The coo said motivating some employees has been a

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often unwilling to become involved. The COO said motivating some employees has been a struggle. He commented that there has not been an effective way to communicate to all employees about the success/failure rate. According to one senior executive, some staff resisted Lean because it came from the automobile industry and specifically from Toyota, which is nonunion. He commented that Lean was rebranded as “ Project Advance ” because “Lean sounded like cutting.” Corporate had to commit to a no-lay-off policy as a result of Project Advance activity. This commitment did not preclude changes to job responsibilities subject to union restrictions. Another executive felt that the initial problems in applying Lean stemmed at first from staff not understanding what Lean was. He added that even 3 years later, there is not a full understanding. A senior executive indicated that nursing as a group has not engaged enough in the Lean process; she hopes in time they will become more involved. Another executive attributed nursing’s reluctance to the challenges of reaching a compromise with such a large group, both on and off the RIE team. One problem associated with nursing was seen in the Pediatric RIE. Patient care associates (PCAs) saw certain clerical duties to be outside of their job scope as clinical staff. According to a frontline staff person, the PCAs would not assume the new task of calling patients after the RIE was over because it was not a part of their job description. This conflict None of us really understood what this was. I don’t think we all fully understand it now. But you know what? All of the senior staff have participated in RIEs since it started. You learn the process. You say you participated and you’re an equal participant, then you see the benefits and difficulties. Frontline staff member
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206 may be rooted in the hiring freeze, which created a shortage of administrative staff in the ED. One executive reported that the hiring freeze had reduced staff confidence and caused people to feel strapped for time. Despite the challenges of engaging frontline staff, leadership at Heights was able to find approaches to make progress on RIEs. A physician leader set the expectation among new residents that Lean would be part of their work while they are at Heights Hospital. Educating project team members and department staff on the need for a particular Lean project can decrease resistance to change. A few interviewees stated that it is easier to facilitate a project when people understand the background of a problem and the need for change. This knowledge helps those involved to buy-in to the solution. Two senior executives believed that starting the improvement cycle with employees who were enthusiastic about Lean was crucial to building momentum and staff confidence in Lean. They commented that this strategy helped to set an ambitious pace for future Lean events.
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  • Fall '17
  • Shankar Purbey

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