Nursing Flashcards
1
Q
A
2
Q
(5) Job related actions to enhance position in medical labor force/achieve status of profession
A
1) shift to univeristy training
2) taking over physicians dirty work
3) use of managerial ideology
4) taking control of technology
5) unionizing
3
Q
Occupation in crisis
A
Nurses
4
Q
Impact of cutbacks on Doctors vs. Nurses
A
doctors have always been relatively privileged group - still had to work harder (reported increased stress) but incomes have remained high
Nurses have received the most pressure yet earn the same as national avg income
5
Q
in 2012, average annual income of:
a) GPs
b) specialists
A
a) 180k
b) 350k
6
Q
History of nursing begins with?
A
Florence Nightingale
7
Q
Florence Nightingale
- background before Crimean war
A
born into relatively wealthy family in 1820
- strong-willed woman
- despite her familys strong objections to working as a nurse, she studied HC anyways
- became director of nursing home in England where she transformed it into an efficient little hospital
8
Q
Nightingale effectively transformed nursing from… into…?
A
FROM occupation restricted to untrained nuns/charity workers INTO genuine occupation requiring vocational education
9
Q
Nightingale is famous for her work in? (years?)
A
the Crimean War (1853-1856)
10
Q
What was the nickname Nightingale earned in the Crimean war? For what reason?
A
Lady with the Lamp
- for her nightly rounds of checkin on patients with her lamp
11
Q
When Nightingale and her group of nurses first arrived in Crimea, how were they recieved?
A
met with hostility from doctors there
(doctors were obsessed about maintaining control/a monopoly over HC)
12
Q
How did Nightingale respond to the doctors hostility? (3 pts)
A
reassured them that nurses were not competition and were strictly there to obey the doctors orders & do women’s work (cooking & cleaning)
13
Q
How did Nightingale make a difference by cooking & cleaning in the Crimean War (1853-1856)?
A
by taking over cooking & cleaning, she was able to introduce proper standards of nutrition & sanitation which was previously ignored by male doctors - mortality rates declined sharply
14
Q
One famous case where Nightingale helped improve sanitation
A
persuaded military officers to go upstream & found dead horse spewing bacteria - convinced them to move it
15
Q
Florence Nightingale -After Crimean War
A
took heavy toll on her, ill & bed-ridden most of her life
- became public heroine & used her fame to write about nursing, engage in political activism & organizational work that laid the foundation for modern nurse training
16
Q
First Nursing School in Canada
A
St.Catharines
- established in 1874 in Ontario
- based on Nightingales model of nursing
17
Q
Nursing - occupation for women
A
virtually only paid occupation for women
- therefore it was very attractive for those who wanted an education & career (middle-class women)
18
Q
# of nursing schools in Canada in…
a) 1900
b) by 1909
c) by 1930
A
a) 20
b) 170
c) 220
19
Q
The first 30 years of the 20th Century were known as the period that..
A
saw the greatest expansion in nursing
20
Q
Impact of the Flexner Report on Nursing
A
following the recommendations of the Flexner report, the 1st university degree program in nursing was established in 1919 at UBC
21
Q
1900s: # of nurses vs doctors
A
200 nurses compared to 5,000 doctors
22
Q
1930: # of nurses vs doctors
A
30,000 nurses compared to 10,000
23
Q
After 1930, what happened to the rate of growth of nursing?
A
declined
24
Q
Despite the decline in the rate of growth of nursing after 1930, Throughout the 20th Century…
A
nursing maintained average annual increase of 50%
- compared to less than 10% for doctors
25
By **2006**, How many **registered nurses** in Canada? What **% were women?**
**320,000**
**94% women**
26
Nurses made up __ of all HC providers becoming the...
**2/3**
**single largest profession** in Canada
27
In **economic terms**, the **expansion of nursing** allowed...
Canadian women to get **back into labor market** from which they had been virtually squeezed out of by **late 19th century**
28
**Routes for Economic Independance** for women in early 20th century? (2)
1) **Inheritance**
2) **nursing**
29
Despite being the **only route to independance** (apart from inheritance) for women, there were still **drawbacks/limitations** to nursing.
hard road to travel
only gave **limited** form of independance
30
Although Nightingale herself was strong & independent, her teaching methods demanded...
