Last week, an article in the Wall Street Journal caught my eye:
My immediate short response was to tweet out an illustration that I hoped would get circulated around Twitter. I also got an article published in MD+DI (Medical Device and Diagnostic Industry). I'll share both of those here.
Even if you can't read the initial WSJ piece, you should be able to watch this embedded video where reporters talk about the story, with additional commentary:
From the WSJ story:
In the next few years, thousands of “service robots” are expected to enter the health-care sector—picture R2D2 from “Star Wars” carrying a tray of medications or a load of laundry down hospital corridors.
Fewer than 1,000 of these blue-collar robots currently roam about hospitals, but those numbers are expected to grow quickly.
I've seen those “tuggers” in factories and (less frequently) in hospitals.
Here is the graphic I created and shared:
People get so giddy about robots… and they forget to think about the inherent improvement capabilities that workers at all levels have. The man pictured at right works at the hospital where my Healthcare Kaizen co-author works. He works in the housekeeping department and he submitted and implemented a “kaizen” improvement in his own work. Robots can't do that. Even people doing “menial” work can generate ideas, if we respect them and engage them.
A robot that's delivering supplies can't provide any service or help to visitors. A human delivering linens can offer a friendly smile to patients who are rehabilitating in the hallway. Humans can notice a visitor who looks lost, pointing them in the right direction and then initiating improvements to hospital signage that prevents others from getting lost in the future.
Robots automate just one part of the supply chain and delivery chain for supplies like linens and meds. A robot has to be loaded by a person. The robot can then roll along to a unit. Then, a person has to unload the robot to place items onto shelves. There's just a smidge of labor taken out. Robots add the upfront cost of programming and setup, installing sensors in the floor (if necessary), and the ongoing maintenance.
If you think there's a great “ROI” on robots, you should look first at the ROI of your peoples' ideas — and people can generate ideas that improve quality, safety, and other dimensions.
So in my MD+DI piece, I wrote something targeted toward the people who design and sell these robotics:
Companies that sell robots may see healthcare as a new market opportunity, especially in the case of one manufacturer that expects its military sales to shrink dramatically, given government budget cuts. Instead of asking “where else can we sell what we make?,” the makers and buyers of technology need to first ask what problem is being solved with a given technology.
….
Both buyers and makers would be well served by following the 8th principle of The Toyota Way: “Use only reliable, thoroughly tested technology that serves your people and processes.” The automaker is not Luddite in its approach—it certainly uses robots, software, and other technologies, but only when they produce better quality, protect employees, or have a clearly proven long-term return on investment. Borrowing from the “Lean Startup” methodology popularized by Eric Ries, engineers need to not only ask “can I build this?” but they should also ask “should I build it?” from a market perspective.
You can read my whole article here and please leave your comments and thoughts here on this post. I'm not opposed to robots… but I am opposed to companies just pushing their technology because they see “a new market,” and I'm opposed to hospitals buying technology just because of a gee whiz factor.
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Hi Mark,
Very nice post. Robots and shiny objects get a lot of attention, but often for the wrong reasons. While robots do have their place (for example, to conduct activities that are dangerous or require certain precision), they are depreciating assets. People, especially within a kaizen culture, appreciate in value.
This is why Toyota, when confronted with the business downturns several years ago, did not sever any of the permanent employees. They knew that it would take 10 years to “replace” a 10-year employee. You can’t say that about a robot.
Agree, thanks for the great comment.
Toyota factories supposedly have less automation than GM plants (it was GM’s Roger Smith who had the pipe dream of a “lights out factory). Toyota focuses (I hear) on jobs where there would be a safety concern for workers or if robots can do something, like a certain weld, at better quality than a person.
The hospital delivery robots seem to not meet that test.
This is not a new phenomenon in hospitals. Huge investments in medical equipment of all types have been made in the last few decades, often without clear evidence of it being better than cheaper alternatives or what it replaced. I would expect that, as in manufacturing, the people who would use the equipment roam the trade shows with as much excitement as manufacturing engineers roam IMTS. Lean makes new equipment pass the reasonableness test, looks at creativity before capital, and as you say, appreciates the flexibility of humans. By creativity before capital, I mean adapting equipment you have rather than buying new, keeping equipment in reliable running order with appropriate maintenance, and right-sizing equipment to its need. You might actually need the latest X-ray or ultrasound technology (or not), but it’s different in the kitchen.
As always, while I am a Lean advocate, I feel compelled to offer the contrarian point of view.
The real benefit with these small load AGVs (automatic guided vehicles) or tuggers is the elimination of long travel distances by personnel which can often be the largest component of time for an individual, not the loading or unloading of items from the unit. This is especially true in a campus environment with buildings that are interconnected with a maze of tunnels.
