If you were to ask me to summarize in one sentence the enormous number of articles about staff shortages in healthcare, I would say:

“Staff shortages seem to be an ‘insurmountable’ problem and, above all, a problem that is ‘far beyond the sphere of influence’ of doctors, nurses and other health care providers.”

And yes, I use the word ‘seem’ deliberately, because almost everyone looks at the “problem” of staff shortages with a particular view. As I  made clear in my previous blog, it is this current view, this current way of thinking, that causes people to see staff shortages as “insurmountable” and “far beyond their own sphere of influence”.

Maybe it’s your perspective too?

If you want to get rid of your (idea about) staff shortages, that is very easy, provided you are willing to change your view on staff shortages.

For example, what would happen if you took a ‘Lean” perspective on staff shortages and work in healthcare?

The current view of the problem is: “We don’t give all patients what they need, because we don’t have enough people.”

If you define “staff shortages”, or ‘too few people’, as the problem, like many are doing nowadays, then your assumption is that the 1.3 million people, who now work in healthcare in The Netherlands, are not enough to help everyone who needs care. This assumption is only correct if all those 1.3 million people only do work that is needed for patients.

And unfortunately, as you probably realize, that is not the case.

So, what’s going on?

My hypothesis, based on my years of experience practicing Lean thinking in healthcare, is that we have enough people but “we don’t deploy people in the right way.”

Where does all that capacity of those 1.3 million people in healthcare go?

The many studies in healthcare show that a huge amount of human capacity is being lost.

Where are we losing human capacity in healthcare?

1. Ineffective or unnecessary care. A large part of the care provided is actually unnecessary, not evidence based or sometimes even proven ineffective. On a Dutch talk show, a doctor estimated it for his hospital at about 25%(!). This category includes medical errors and misdiagnoses. In addition to harming patients, these also lead to unnecessary extra care.
2. Inefficient processes: Healthcare providers spend only about 30% of their time on the necessary patient care. The rest of the time is spent on administration, coordination, walking, searching, waiting, checking, and other wasteful activities.
3. Overhead. An increasing proportion of people (now about 40%) work “on” healthcare instead of “in” it, which – contrary to what you might think – leads to even more inefficiencies for healthcare providers. Due to extra rules, registrations and administration, healthcare providers themselves also spend about 40% of their time on “overhead”, often devised by these non-healthcare providers, working on healthcare.
4. The high turnover rate among healthcare professionals. For example, in The Netherlands forty percent of newcomers leave within two years, often caused by the aforementioned problems, which make the work, euphemistically put, unattractive.
5. (Or rather, problem number 1.) Avoidable healthcare. Due to, among other things, our lifestyle, the way our economy works (focus on making as much money as possible, regardless of how), and increasing inequality between social groups, there are many (chronic) health problems. These lead to a strong extra demand for healthcare, while many of these problems can be prevented.

So, there is still a lot of “hidden” improvement potential in healthcare.

But, how can you, as a healthcare provider, reap the benefits of this improvement potential yourself?

Ineffective or unnecessary care

The most obvious way to free up capacity is to stop ineffective or redundant care. Especially because it allows you to prevent harm to patients. Fortunately, there are already several initiatives to do something about this. After all, this is already the responsibility of healthcare providers themselves.

Be sure to continue with this or start doing it!

Inefficient processes

The most potential, when you look at capacity loss, is to make your processes more efficient. The first question you need to answer to make your processes more efficient for caregivers is: ‘where does caregivers’ available time go now?’

You can’t just answer that question because in healthcare we are used to calling everything ‘work’. This suggests that everything you do is necessary, because it is your ‘work’.