**strict obediance to male doctors**
31
Argument about Nightingale's teaching methods
some say she did a **disservice** to women
- but may have been the only way to be accepted & overcome the hostility of male doctors
32
Only way that nursing could be accepted by doctors was if...
they defined themselves as an **AUXILLARY OCCUPATION** to that of doctors (a supplementary occupation)
33
The general attitude about nursing by male doctors
women were still doing women's work, just in a hospital setting
- which was acceptable to male docs at the time
34
Connection b/w Patriarchal relations that existed in Victorian family/society & HC
the **patriarchal relations** that existed in Victorian society/family (era: **1837-1901)** were reproduced within the hospital
35
The Patriarchal (male-dominated gender) relations that existed in Victorian society/family were reproduced within hospital, creating...
a new **gender division of labor** in HC
36
Men providing **cuts & chemicals (surgery & drugs)** & women providing **nutrition & sanitation** was a reasonable division of labor. However, the problem was..
men ended up **taking most of the money** & **power** but the women did most of the work
- particularly nursing students
37
**Early 20th Century -** Nursing students
- treated like **slave laborers**
- work consisted of **hard manual labor** (washing floors/windows, changing beds, cooking)
- forced to work **12-16 hours/day** in hospital **WITHOUT** **pay**
- only received **training**, **room** and **board**
38
When did Nursing students get **paid**?
How much **compared** to average male wage?
Only after they had graduated & recieved their Nursing Diploma
- only **1/2 of average male wage**
39
Nursing students training consisted of..
mostly **on-the-job training** which consisted of **working hard while being supervised** by small permanent staff of grad nurses
- no time for actual study/theory
40
How long to finish a Nursing Degree in the **early 20th century?**
2-3 years
41
How did the hospitals benefit from nursing students in the early 20th century?
provided hospitals with **rotating pool of cheap labor**
42
After graduation, where would nurses work?
some worked as **private nurses** but increasings #s found **jobs in hospitals**
43
The explosive growth of nursing schools was greatly motivated by?
the desire of hospital administrators & doctors to have **cheap labor**
44
What effect did permanent nursing staff have on hospitals?
no more cheap labor
- less motivation for growth of nursing profession
45
How did nursing change hospitals in **early 20th Century** compared to **19th century**?
**19th century** - hospitals were places people only went to die
**20th** - changed hospitals into **hygienic centers of care** & **recovery** which
changed **public image of hospitals**
46
Nursing made major contribution to... yet?
medical profession & doctors reputation yet still they were heavily exploited
paid virtually nothing for a lot of work
47
As the # of nurses rose, they begin to..
fight for their rights
48
Nurses realized the only way to get better wages & working conditions was through (2)?
**self-organization** & **collective action**
49
**1908 -** established?
Canadians Nurses established **Canadian National Association of Trained Nurses (CNATN)**
50
**1924**
reorganization **CNATN** and renamed as **Canadian Nurses Assocation**
51
**Canadian Nurses Association** - significance today
still remains main organization that represents nurses interests today
52
First goal of **CNATN** in **1908**
establish **provincial registries of qualified nurses -**only these nurses could practice nursing
53
**1910**
began to set up registries & nurses became known as RNs
54
Through the process of **registering nurses**.. the nursing profession tried to...
**gain monopoly** on **role of assistant caregiver** but never been as successful as doctors in achieving a monopoly
55
By **WW2 (1939-1945)**. organization of Nurses
organized enough to gain some concessions - gained **8 hour day**
56
**1950** - nurses income
nurses pay was **60% of avg national income**
57
by **1980** - nurses income
risen to avg national income - mostly due to pressure from nurses
58
In addition to pushing for better wages & working conditions, Nurses also demanded?
**real education** and not just on-the-job training
59
**1964** - Nursing
**Hall report** - Royal commission looking into HC delivered report that was **critical of nursing education in Canada**
60
The **Hall Report** of **1964** recommended what change to nursing?
**seperation** of nursing training from hospital demands for nursing services
(nursing education should be seperate from training)
61
How did the government respond to the **Royal Commission's recommendations** of seperating nursing education from training?
in **late 60s/early 70s** → nursing education moved away from hospital schools into **newly created diploma programs in universities**
62
What aspects of Nursing were significantly improved after the government responded to the Royal Commissions recommendations?
skills & standards
63
What other change did the government make other than to nursing education?
changed **immigration policy to attract more nurses**
64
As a result of the change in Canadian immigration policy...
