. Take the example of medication overrides. While valiant efforts are being made to reduce or eliminate override occurrences, workaround processes still exist that allow deviation from the approved (and safest) process for medication administration. Allowing this deviation reduces the need for the real time problem solving efforts that will eventually lead to the resolution of the issue. A short term need has been met, but long term patient safety has been degraded. When the system is stressed, failures will likely occur.
The waste that is generated by workarounds is not only experienced by those creating them. Every process or activity involves a customer and supplier who ideally interact in a defined way to ensure quality and efficiency. When either participant in this pair deviates from the process, waste is created for both parties. In keeping with the medication theme, take the example of the floor nurse who has faxed their medication order to the pharmacy and is now waiting for delivery of the first dose. As wait time builds, the order is scanned again and the nurse finally picks up the phone and calls the pharmacy. The pharmacist offers to have the medication waiting at the door if the nurse will come to the pharmacy and pick up their med. Problem solved or problems created? If we look at this interaction through Lean eyes it is fraught with waste. Multiple connections were required to complete the process. The nurse had to leave their patients in order to get the medication and the pharmacist will lose valuable time due to the interruptions caused by the request and the work required to remove excess scans from the system. Finally, we must consider the impact of this workaround being used by all of the staff in the facility. How much of the wait time that forced the workaround was created by others using the workaround as well?
Whenever we face a decision to deviate from an existing process, there is an opportunity to create a workaround. To avoid this trap, test the change against fundamental Lean Healthcare principles. Consider asking these two simple questions:
- Am I giving up something (Satisfaction, Quality, Time, Financial) in order to meet my goal? (Tradeoff Thinking)
- Why am I considering deviating from the process? (Use the 5 Why’s)
Answering these two questions should assist in exposing the proposed solution as a workaround (if it is one) and exposing the root cause of the issue. Once exposed, the waste can be eliminated without tradeoffs and the creative energies of your organization can be applied to improving the business rather than creating temporary solutions.
This week’s blog was written by HPP’s Marshall Leslie. Marshall, a Six Sigma Blackbelt, oversees various HPP projects and Lean Healthcare transformations for clients throughout the USA. As a former multiple year “top-ten percent” performer at General Electric, Marshall brings clients the much needed tools and techniques needed in any industry, including healthcare. Marshall is a graduate of General Electric’s Operations Management Leadership Program; he has experience in various supply chain capacities including quality engineering and global sourcing for both GE and Procter & Gamble. Marshall’s expertise in both Six Sigma and Lean enables him to apply a broad spectrum of process improvement tools tailored to the healthcare industry’s needs. He holds a degree in Industrial and Systems Engineering from Georgia Tech.