In the world of American healthcare, a paradox often emerges when discussing improvement and efficiency. As a money expert at money-central.com, I’ve observed a recurring theme in conversations within healthcare organizations: the hesitation to invest in continuous improvement initiatives, often citing budget constraints. It’s a common refrain: “We don’t have the budget to start that continuous improvement initiative right now, but maybe in six months.” Conversely, and less frequently, you might hear a health system boast, “Our leadership doesn’t see a need for Lean because our margins are over 10% and things are fine.” Adding to this perplexing picture, some hospitals are even cutting back on internal Lean teams, a move purportedly aimed at saving money or reflecting a shift in strategic direction.
This raises a critical question: Is the “we don’t have the budget” excuse a genuine financial constraint, or is it a smokescreen for a lack of prioritization or a misunderstanding of the true value of initiatives like Lean? Perhaps it echoes the cynical saying from General Motors, “We’ll save money… no matter how much it costs us!”
My concern deepens when I encounter the perception that Lean is solely about bottom-line margin reduction. The fact that a hospital boasts acceptable margins doesn’t automatically equate to superior quality, patient safety, or other crucial performance indicators. High margins might simply be a result of market dominance or external factors, not necessarily operational excellence.
This recurring narrative inspired my latest cartoon collaboration with Carrie Schurman, reminiscent of the satirical style of “Stan Kelly” editorial cartoons from “The Onion.” This cartoon, a parody within a parody, uses humor to highlight a serious issue within healthcare finance and operational strategy.
Cartoon depicting a crying Statue of Liberty overlooking a ‘Dumpster Fire’ labeled ‘Hospital Finances’. Boxes of ‘Rejected Employee Ideas’ and piles of ‘Cartoon Money’ are being shoveled into the fire by a CEO in tycoon attire. A ‘Process Improvement’ reporter with a ‘Lean’ hat and ‘P.I.’ clipboard observes the scene.
For those familiar with Stan Kelly’s work, the cartoon incorporates several parodic elements: the ever-present crying Statue of Liberty, the cartoonist self-insert with a wry comment, and unsubtle, labeled metaphors. Boxes represent “rejected employee ideas,” piles symbolize “Cartoon Money,” the CEO embodies an old-fashioned tycoon, and the Process Improvement figure is depicted as an earnest reporter, clipboard in hand.
The heart of the cartoon’s message, and my persistent frustration, lies in the rationale, “We don’t have the budget for continuous improvement” (or Lean). The irony is stark. Improvement work, when effectively implemented, should directly bolster the financial health of an organization. While the initial costs might be apparent and immediate, the substantial benefits in quality and productivity are projected for the near future. Shouldn’t healthcare institutions be willing to make modest investments today for significant returns in the realms of quality and efficiency tomorrow?
It’s crucial to remember that Lean methodology transcends mere cost-cutting. As I’ve argued previously in articles like “Where Do Hospitals Get the Idea that Lean is Only About Cost Reduction?,” cost reduction should be viewed as a byproduct – the end result – of enhancing critical areas such as patient safety, employee safety, quality of care and patient outcomes, reduced waiting times, improved access to care, and heightened employee engagement and morale.
Hospitals often plead poverty when it comes to investing in improvement. Yet, they seem to readily absorb the financial losses stemming from inefficient processes and systems—the very issues that Lean and similar methodologies are designed to resolve. This is akin to willingly throwing cartoon money into a dumpster fire, day after day.
The phrase I often use, “hospitals don’t have money for Lean, but they’re apparently happy to shovel money into a burning dumpster every day,” is visually represented in this cartoon. It’s a harsh depiction, admittedly, but reflects a harsh reality.
Considering estimates from experts like Don Berwick, who suggest that up to 30% of national healthcare spending is waste—much of it rooted in process inefficiencies and subpar quality—the question isn’t whether we can afford to invest in improvement, but rather, can we afford not to? Delaying improvement isn’t a viable financial strategy; it perpetuates waste and, more importantly, compromises patient well-being. For many hospitals, the current operational state is, indeed, a “dumpster fire.”
This situation mirrors the meme about not having time for improvement, yet somehow finding time for constant “fire fighting,” as explored in my previous piece “… But I Do Have Time for Fire Fighting.”
Ultimately, if we struggle to shift these ingrained mindsets, I hope this cartoon, depicting the absurdity of burning cartoon money while neglecting crucial improvements, at least provokes thought and discussion. Perhaps it will encourage healthcare leaders to reconsider their financial priorities and recognize that investing in Lean is not an expenditure, but a strategic investment in a healthier, more efficient future.