over **20,000 nurses immigrated to Canada** - mostly from Britain
65
Britain's NHS
**Britain's National Health Service/System (NHS)** was more **advanced & developed** than Canada's HC system
66
**NHS** - impact on Canadian HC
Canadian government **deliberately tried** to **upgrade nursing standards & increase # of nurses**
67
The government's attempts to upgrade nursing standards & increase # of nurses by changing immigration laws was part of..
overall policy of Canada to establish Medicare by copying Britain's NHS
68
Time period that saw considerable expansion in # of nurses
**1960s** & **1970s**
69
The expansion in the # of nurses in 60s & 70s was accompanied by..
a growing division of labor
70
Nursing saw an increase in (3) things
1) specialization
2) fragmentation
3) hierarchization
71
Nursing began to generate its own __ \_\_\_
auxilliary occupations
(therapists, dieticians, orderlies, technicians)
72
**specialization** of nursing
some nurses **took more education** to upgrade their qualifications & specialize in one area of nursing
- realized pay **only increased marginally**
(still 3/4 of nurses are **general duty nurses**)
73
While there were some changes in nursing, more changes changes occured where?
at **bottom of occupational ladder-** auxiliary occupations
74
How did hospital administrator try to cut nurses wage bill after they had just gotten their wages increased?
replaced many nurses with registered nursing assistants (**1970s**)
- when RNAs got organized & pushed for higher wages, they were replaced with nursing attendants (**1980s**)
75
The replacement of nurses with registered nursing assistants & then nursings attendants demonstrates...
**class struggle in action** which is seen in any area of the economy
- cycle that is built into capitalism
76
Despite all these changes to the Nursing field, what remained constant? How?
**Ongoing feminization of HC system**
- by **1990s**, **2/3** of HC system workers were nurses (**90%** women)
- nearly **80% of all HC workers = women**
77
Despite the increasing proportion of women in the HC system..
women's influence & power has **not grown in proportion to their #s**
78
in the **late 80s/90s**, how were hospital bills broken down?
**into thirds**
1/3 for **doctors**
1/3 for **nurses**
1/3 for **administrative & support staff**
79
Nursing expanded greatly in **60s & 70s**, but in **80s & 90s**, there was a major increase in..
administrative staff
80
(2) reasons for the **major increase in administrative staff in hospitals**
1) certain **support services were removed from nursing** & **subcontracted** to private companies
2) **growth & change in kind of hospital administrators**
81
**80s** → certain support services removed from nursing
hotel services (cooking, cleaning, laundry, catering) were no longer nurses responsibility & hospitals subcontracted these to private companies
82
What was the beginning of **privatization of HC**
subcontracting private companies for hotel services
83
Growth & change in in kind of hospital administrators
in **5 years (1981-86),** # of HC administrators grew by over **2/3s**
**-** hospitals began to hire administrators outside of HC field-
mostly managers from **private sector** who had an **education** in **management** & not HC
84
**Before the 80s**, who were hospital administrators?
mostly doctors or other HC workers that had climbed administrative ladder internally
85
by **1993**.. HC administrators **characteristics**
1/3 of HC administrators had **NO HC experience**
- mostly **men**
- business degree/experience in management
86
**Changes in control/influence** due to the new kind of hospital administrators
doctors lost control of hospitals
- womens influence decline
87
How did these new hospital administrators view their job & how did this affect working in the hospital?
saw their job as the **same kind they had in private sector**
- pressure workers work as hard as possible
88
Why did most of pressure from hospital administrators fall on nurses?
doctors were still seen as relatively privileged group, middle-class professionals who deserved to not be pushed as hard
89
**Managerial structure** emerged in hospitals
private administrators \> doctors \> nurses & auxiliaries
90
To the hospital administrators, nurses were seen as..
the **working class of the HC system** which management has always pushed to work harder
91
How did Hospital administrators push nurses to work harder??
through the process of **deskilling**
92
deskilling
breaking down jobs into **simple tasks** so highly paid experts can be **replaced** with less-skilled cheaper workers
93
(2) advantages of deskilling for management
1) **increased control** over workforce
2) **saves $$** by decreased wage bill
94
**Deskilling** - first noted in academic terms by..
**Chares Babbage** in **early 19th Century**
→ known as **Babbage Principle**
95
Other terms for deskilling
**late 19th century** → **Fordism** (Henry Ford)
**early 20th**→ **Taylorism** (named after Frederick Taylor who invented time & motion studies & scientific management)
**late 20th**→ **Mcdonaldization**
96
Terms for Deskilling within the field of HC
Managerial Ideology
Case-mix grouping
Total Quality Management (TQM)
97
Why should **TQM** be called Totalitarian Quality Management? *(as opposed to total quality management)*
because it introduces total control over nurses work
***totalitarian (def'n) -** system of government that is centralized, dictatorial & requires complete subservience to the state.*
98
What were nurses told that TQM do?
provide greater **autonomy**
make jobs **easier** by improving job **effeciency**
**help to assess staff needs -** hopefully to **decrease workload** of nurses
99
What did TQM actually do?
