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Behavior and Selection in Adopting a Lean “Stop the Line” Mentality in Healthcare Hiring

March 8, 2012

healthcare-selectionWhat does it mean to adopt Lean in healthcare?  Doing some process mapping?  Scheduling a Gemba event?  What about “stopping the line”?  This last concept can be a real hurdle because of the culture of a hospital.  From a recent Healthleaders Media article:

  • [T]he phrase "stop the line" has made the jump from assembly lines into hospitals. It comes from the manufacturing world, where Toyota is the famous example of a company with a stop-the-line policy: Every employee is encouraged to stop the production line if they see a problem.

How well does this concept go over in healthcare?  A recent Wall Street Journal Healthcare Blog points out a real barrier:

  • 58% of nurses said they’d been in situations where it was “either unsafe to speak up or they were unable to get others to listen.”
  • An author of the study concludes:  Teams need to create an environment “in which anyone can speak up to anyone about their concerns, and everyone holds everyone else accountable for safe practices.”  

There’s the challenge.  How do you shift from a culture of expertise, power and autonomy, to one of collaboration and the willingness and ability to point out errors, even by physicians?  From the Healthleaders Media article:

  • Although many hospitals do encourage employees to stop the line, the practice isn't as prevalent as it should be, says AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN, clinical director of transition unit and emergency nursing at the Hospital of the University of Pennsylvania, and nurses often have trouble questioning physicians.   Hospitals that prioritize patient safety and have a culture of respect and regard will be able to successfully make stop the line routine, says Papa.

We talked about this concept previously when looking at reducing central line infections:

  • "Bottom [l]ine: Research has repeatedly shown that hospitals, even large urban ones, can dramatically reduce and even eliminate central-line infections," states Consumer Reports.  

John Santa, MD, MPH, director of the Consumer Reports Health Ratings Center, goes on to say: 

  • "For the process to work, each individual has to make a commitment to perform each step each time, and have the courage to correct their colleague when they see an error has been made."

Dr. Santa hit the nail on the head.  You can implement every technology and process known to medical science, but eliminating infection rates comes down to people!  Here’s the problem:  The traditional healthcare hiring process does NOTHING to assess a candidate’s willingness or ability to “perform each step, each time” and to “have the courage to correct their colleague” – both of which are required if you are to adopt a Lean “stop the line” mentality.

How are you assessing these behavioral competencies in the Physicians, nurses and staff you hired this week? Check out our whitepaper:

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Bryan Warren Bryan Warren was the former Director of Healthcare Solutions at PSI. He was responsible for developing and promoting tools and services designed specifically for the unique challenges faced by healthcare organizations.