Administration is employing a new tool to manage staffing levels at our hospital, Just-In-Time. It is not a new tool of management. It is part of the Toyota Production System. In the business world it is considered one of the primary reasons that Toyota came to be such a streamlined, successful player in the manufacture of cars and trucks. I believe it is new to apply it to staffing levels on hospital units.
What is JIT inventory management? Basically, instead of having a lot of inventory on hand for manufacturing a product (like a car), there is a limited number of each little part. Parts are reordered more frequently when the supply of each runs low. Now the maker doesn't have lots of money tied up in inventory, doesn't have the expense of storing excess inventory, and doesn't get stuck with a lot of old inventory that won't fit the next model.
How is administration at my hospital employing JIT when staffing for the next shift? The staffing supervisors are being encouraged to put nurses and nursing assistants on call for an hour or two at the beginning of a shift. The staff is put on call even when new patients are expected to admit to the unit within the first two hours of the shift, boosting the unit census to a level that calls for additional staff. "Trim every hour you can" is the new staffing motto.
The number crunchers are saying we all have to give a little, or they threaten that something drastic will have to take place. The last drastic measure was the laying off of dozens of nurses and other support staff without notice. Each time this type of threat is made by administration, the employees grow more stressed and more resentful. Threats are not a positive way to motivate.
I get that the census is not predictable. I get that there are times when I will be on call and times when I will work extra shifts. What I don't get is why it has suddenly become the nurses (and NAs and clerks) who must bear the burden of all the variability. In the past we used the slow hour to read the emails from the supervisor, catch up on new competency mandates, clean the unit, and do our annual ethics compliance trainings. Nurses clean the unit? Yep. Housekeeping only cleans rooms when patients have discharged, or when paged to clean up a spill; and housekeeping cleans the hallways and lobbies where patients and visitors walk. No one is cleaning out the dust bunnies under the supply servers, the spills on the wall by the trash, or the countertops in the nurses' station. We are back to the basics here Miss Nightingale.
Many of the units now get to start the day with no unit clerk. What? Yep. That busy time of the morning when the doctors are writing a lot of new orders... the nurse who is doing morning assessments, passing morning meds, giving morning updates to the family, checking morning blood sugars and helping set patients up for breakfast, aka the morning meal, must also now enter all her own orders, oh, and answer the unit phone.
The problem is that the number crunchers don't seem to understand that there is a rhythm to each shift. I would much rather have an extra staff person (nurse, NA, unit clerk) during those rushed first hours than three hours into the morning. Let us take turns having 60 or 90-minute lunch breaks instead. I'll go work out or run errands. The best time of day to shave hours isn't at the beginning or the end, unless there are dramatic changes in the census. It seems like administrators are sinking to a new level of shadiness when they start applying tools for managing inventory to managing staffing levels for hospital units. I am sure in some industries this tool is applicable to managing "human resources", probably not in this situation though.
If they are going to employ manufacturing philosophies to manage hospital staff, then don't forget a couple more of Toyota's philosophies (you can find more at http://en.wikipedia.org/wiki/Toyota_Production_System):
1.Base your management decisions on a long-term philosophy, even at the expense of short-term financial goals. Right now administration at my hospital is managing month-by-month, and quarter-by-quarter. There is a definite lack of interest from above in building real relationships with nursing staff. We are not parts. We are people.
2.Go and see for yourself to thoroughly understand the situation. Ever seen an administrator in the hallway outside of an inspection? Nope. Not in a slow time, certainly not when it is busy.
3.Level out the workload. (Work like the tortoise, not the hare.) Don't make your nurses frantic, it increases chance of errors and can threaten patient safety. When you know a newly admitted patient is on the way, why wait to call in the nurse? It puts added stress on everyone, including the patient. If the nurse is doing the admitting orders because there is no clerk, who is taking care of the patient?
These healthcare companies never cease to amaze their nursing staff with the brilliance of their stupidity. Be on call or else be laid off? Well, if you're on call most of the time as opposed to working you might as well be laid off at least then you can draw unemployment. I think a rude awakening is in store for most of these big shot healthcare corporations over the next decade or so and I wouldn't be surprised if many of them either go out of business or wind up having to cut some of their administrative fat in order to financially survive.
I have worked at the same hospital for 15 years. In those 15 years management positions haven't changed. Management RN positions within the hospital have not been consolidated or eliminated.
Until those nurses, and other management, become equally at risk with malpractice threats they have no interest in increasing staffing to safety levels.
This Just In Time Gig is being done to cut costs but I'm very interested to know how much this hospital paid to get this program implemented. Just like the Studor Propaganda, I love that Studor has all these "studies" to pass around but when you look at the fine print all the research has been paid for by, who else, but the Studor Group. Fortunately at my hospital patient acquity is taken into consideration and we're all about customer satisfaction, patients aren't smiling and giving us all our "stars" on our surveys if they have to wait for ANYTHING so we seem to be staffed pretty nicely, all to make our 'customers' smile and tell their buddies to come to our hospital.
This is ABSOLUTELY rediculous. I worked for GM when we did implementt JIT( we called it bullJIT , lol)But that was when we had predictable production- like a schedule of so many parts /day, based on what moved out the week before and the predictions of sales. And guess what- how many manufacturing jobs are left in the US????? not too many. IT FAILED. Because in that case parts could be made for pennies less by foreign competition- all the JIT in the world wouldn't have helped.
I have some strong misgivings about the applicability of an inventory management system to staffing. However, JIT most certainly did not fail at GM. It is the standard in every manufacturer with a large enough volume to set up its supply chain to meet its needs.
As you say, however, the primary difference between inventory management and personnel staffing at a hospital is the highly variable demand for the "parts." With sufficient reserve capacity, though, it might be functional insofar as getting the work done. It will, however, suck for the staff who are forced to do the substantial on-call shifts with no guarantee of hours or pay.
As the nursing glut continues to grow, expect the suits to increasingly push such crap at the expense of the nurses.
What I don't understand is that while Gm was in town( they sold out and moved everything to mexico) and in 17 years of me working for them , I was laid off maybe 2 times that whole time, maybe for only 1-3 weeks total.I NEVER had to be "on call" and for the majority of the time, I had a 40 hour paycheck- very very rarely got sent home due to no work. As previous poster stated, given the hospital application of this JIT, if they would be "allowed " to send us home, one might be betterr off with unemployment.
@music- i guess I shouldn't have said jit failed for gm- it was more so GM failed us- I understand a lot of the work has actually made it back to the stats due to quality issues. Duh , we could have told them that, :-(
I am sorry, but that whole Lean Six Sigma is a bunch of crap. Its just another thing that unusually large amount of executives at my facility do to fill their calendar. The front line worker never has any input...
It's not a bunch of crap but if the front-line workers aren't actively participating in the process then the implementation is useless. Lean and SS are not intended to be top-down, they're intended to be bottom-up processes.
They do work but *only* if they're implemented properly - which the ones at your place clearly aren't.
TheMoonisMyLantern, LPN, RN
924 Posts
These healthcare companies never cease to amaze their nursing staff with the brilliance of their stupidity. Be on call or else be laid off? Well, if you're on call most of the time as opposed to working you might as well be laid off at least then you can draw unemployment. I think a rude awakening is in store for most of these big shot healthcare corporations over the next decade or so and I wouldn't be surprised if many of them either go out of business or wind up having to cut some of their administrative fat in order to financially survive.