**breaks down** nursing into specific jobs & **assigning specific amounts of time** for each task *(based on polls asking nurses how much time they needed for each)*
- allowed administration to **cut amount of time allowed for each job** to **force** nurses **to work harder/faster** & **save money** by not hiring more nurses
100
**Origin** of TQM relating to the **negative consequences** of TQM
TQM was taken from factory work where assembly lines can be **standardized** to **improve efficiency**
- However, **people are not machines** & **HC cannot be standarized** because it **wouldnt account for personal differences**
101
How does the **standardization of HC** by TQM affect nursing care how?
left nurses **without enough time** so that they were constantly **falling behind on tasks** - made **decision making difficult** b/c they had less time to make possibly life-or-death choices
102
**Quality of Care** given by nurses after TQM introduced
of **mistakes** increased
of **people harmed** increased
*- because they did not have enough time*
103
TQM's **attempt to standardize HC** had **negative effects on...**
the **patients** & the **nurses**
104
Study by **Canadian Institute for Health Information (2004)**
- main finding
over **5 million CDNs** reported they or member of their family had been **harmed by medical errors in hospital**
105
Study by **Canadian Institute for Health Information (2004)**
- statistics given **(5)**
- **1 in 9** reported receiving **incorrect** **meds**/**dosage**
- **1/9 adults** & **1/11 children** contracted **infection** in hospital
- **1/81 newborns** suffered **birth trauma**
- **1/~1000 seniors** suffer **hip fracture**
- **1/~7000** reported having **foreign object** left inside them after procedure
106
TQM treats nurses as if they were?
**interchangeable components** on assembly line
107
How has TQM resulted in **a lack of continuity of HC?**
different nurses do different jobs on same patient → **unable to learn patients overall health situation** so nurses can't treat patients like individual with individual needs
108
TQM is the ultimate **extension** of?
& **denial** of?
extension of **male mechanical model**
& denial of **traditional holistic female approach to HC**
109
TQM turned the **continuous process of care into?**
**series of compartmentalized cures** that were about seeing to a patients minimum needs
110
TQM also eliminated what side of HC?
**subjective** side of HC - part of nurses work called **emotional labor**
111
Explain how private sector administrators view HC & how that is reflected in their management.
administrators deal with **balance sheets, numbers & money**
- the **comfort** that **nurses provided** is **invisible** & **seen as a waste of time** that must be eliminated to ***increase speed**, **efficiency** & **decrease cost***
112
How does TQM treat
a) nurses
b) patients
a) as if they were **uneducated unskilled labourers** who have to be told what/how/when to do things
b) treats patients in a **standardized manner**
113
In Sociological Terms, professionals want control over their own __ \_\_
**labor process**
114
TQM has greatly increased level of ___ that nurses experience from their jobs
alienation
115
How has TQM affected **quality of care given by nurses?**
**How** has this **affected hospital** in **last 30 years?**
has **forced** them **to do** their **jobs badly** bc they **do not have enough time** or **resources**
- **heal**th, **sanitation** & **nutrition** levels **declined** over last 30 years
116
In general, how has TQM affected nurses?
- cause nurses to **blame themselves**/**other** nurses
- increases levels of **stress**
- ***physical** stress of **overwork***
* - **psychological** stress of **not being able to do jobs properly***
**-** rise in **work-related injuries** & **illnesses** for nurses
117
By the **late 1990s,** as a result of TQM, nursing has become known as..