My hypothesis is that ‘we don’t deploy people in the right way‘ and therefore that not everything you do is necessary. To be able to analyze this, I distinguish between:

1. Value-added activities: what patients need
2. Non-value-adding, but (still) necessary activities, such as legal obligations, security measures, and/or administration. Almost all bureaucracy falls under this category
3. Waste: any activity that does not add value for your patient, i.e. that does not increase, or even decrease, the quality of life for your patient, and is not necessary. You can think of waste as a way to cover and/or deal with your problems, such as waiting times, double checks, searching, transport, etc. Waste is, as it were, a symptom of a ‘sick’ process, a sign of stagnation, an indication that the process can be improved.

From my many analyses of (care) processes and experiences in the workplace, such as time studies among doctors (see the graph at the top of this article for a practical example), and also from other studies, the following picture emerges:

1. Value-added activities – 30%
2. Non-value-adding, but (still) necessary activities – 40%
3. Verspilling – 30%

So only about 30% of the available time of caregivers goes to value-adding activities, to care actions; to what patients need. This means about 70% (!) of their time is spent on non-value-adding, but (still) necessary activities (40%) and waste (30%).

In the work that caregivers do on a daily basis, there is still enormous potential for improvement, up to 70% of their available time.

Get rid of all your vacancies without hiring people

The expectation is that – if we don’t change anything – we will have 125,000 vacancies in healthcare by 2030. This is almost 10% of the number of people currently working in healthcare.

Can we solve this with process improvement?

My experiences say so. By reducing waste and bureaucracy, we can still free up a lot of time.

Lean thinking assumes that you strive for the ideal process for your patients. You don’t achieve this by adding things (extra people, technology or rules), but by removing unnecessary things.If you focus on removing waste and reducing (currently) necessary activities, you free-up capacity for value-adding activities; for helping patients. This results in you being able to give more patients, what they need, at the right time.

The 10%-challenge

Imagine giving caregivers the freedom to improve their own work, with the goal of saving 5 minutes a day, every month, for 10 months. Then, after about a year, they would end up freeing up 50 minutes a day, or 10% of their time!

What could this mean for the Netherlands?

If all 1.3 million people working in the care sector were to free up 10 % of their available time or someone else’s time in this way, that would be 130 000 jobs. This is roughly equal to the expected number of vacancies for nurses and caregivers in 2030.

Is that realistic?

Examples from the practice of my clients:

Unnecessary care

• An ambulatory supervisor made a 5-minute analysis of her working week. She found that she was wasting an hour on “overcare.” Now she spends 3 instead of 4 hours at the client’s home every week and this is nicer and more effective for both.

Bureaucracy

• In a nursing ward of a university hospital, they filled out a measurement form every day (5 minutes a day). After analysis, it turned out that the form was then stored in a cupboard to ‘gather dust’. The student who needed the data for her research project had graduated years ago. Stopping filling in was quickly arranged J

Waste

• In an institution for the disabled, caregivers alone spent 50 minutes a day looking for information, materials, equipment, colleagues, etc. By organizing their workplaces differently, they were able to avoid almost all search time.

Yes, but …

Of course, it would be spectacular if we were to improve healthcare with 1.3 million people and free up 10% more capacity. But I can already hear you thinking: ‘how?’, ‘I don’t have time for that’ or ‘yes, but “they” have to do it first…’ And it’s true, ambition alone is not enough. You need a change strategy. Lean thinking, according to me and many of my clients, could be this strategy.

Lean thinking makes you look differently at your problems and their causes. It helps you to research them and come up with solutions for them yourself, together with your colleagues.

It makes your problems solvable, within your own sphere of influence!

This way of improving gives a lot of energy and job satisfaction, through the use of creativity, multidisciplinary collaboration and focus on what patients need.

One of the most effective and underrated ways to improve performance in healthcare is to involve healthcare professionals in solving the problems and improving the processes.

This has several positive effects:

• They know the problems, the causes and therefore the solutions that work best.
• Their engagement and job satisfaction will increase, leading to higher productivity and – more importantly – lower turnover.
• They are evolving. They learn about their processes, their colleagues, and how to solve problems themselves.

This is Lean thinking in a nutshell!

So, let’s get started?

Arnout

P.S. that’s not possible with your current way of thinking 😉

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