Why 5s Isn’t Always the Best Place to Start (Hospital Case Study)

no 5 sMost Lean resources will tell you that 5s is the best place to start a Lena initiative.  Some will go one step further and say start where there is a need and go from there.  While both are good advice we still see a high rate of failure for Lean (70%-98% depending on the research study).  So why is the failure rate so high?  The answer is that we ignore the behavioral reasons to why we do things a certain way.  To understand this let’s first look at a little bit of history.

Taylorism and Scientific Management

In the late 1800’s Fredrick Taylor introduced the concept of scientific management and revolutionized how we run our businesses.  However no matter how great the new ideas were it did have a blind spot and that was with human relationships.  It wasn’t until the early 1900’s that people started looking at the human side of change.  With Taylorism came the attitude of workers just being a “pair of hands” and we should look at them more as widgets instead of people.  This mindset has stayed and has morphed.

Employees are People no Machines

The reason why we see so many failures with Lean and other change efforts is because we don’t look at the human emotions involved.  There are many experts who know the technical skills to implement change but very few lack the structure, knowledge, and experience to deal with the emotional component to any change.  The real root cause that people resist change (and the cause of such a high failure rate) is usually an emotional reason and not a skills reason.  Ironically because people aren’t machines we are now seeing a trend towards machines doing more and more work.

Case Study at a Hospital

A hospital in North Carolina has their internal Lean leader do a 5s event with a department to help them mange their inventory.  This department housed critical fluids for patients like saline and other fluids.  The department has challenges with too much of their inventory expiring before use.  The Lean leader came in and helped them 5s their area and was initially successful.  However after a few weeks the managers started going back to their old habits of keeping extra inventory in stock.  What do you think happened?  Why did the management team go back to their old habits?  Most people at this point say that there wasn’t enough accountability and that was true however there was a deeper root cause.  I mentioned that they are somehow rewarded by their behavior and it turns out that 35 years ago there was bad weather and they couldn’t get their supply of fluids in and they ran short at this hospital.  You can imagine the chaos that would have caused and potentially the number of lives that may have been affected.  Because of this one event 35 years ago the department was still hording their inventory.  The solution was to address the concern over stock outs and then we test it.  Once we agreed to the solution as a team then we could hold them accountable to the new system.  If we had just tried to hold them accountable we would have seen disengagement from many of the staff and potentially some turn over.  By taking this root cause approach we were able to have a productive solution that helped the people grow vs. a solution that might have been painful to implement and disengaged people.   Even though 5s was the right technical tool the first place to start would have been to ask why does the team have this behavior in the first place and let’s address that first before we address the 5s effort.


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