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Mark Graban

Mark Graban: Focusing on staff morale, quality, and waiting times leads to better productivity, but as an end result not a primary goal

By Mark Graban, - Last updated: Sunday, January 27, 2013 - Save & Share - Leave a comment
In hospitals, productivity measures are typically based on direct labor productivity or financial calculations (such as the oft-dreaded “Worked Hours Per Unit of Service” measure). These raw productivity measures are often easy to tabulate, but it doesn’t mean that it’s the most important thing or that it’s meaningful to staff. A hospital can measure revenue per employee or the lab department can measure the number of tests completed per hour of labor, but they often struggle to measure things that are more important – like safety, quality, and waiting times.
My observation is that the sole (or primary) focus on productivity (and other financial measures) is the cause of many problems in healthcare. As in Sammy’s example from Best Buy, you will get what you measure. Brian Joiner (Fourth Generation Management, a great book) said people could do three things when under pressure:
1) Distort the measure
2) Distort the system
3) Actually improve the system
We know that #1 and #2 are much easier to do, unfortunately.
A nurse manager might be under a ton of pressure to keep worked hours low. So, when the patient census drops, nurses are sent home early. This harms morale (as they are being treated like expendable direct labor instead of honored and respected professionals) and it can harm quality. Productivity is improved in the short term, but nurses quit, meaning the hospital has to spend $100,000 to replace and retrain each one. Has productivity really been improved in the grand scheme of things? Productivity might be improved, but let’s say more patients fall and get hurt (because a manager was overzealous in their chasing of the productivity dragon). Has cost really been reduced?
When nurses are sent home early, they miss out on the chance to work on quality and process improvement. As one hospital Lean leader complained, “Our daily focus on the productivity measure is the exact thing that prevents us from improving productivity.” Hospital leaders complain they don’t have time for kaizen, but they shoot themselves in the foot by sending people home early instead of allowing them to work on kaizen for an hour or two. The results are completely predictable – stagnant or declining productivity… but it’s being measured really precisely!
The book Obliquity makes a compelling case that organizations often get MORE of something by focusing on it less. My experience shows that focusing on staff morale, quality, and waiting times leads to better productivity, but as an end result not a primary goal. When we say we want productivity improvement, we should ask, “What’s the real goal for our organization?” Nobody makes money from raw productivity…

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