Thursday, May 22, 2008

Front Line Workers Account for 80% of Improvements

Do you need more evidence that front line workers need to be given the tools and power to make changes? Ralph Bernstein over at Lean Blog is reporting on the TWI Congress and the keynote speech Training within Industry. TWI standardizes training processes and assists front-line supervisors in teaching new operations to workers quickly and effectively. According to lectures at this congress;

"In today’s successful companies, 80 percent of improvements come from front line people. Many managers do not realize this or do not know how to effectively tap this rich resource. Although the TWI programs provide many benefits to organizations, two general positive effects are that they change the way employees think about their jobs, and they tie standardization together with ideas. These two effects alone can be responsible for bringing an organization to the next level."

It is normal to have new staff on the front desk or in the clinic area but what information and training are they given on running an efficient practice? What information are administrative staff given on techniques to minimize wait times? When applying the TWI concept to health care wait times (and more specifically clinic wait times) the administrative staff should be given a standardized training session on assessing and controlling wait times. They should then be allowed access to measurement tools to monitor wait times and the ability to change the schedule to better goals. The providers need to set the goals (eg, we want to see all patients with a skin lesion within 10 days) then give the staff enough latitude to meet those goals. For the back staff (clinical staff) , teach lean concepts and let them try different techniques to improve patient flow.

Extending this concept to the hospital would mean engaging the doctors and nurses in the decisions and giving them the power to make some changes. In my mind, there is a difference between trying to "build consensus" between clinicians and administrators and having the clinicians set goals based on clinical outcomes and giving the administrators the latitude (and budget and staff) to meet the goals. Do you think that hospital's would have a different set of priorities if it was the job of the doctors and nurses to set the goals and the that of the administrators to try and meet them? All too often it seems that the opposite is true.

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