U.S. Labor News Roundup

‘Lean Production’ Comes to Hospitals

Today’s hospitals are as committed to running lean as any factory.

Seattle Children’s Hospital, for example, uses Toyota’s “continuous improvement” system. Another Seattle hospital offers trainings to help administrators across the country “eliminate waste and increase value.”

Who could oppose improving quality or eliminating waste? Highly paid consultants scrutinize hospital processes, measuring staff-hours-per-patient-day.

“But they’re not talking about efficiency in how we provide care,” said nurse DeAnn McEwen. “It’s really about profits.”

In health care, 50 to 60 percent of operating expense is labor. So there is constant pressure to reduce staff.

Hospital staff are already moving fast. Judy Sheridan-Gonzalez, president of the New York State Nurses Association, saw a consultant’s time-and-motion study backfire. The consultant found “what we’ve been saying all along: we have no downtime,” she said.

Technology underpins many schemes for speeding up work. When a nurse watched heart monitor screens, McEwen said, she could easily discover a false alarm. And if the patient really took a turn for the worse, that nurse was one more person to help respond. But hospitals are consolidating heart monitors away from the patient, where a lower-paid tech watches them.

Even doctor consultations are happening over video screens, although a patient interviewed over phone or video is more likely to tell the provider what she wants to hear—especially if the patient is ashamed he didn’t refill a prescription or couldn’t afford the recommended diet.

Over video, the nurse can’t see swollen ankles, lay a hand on clammy skin, or smell an infection, McEwen said. “If I had them in front of me, I could tell.”

Many hospitals have stepped up surveillance—with cameras everywhere, swipe-entry doors, and electronic tracking chips in the badges workers wear.

Another method of surveillance: the electronic medical record.

The electronic paperwork to discharge a patient is “eight pages of clicks,” said Betsy Prescott of the Massachusetts Nurses Association. “Some of these floors can have 15-19 discharges a day,” she said. “You’re not taking care of the patient, you’re documenting.”

All this documentation helps the hospital track every item it wants to charge the insurance company for—and pin the blame for any problems on nurses.



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Standardization is a watchword of lean management. 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 virtually none of them do.

Hospitals try to script the conversations staff have with patients, McEwen said. “It’s a form of time management that is insulting to professionals, and actually increases the risk of harm.”

Hospitals are pushing for schedules that maximize “flexibility”—theirs, not yours.

They want to keep staff on call, with no set schedule and no guaranteed hours. “Traditionally in hospitals the number of on-call or per diem staff is somewhere between, say, 10 and 15 percent,” said John Borsos of the National Union of Healthcare Workers. “The newest trend is to taking more and more benefited positions and making them flexible and contingent.”

If staff aren’t really the problem, why are health care prices skyrocketing?

• consultants’ fees

• insurance industry paperwork and bureaucracy

• too many administrators

• high salaries for executives and doctors

• advertising, branding, and fancy new buildings

• replacing high-tech systems every few years

• poverty and inequality worsening our health

• too much emergency care—because people don’t have access to good primary/preventive care

• profits—for hospitals corporations, insurance companies, and drug companies.