the **sickest profession** in Canada
118
Nursing - Sickest Profession in Canada - Example
**1997** - sick leave average
CDN = 1 week
nurses = just over **3 weeks**
119
Nurse Burnout
in **1990s**, as a result of TQM - many nurses **quit** because they couldn't take the pressure
120
Why is the phenomenon known as **Nurse Burnout** only happening in the **later 20th Century?**
in the **late 19th/early 20th Century**, nursing was really the only acceptable & paid job for women
- now, women have many other options
121
**2000** - **Canadian Nurses Association** *study* found..
~ **1/3 nurse graduates** left canadian nursing **within 5 years** of graduating
- **20% quit altogether**
**-** **10%** went to **USA** to work in private sector (paid more)
122
What decade saw a **sharp decline in the # of applicants & graduates of nursing schools?**
**1990s**
123
**Nurses graduated in Canada** in **1999** vs. **2000**
**1999:** **~9000**
## Footnote
**2000: \<5000**
124
How did Nurses try to fight back against the increasing stress put on them? (3)
in **late 1980s**, **Nurses Union** proclaimed TQM was **endangering patients life** through pressure putting on nurses
- **Provincial Nurses Unions** took a stand on **SAFETY TO PRACTICE** issues
- went on **strike**
125
First Wave of Nursing Strikes
bc they were being completely ignored, wave of nursing strikes swept across Canada in **late 80s/early 90s**
126
**late 80s/early 90s -** Nursing Strikes
**1988**- SK & AB
**1989 -** BC & Quebec
**1991** - Manitoba (longest strike)
127
What was the **result** of the Nursing strikes?
a **professional responsibility clause** was added to nurses contracts that **established channels for nurses to express their grievances**
128
2nd wave of nursing strikes - **when?**
**late 90s/early 2000s** - every province in Canada
**1999**- SK
129
How did SK government **respond** to SK nurses going on strike
NDP gov met nurses w/ great **hostility** despite being party of the working class
- ready to enact **back to work legislation**
**-** used courts to **threaten unions** with **fines** & **leaders** with **prison time**
130
Throughout the **2000s**, nurses have been \_\_\_, ___ & \_\_\_\_
overstressed
over-supervised
over-worked
131
**2003** Statistics - Nurses **Overtime**
CDN nurses worked over a **quarter million overtime hours in a week**
- equivalent to **work of 7,000 full-time jobs a year**
132
**2005 - Study on Ontario Nurses** - findings
**58%** of **nurses** & **66%** of **junior nurses** experiencing **symptoms** of nurse burnout
- **1 in 3** nurses **under 30** plan to quit
- **1 in 3** **over 50** plan to retire early
133
**2005 Study on Ontario Nurses**
- **Symptoms** of nurse-burnout (5)
- **reasons** for symptoms of nurse-burnout? (3)
* - depression, emotional/physical exhaustion, physical illness & growing cynicism of job*
1) **work overload**
2) **lack** of **fairness** in workplace
3) lack of **empowerment** (increasing supervision & not in control)
134
How does TQM put more pressure on nurses to quit?
their job **involves making life-or-death decisions**
- mistakes increasing b/c of **lack of resources/time/people**
- worries nurses b/c **patient life** & **health** is **compromised**
135
How has SK addressed this i**ssue of nurse burnout?**
In **2012**, Premier Brad Wall announced that SK will once again lead way for Canada in improving HC (just like TD did) → 1st province to introduce **LEAN Management**
136
LEAN Management in SK
in **2012**, SK government signed **4 year contrac**t with Seattle-based company **John Black & Associates**
- pay **40 million over 4 years** to teach LEAN management techniques in over 1,000 HC facilities
137
Origin of LEAN
Japan
138
Sensei (meaning)
one who has gone this way before
- voice of experience
- teacher
139
How did the public view LEAN?
initially well **until 2014**
- was criticized for **40 million $ price tag**
- **Cam Broten of NDP** called lean a "cult"
140
How has SK Premier defended Lean & its 40 million dollar cost?
says that LEAN management has **already more than paid for itself**
- by **eliminating waste** & **improving efficiency**, has saved**:**
* **35 million** in *blood services*
* **16 million** in *design of new hospitals in Saskatoon & Moosejaw*
* **millions more** in 100s of small savings in HC facilities all across province
141
How was lean created?
