"We need more staff!"

They said they just needed more staff. They said their process was good – that a nearby university had reviewed their process and confirmed that fact. They said I should back off and just support their push for more staff.

The case for more staff was strong: two hours overtime per day, five days per week – and despite this they were turning customers away as they closed for the day, telling them to come back the next day. Very obviously, staff were unhappy, exhausted even. Management reported high staff turnover in the area, with people wanting to be transferred out within six months of starting. 

Customers were also unhappy – waiting for service meant sitting on hard wooden benches in a cavernous, drafty area, cheek-by-jowl with hundreds of others (fortunately pre-Covid). Waiting times of over five hours were common.

My team of collaborators and I had three objectives for the week:

• Improve the situation for customers and staff
• Reduce the overtime spend
• Upskill my collaborators with some of the ‘lean tools.’

My six collaborators, with one exception, were from facilities in other provinces. And the exception did not work in the area we were using as the ‘model cell’ for upskilling and learning during a five-day ‘lean boot camp.’ I had worked with all six of them over the previous seven months, but at their own facilities, so they were new to each other as well.

So, things were not ideal.

 What to do? Well, we stuck to the process, guided by the A3 format: we observed over a couple of days, timed, counted, talked with staff, and drew (and re-drew) a Value Stream Map, noting the overburden, the waste, the delay points, speculating about causes, and proposing countermeasures.

On the third day we shared our findings and recommendations with the model cell staff. All over again, for over an hour, they adamantly repeated, ‘We need more staff.’ Then a junior staffer suggested they at least try our proposal. (I’m eternally grateful to her – without actually testing ideas how do we learn and improve? And the upskilling would have been still-born.)

 Resistance persisted the next morning. Customers were restive and a delegation even went to complain to the facility CEO. But by mid-morning the revised process was in place and the ideas could be trialed. That day, all customers were dealt with within normal working hours. And some customers wrote notes of appreciation – one even volunteering to help sustain the new procedures!

I had no further involvement. Two years later I had the chance to visit. The area manager reported:

• She could not remember when last someone had asked to be transferred
• No overtime had been worked since that Thursday two years earlier
• Further improvements had been made and waiting times were now under one hour, and even shorter for prioritised customers.

Undoubtedly, I could have conducted the Rapid Improvement Workshop better. Despite the many ‘blapses’, by following the A3 process and clearing the ‘experiment’ with the staff, we achieved our three goals.

 As I was leaving that large public hospital those two years later, the head pharmacist said to me, ‘That workshop was the best thing that ever happened to this hospital.’

How I treasure that. I know we ducked many bullets that week. Technically, those lean tools helped the redesign of the process. Goodwill made the trial possible. We do indeed work within a socio-technical environment, and when the socio and technical come together, the results can be both quick and enduring. This stuff works!

Oh, and by the way, they did not need more staff.