Since my last email, the book is still moving through the editing process. I have the typeset pages, so it's exciting to see what the book will look like when it goes to print.

The cover photo is out there on amazon.com, so it finally looks like a real book for sale.

I'm lining up a few interviews and speaking engagements to help promote the book. If you have any suggestions for who can help me get the word out, please let me know.

How Many People Do We Need?

One nagging question that I have faced in a number of different hospital departments is "how many employees do we need?" With Lean, I hope we can steer the discussion away from politics, emotions, and benchmarks. The only true way to know how many people you need to is to study the work in your own environment. Benchmarks from other hospitals might be irrelevant if they have different volumes, systems, or equipment. Politics and emotions might not lead to the right decision and often end up erring on the side of understaffing, which can be bad for patients and for employees.

There are no substitutes or shortcuts. You have to look at the process -- how much volume of work do you have? How long does it take to do that work in a safe, high-quality manner? Don't just guess -- really look at the process and how work is done. How much waste is there in the process that can be eliminated to make work simpler?

We need to shift the discussion away from someone saying, "We feel like we need more people." The easy (and common) answer to that request is an easy one --  "We feel like you don't!!" Only with data and process observation can we all come to agreement on what's best for the patients and for the employees. We don't want to arbitrarily add more employees, since that might not be in the best long-term financial interests of the hospital. We don't waste and excess, but we don't want our employees to be overburdened, either

I've seen this process work amazingly well in two cases recently - once in radiology and once in a lab setting. Using Lean, we were actually able to make a quantitative case for adding employees. I hope that is an eye opener for those who think "Lean is mean" or that Lean is somehow about cutting heads. Lean is about being more effective and better serving the patients, without asking the employees to burn themselves out (or cut corners) due to understaffing.

Do you have examples or success stories about how you used Lean to determine the proper staffing levels for your department? Share them on the message board.

Mark Graban
Author, "Lean Hospitals"

Email: mark@leanhospitalsbook.com