Gastblog van Mark Graban: Loving Care

Op ons symposium Lean in de zorg in 2009 in het Elisabeth was Mark Graban gastspreker vanuit de VS. Mark heeft een bijzonder veelgelezen blog over lean en blogt vaak over de zorg. Hij heeft zelfs al twee goede en veel verkochte boeken over lean in de zorg geschreven: Lean Hospitals en Healthcare Kaizen. We hebben sindsdien veelvuldig contact met hem gehouden. Hij is ook de aanleiding voor mij geweest om zelf te gaan bloggen. Vanuit Lidz is hij ook onze contactpersoon voor het Amerikaanse netwerk voor lean in de zorg.

Onlangs plaatste hij een blog over zijn ervaringen naar aanleiding van onze uitwisselingen over de samenhang tussen het thema lief, of 'loving care' en lean. Naar aanleiding daarvan heeft hij onderstaande gastblog geschreven voor op mijn blog:

Loving Care and Respectful Workplaces

By Mark Graban

It is Valentine’s Day as I write this post. I am looking forward to cooking dinner with my wife and enjoying a quiet night together at home, rather than fighting crowded restaurants. I respect my wife deeply and I love her dearly. Love inspires us be of service to others, to be at our best, and to live life to the fullest.

But, people don’t dare utter the word “love” at work (even in a platonic sense) and we too rarely talk about “respect.” Yet, I believe these are core components of any truly Lean culture.

I consider myself very fortunate to have met Marc, owner of this blog, and his colleagues. They invited me to visit Tilburg and St. Elisabeth Hospital in 2009 and I have seen Marc and some of his colleagues yearly when they visit the U.S. as part of the large Dutch contingent that attends the Lean Healthcare Transformation Summit each June. They share their experiences and participate in the vibrant community of Lean learning.

As Valentine’s Day approached, other than thinking about my dear wife, I found myself thinking (in a different way) of Dr. Jacob Caron, of St. Elisabeth, and how I first saw him talk about “Loving Care.” I had never heard this phrase. Jacob joked, “I don’t think it translates well from Dutch.” It translates beautifully, actually.

The title of his presentation at their Tilburg Lean Healthcare conference was “Lean and Loving…. a Mission Impossible?” Loving care might be, sadly, rare or unusual – but it’s certainly not impossible. Dr. Caron talked about their goal of providing care that is not just clinically excellent and without error, but is also delivered in a “loving environment.”

Far too often, hospitals around the world are places where nurses and other staff are so busy that they don’t have time to attend to all of the emotional needs of their patients. Heck, the staff often don’t have enough time to think about their own emotional needs.

Why is it that a nurse feels pressured to rush out of a patient’s room, after completing a task, off to complete the next task, instead of being able to stop and attend to a patient’s complete needs? What if the patient is lonely? Or they are scared about a surgical procedure that will take place tomorrow. Or the patient wants to better understand their newly diagnosed condition.

Nurses are racing from task to task (if they can even complete them all) because their jobs are poorly designed (meaning they are asked, often, to do 75 minutes of work in each hour) or systems are designed poorly, which leads to waste (such as racing around to find missing medications… and the same medications are always missing).

Whew. It’s exhausting. Staff can barely make through it each day and many are eager to retire (or they quit the profession they once loved… or thought they would love).

In the Toyota Way management system, and in the Lean philosophy, we talk about one of the dual pillars of “continuous improvement” and “respect for people.” These ideas are intertwined – because we respect our patients, we practice continuous improvement to reduce waste and free up time for nurses and staff. Because we have respect for people – the patients AND staff – that freed up time is then rededicated to better patient care (making sure all required tasks can be done) AND more loving care (attending to those emotional needs).

I had a chance to interview Dr. Stephen F. Covey a few years back and I asked him what he meant by “respect for people.” He said:

“I think that it’s of profound importance because it means you are caring and you trust them to do the right thing.”

It’s mostly a rational decision to respect people. We give or respect (or it is “earned”). The idea of love goes further. Sometimes love just happens to us. When we are married, hopefully both spouses continually choose to continue giving and sharing that love. Love goes further than respect. I wish I had asked Dr. Covey if the word “love” was appropriate for the workplace.

There are some bible verses that are often cited at weddings – you may know them (Corinthians 13:4-7):

“Love is patient, love is kind. It does not envy, it does not boast, it is not proud. ⁵ It does not dishonor others, it is not self-seeking, it is not easily angered, it keeps no record of wrongs. ⁶ Love does not delight in evil but rejoices with the truth. ⁷ It always protects, always trusts, always hopes, always perseveres.”

I think that all applies to the workplace. We should be appropriately patient with our employees, co-workers, and managers (while being impatient with processes that need to be improved). The rest of Corinthians can certainly apply to the workplace.

If we love or respect our employees, colleagues, and managers, good things happen. We should love every patient as if it were our own mother, which inspires improvement that is facilitated by the respect or love that we have for our co-workers.

The “Love is patient” verses are probably never quoted at the beginning of Kaizen Events, nor are they recited in new employee orientation.

If the word “love” makes you uncomfortable in the workplace, try the verses this way:

“Respect is patient, respect is kind. It does not envy, it does not boast, it is not proud. ⁵ It does not dishonor others, it is not self-seeking, it is not easily angered, it keeps no record of wrongs. ⁶ Respect does not delight in evil but rejoices with the truth. ⁷ It always protects, always trusts, always hopes, always perseveres.”

I bet that attitude – expressed as love or respect – will inspire improvement. It will also inspire the right behaviors that make improvement more successful and sustainable. And that seems like the key to “loving care.” People in hospitals are sometimes fearful that Lean means “turning their hospital into a factory,” as if that means it would now focus only on cold, ruthless, efficiency. Ironically, those methods from manufacturing are exactly the thing that creates a more loving environment for all.