Short post today, but a simple message, I think. One of the best lessons I've learned about Lean management is about the need to ask “why?” Don't assume, don't blame – ask why.
It's a very common situation in a hospital to find hoarders everywhere. Be very careful when you enunciate that word, “hoarders,” or you'll get in trouble…
It's not uncommon to find that front-line hospital staff, including nurses and laboratory technologists, are hoarding and stashing inventory everywhere, in every hidden nook and cranny they can find. This isn't a pathological problem like you might see on some cable reality show.
We might find that lab techs have stored purple top blood collection tubes in eight different places, some obvious and some secret. I actually found this once – eight different storage spaces in a room that's maybe the size of your master bedroom.
Instead of blaming them or “beating them up” or saying “that's not Lean,” managers should ask, “Why do people hoard supplies?”
If you just punish people for hoarding, they'll find more creative ways to hide secret stashes.
Why do they do this?
Usually, it's because they don't trust the materials management or supply chain processes. To reduce the hoarding, we have to improve the process. Installing a simple and well-designed kanban system can do wonders – it can ensure the continuity of supply that nurses and other front-line staff need to provide patient care.
Fix the system, THEN eliminate the hoarding. Until you build trust, you're just punishing people for trying to do the right thing for the patient. Hoarding is a workaround – eliminate the need for the workaround…
I've seen a number of hospitals address, including some quite recently. I've taught people how to set up simple and effective kanban systems that are sustainable, with the right management focus and culture change.
What about your hospital?
Are there other situations where you need to “ask why” instead of just blaming people?
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I think that you are correct to assume that hoarding in that context is symptomatic of a mistrust of the supply chain.
In the military we had a term for folks like these: dog robbers. These were people who insured that our company had what it needed by using any means at their disposal and were quite clever at their craft. MASH’s Radar O’Reilly was a good example.
A trustworthy supply chain in the military at that time and place was an oxymoron.
What an intriguing post. This allowed me to reflect upon the days when I was a network engineer. I specifically recall “hoarding” cables, and hardware because there were many occasions when it was announced there would be no more spending money in “x” quarter, yet we expect you to carry out the projects. This was/is just the tip of the iceberg, and you’re right it is highly probable there is a problem within how the system is designed. We still need to deliever value to customer in spite of the system.
I’ve had DirecTV service reps say they’ve had to do things like what you’ve described, Synfluent and Kathy B.
If you watched the Undercover Boss episode on DirecTV, you saw this actually happening live. I watched it and wanted to jump through the screen and help redesign their distribution system. So much opportunity. As a lean person you can’t watch the part about the distribution warehouse (after following an excellent tech that had to call all over kingdom come to find an HD box) and not want to show them visual management and kanban. You saw the tech struggling and then you saw why at the distribution center. Now that I think about it, every job the “boss” did was affected in some way by hoarding.
Offices have the same problems with basic office supplies. Where do they teach managers/admins that specifying certain Post-it sizes and pen types returns measurable bottom line results? It just drives people to hoard the “good stuff” when it’s available, and then the powers-that-be see this spike in cost, and that signals to them that they shouldn’t order that stuff any more (drove costs up). Then they lock the cabinets to restrict outflow, which drives even more fluctuations into the system. People use basic supplies at the rate they use them. Choking and/or manipulating the supply only drives costs and hoarding to go up. It’s basic economics, much less a revolutionary lean concept.
I almost referred to that episode of Undercover Boss in my comment below. I honestly couldn’t believe the amount of waste caused by hoarding: The time and effort wasted by the technician who had to phone round looking for a box. The time, effort and fuel wasted by the technician who had hoarded boxes and had to take one to the first technician. The time wasted for the customer who had to wait around while all of the above was going on.
I wonder if they have fixed the system yet?
Mark, I wholeheartedly agree that people are unlikely to stop hoarding until they trust the system. But have you considered that hoarding is a vicious circle; people hoard because the supply chain can’t meet demand, the hoarding then causes further unevenness and shortages, which then causes even more people to hoard.
While I’m sure a well executed kanban system can alleviate some of the supply chain problems, how can you fix the supply chain without first educating people about the problems their hoarding causes? Do you not find that (at least initially) when the supply chain is improved that people will try to game the kanban system, hoard even more and cause more problems?
Also how do you deal with shortages that are outwith your control (caused by suppliers etc), that can wreck the trust in your system and cause people to revert to their old hoarding ways?
Yes, a “vicious cycle” is a good way to describe that dynamic, you are right.
I think part of the kanban and 5S process is to have that education – explaining how hoarding takes extra space, leads often to expired supplies, etc.
But you have to fix the system before you can ask people to stop the hoarding… and engage with people as you are working to fix the system so they are aware of the efforts.
As for shortages that are out of your control – supplier shortages of meds or supplies are going to be a problem with a kanban system or with traditional supply chain processes. Again, communication with staff about the cause of a materials shortage can help them avoid blaming the kanban system.
The hoarding can be a bad problem and asking “why?” is a good way to find out the cause, but I have found explaining the “why?” there is problem can prevent the hoarding.
For example, when I worked for an electro-plating company we had an issue with roughness in the chemical bath. We found one of the root cause to be electrical tape the operators used to wrap broken hooks. Once I explained the root cause to the operators, they all brought the tape they were hoarding in their lockers to me without even asking.
It really hit me to what the power of explaining why can do to change behaviors.
Hoarding, whether post-its or meds, is inherently a work-around. It’s people who mean well trying to do what’s right when the system won’t allow what’s right to happen easily.
Jamie
Right – it does no good to blame an individual for a system problem. We often see the same thing with batching… it’s a workaround of a bad system that leads to someone batching up work. As with hoarding, we can’t just shame the person for batching…. fix the process!
[…] at LeanBlog, Mark Graban asked the same question about hospital employees that stashed extra supplies around the office, making it hard to really […]