Certainly an AGV can’t offer ideas for process improvement. But it can free up personnel to perform more value-added activities. Pushing a laundry cart or cart of supplies thousands of feet is considered non-value added time, is it not? Does it not free up personnel to provide better patient care? Free up time to do continuous improvement?
I would agree that often time people get too excited about technology without first looking at simpler, less costly alternatives. Before suggesting AGVs to transport items from a centralized stock area to satellite locations, is it possible to move the centralized stock area closer to the the points-of-use?
No, an AGV can never replace a human. But it certainly brings benefits that should be discussed in any cost/benefit analysis.
JM – I completely see your point. My take was a bit extreme in the “no robots” side, but to serve as a counterbalance and food for thought for the WSJ argument.
Sure, the pushing/pulling of a cart isn’t value adding or particularly interesting work… but I think the fact that a hospital would replace a person with that type of robot shows they view the person as just a “pile of meat” (as some would say) whose job it is to move linens.
I think a more effective hospital and culture would have everybody in a customer service role – smiling at people, helping lost visitors, looking for problems and solving them.
As to freeing up time for clinical activities, that wouldn’t be the case for a supply chain or materials or housekeeping person who might be delivering those materials.
Thanks for your comment and contrarian to the contrarian view :-)
Goos article Mark. I have a slightly different view agian. Whether we use a robot, an AGV or human, the problem is the transportation of materials (particularly over long distances) is waste. All the robot or AGV does is to automate a wasteful process so humans don’t have to do it. Often this is because the dispensing of materials or laundry are done in large central locations. Many times this is done in the mistaken belief we’re optimizing the process.
Shouldn’t we in the Lean community be looking at eliminating waste first? To do this we need to engage the hearts and minds of our people.
Very insightful, Al. In my zeal to trumpet people’s inherent improvement capabilities, I lost sight a bit that the whole activity is waste!
A robot won’t suggest reducing the length of its route (it’s programmers wouldn’t let it do such a thing, ha ha). Funny that the robot company would consider that path it takes “value,” but that’s a different story.
A human might suggest, as you said, changing storage locations to reduce the distance. Then, as I’m sure you’d agree, it’s critical to make sure the person isn’t laid off as a result of such a productivity improvement.
Very enlightening blog. I often find myself craving robotics and automation, but you’ve reminded me of some of the dangers of that type of thinking. People are still our best asset (at least until Skynet becomes self-aware).
Great article Mark. It’s interesting to see the direction Lean is taking in healthcare, I see a lot of parallels to how manufacturing adopted lean thinking.
As an industry is grappling with how to adopt Lean principles they are trying many different methods and there is a level of excitement with the start of each new method, thinking the “silver bullet” has been found. Then that new method fades away when it’s realized it didn’t fix all the problems.
In manufacturing I think many companies and have realized there isn’t a silver bullet that fixes everything. Hard work and dedication fixes problems and there’s no way around that. Once that realization occurs companies move from the program of the month implementation to a more consistent direction of daily problem solving. I’m not sure if many people in the Healthcare industry have learned that yet.
I see the use of robots and other fancy technologies as another phase in the healthcare industries learning of continuous improvement.
Thanks, Brian. There’s an aspect of this evolution in lean thinking for an industry and an organization, where they shift from:
1) Early on, constantly asking “is this lean to ______?”
2) Just evaluating what makes sense for the organization in the long-term, using lean principles and thinking that become embedded (we’re less consciously “practicing lean”)
In phase 1, people would ask “is it lean to have delivery robots?”
I really don’t care “if it’s lean.” I’m more concerned about what’s best for safety, quality, cost, patient access, etc.
I’ve seen far too many cases where hospital technology hasn’t panned out for people:
– pharmacy robots
– “total lab automation” systems in laboratories
There are always tradeoffs. And I don’t think the tradeoffs are always evaluated properly. It’s easy for tech vendors to sell something as a silver bullet, but it’s never that simple. Buyer beware. Buyer be smart.
The public radio show “Marketplace” has had an interesting series this week on robots.
One place they fail is the hospitality industry:
http://www.marketplace.org/topics/tech/robots-ate-my-job/robots-lose-out-hospitality
Check out the series:
http://www.marketplace.org/robots-ate-my-job
[…] years, we see news articles about virtual reality robots that will roam hospital hallways – delivering medicines or supplies or allowing remote physicians to examine and communicate with patients in far-off locales who might […]
Here is a press release from a robot maker. They claim installation in 15 hospitals and also claim their robo couriers fit in a lean process.
http://www.marketwatch.com/story/photo-release-adept-technology-delivers-largest-shipment-to-date-of-autonomous-mobile-robots-to-swisslog-2012-05-14