In Lean, we talk a lot about systems; that Lean is a systems approach to management. The axiom is that there are no evil workers, only evil systems. One of the tools of Lean to discover the root cause of problems is 5 Whys. Notice, it is not called 5 Whos. As veterinarians and scientists, we understand systems, but, I think, we have a difficult time extrapolating this understanding to areas of practice other than medicine. We want to blame problems on other people; our employees. The truth of the matter is that rarely is it a people problem, it is a system problem.
I was once taught that there are only four reasons a job is not being performed adequately:
- The person does know that the job is his/her responsibility
- He/she has not been thoroughly trained on how to perform the job
- He/she does not have access to the tools required to perform the job correctly
- 4) He/she is not receiving correct input or adequate, timely communications (garbage in, garbage out).
But in Lean thinking, we would look at the system. We would assume that employees are generally well intentioned, conscientious, hard working, and truly wish to do a good job. In Lean, the system is the problem, until proven otherwise (and maybe the system failure is the hiring system). The system, then, is scrutinized to identify problems at their root cause, changes made to the system and put it place. The new system is re-evaluated later to determine if the results were positive or negative, and then adjusted, or adopted as new standard policy.
Consider mitral valve insufficiency (MVI) leading to congestive heart failure (CHF). The patient has fluid in the lungs, the heart is beating more rapidly, there is weight loss, etc. If you look at this system of failure from a "who" perspective, then maybe it is the kidney's fault. If the kidneys would just work harder, excess fluid would be eliminated and that would solve the problem. Or maybe it is the vascular system that is the culprit. If it would just do its job, then the arteries would not respond detrimentally. No, it is the lung's fault. We need newer lungs. Or maybe it's the endocrine system. We'll offer it a bonus for improved function. Or the A-V node. Maybe it needs more CE training. And, in fact, we treat the illness with symptomatic therapy designed to "improve" (micro manage) the different organs. The patient improves, but is still in congestive heart failure, because it is none of these individual organs that are at fault. The system is broken and the system is not going to be fixed until the mitral valve is replaced. Only then do we eliminate CHF. This is obviously a somewhat contrived analogy, but hopefully, makes the point.
As I stated above, we understand systems, but I think we have not been educated to see veterinary practice as a system, also. Below is a link to a series of YouTube videos demonstrating Dr. W. Edwards Deming's famous Red Bead Experiment. It demonstrates, among other things, how management typically deals with employees when key performance indicators are not meeting goals. Workers have no control over the system they work in. Systems are designed and dictated by management. It is management's responsibility to fix systems.
The video link below is actually a series of short videos. The Red Bead Experiment is in 6 parts via the playlist, below.
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