**Toyota** automobile corp.
- the term was coined by American Analyst **John Krafcik** who wrote article about Toyota in **1988**
- introduced idea of LEAN to the west
142
**Toyot**a - History
founded in **1930s** as small family business
-has since grown to be the **5th largest corporation**
143
The Toyota Way - **History & Basis**
based its production on **assembly line techniques** pioneered by **Henry Ford** In USA
- concerned with **efficiency** & **elimination** of waste **by standardized & simplified production process**
- an **extension** of **Fordism** & **based** on **Taylorism** (time & motion studies)
- **Flow System** -production should flow smoothly - no *bottle necks* or *unused resources*
- *aka Just in Time system* - each person finished their part of job just in time for next person to take over
- dont need lots of backup inventory (save $$)
144
The Toyota Way **Philosphy**
(6) points
- culture
- philosophy
- emphasizes
- decision-making
-
- establishing culture where everyone is **committed** to always **looking to improve process**
- **managerial philosophy**
**-** emphasizes **teamwork** & **mutual respect** between management & employees
- decisions reached by **consensus**
**- regular meetings** to look for ways to do things better
- work as **team**, come to think of as **team**
145
How does the Toyota Way differ from **standard manager-worker relationships**
management **regularly consults workers** & gets **feedback**
- workers are involved in **decision-making process** & their **opinions** are **respected**
- makes them feel like it is their company so they want to be more efficient & finds ways to do job better
146
What does Toyota literature say is the primary reason behind their time-saving techniques?
these time-saving techniques are **by-products** of the **positive attitude**, **teamwork**, **mutual respect** & **culture** of **improving workforce**
147
Why is the Toyota Way **unsuccessful** for many companies over the longterm?
most managers **dont think**/**dont want to** think this way - they **beleive** that managers should **give orders** & workers should obey (**top-down manner**)
- rather than set up meetings, they **hire Sensei's to tell workers what to do** which **makes workers angry**, **decreases morale** & makes **workers less engaged**
148
149
(5) Job-related actions
150
Top-down manner of LEAN in HC
techniques implemented without consulting workers
- nurses are expected to learn **japanese terminology** on top of their job
- alienates workforce
151
The top-down arrogance eliminates chances of?
from the beginning, eliminates chances of creating a **teamwork** **attitude** & gaining workforce **support**
152
Why is the experiment of introducing LEAN into HC inevitably going to lead to problems ?
LEAN was invented in factory setting to provide goods not services
153
Problems with LEAN in HC Setting (3)
1) standardization
2) Flow/Just in Time
3) Eliminating Unused Inventory
154
1) Standardization
LEAN works by standardization → can't standardize people → need **customized/individualized care**
155
2) Flow/Just in Time
in factory setting, production slowed/temporarily halted - may lose $$ but overall system still making money In HC → If one person doesn't do their job on time - **endangers peoples lives**
156
3) Eliminating Unused Inventory
in factories, production & supply needs are fairly predictable - can just order supplies if needed In HC → needs are **not predictable** & goods needed right away or patients can die
157
April 2014 - SK Survey
50% of nurses said quantity & quality of supplies available have declined since LEAN - vital equipment missing & meds unavailable
158
The Governments real motivation behind LEAN
to save money
159
What evidence backs up the idea that the Government only introduced LEAN to save money and not improve HC?
**Nurses Survey (April 2014) **
before LEAN, prov. gov. increase HC budget by 7-10% but now after LEAN → only **3-4%** annual increase
**- July 2014 Report**
160
**July 2014 - Report**
published by i**ndependent assessor of HC system**
Conclusions?
Wall gov. has neglected HC facilities
- need to spend **2.2 billion $** just to provide **essential repairs** to existing HC buildings that are falling apart
**- 87% of HC facilities** rated **poor-fair**
161
LEAN implentation timeline
2012 - contract signed
2013 - introduced at start of this year
162
Tracy Zambory
President of SK Union of Nurses
163
Change in SUN's opinion of LEAN
**2013:** LEAN leading to "**many commendable changes"**
Within 1 year (early **2014**): already became obvious that only purpose of changes was **"budgetary savings"** & these changes had "**little impact** on direct **care** at **bedside** & patient **outcomes**"
- does not fit into safe nursing practice
164
Positive Change of LEAN (4)
1) inventory management
2) waste reduction
3) saving $$
4) undo certain steps of TQM - sped up delivery of HC
165
SUN Survey
Found HC has sped up form before LEAN (**2012**) to after LEAN (2013)
- also increase in critical incidents faster not safer
166
What is the only way that LEAN could work in HC?
If LEAN was really done Toyota Way
- **regular** **meetings** & consultations b/w docs, nurses & hosp admin - IF so → give front-line HC workers more input & reduce input of admin
167
LEAN done the SK Party Way
not about improving HC
- about saving prov. gov. $$ & increasing power & control over front-line HC workers
168
What can LEAN not do?
- deliver on its promises of better HC
- gain support of nurses
169
LEAN as a fad
enthusiasm has waned, eventually will fade away when next fad comes along
170
Cycle of HC Fads
TQM, LEAN... - always about reducing costs & increasing control
