The whole point of lean is to learn to change and adapt (serenely and smartly) to new, challenging conditions. As the COVID19 crisis unfolds, and we are increasingly touched both as human beings and as citizens, we’re seeing each country, region, town respond with more rules and regulations “for the common good.” This is alternatively confusing, angering and dispiriting.
The agenda is not ours: it’s the epidemic’s. To address the progression of the disease, governments do what they know how to do: they try to control their populations. The bewildering array of countermeasures that are offered reflects one of the best known issues in lean: without a consensus on the problem, people argue incessantly about solutions – and the strongest, not necessarily the most effective, wins. Western society has a long tragic history in medicine of refusing to look into the real problem and continuing to apply crazy treatments – from refusing to accept Simmelweiss’s idea that bacteria carried on doctor’s hands could cause infections, to taking on board that mosquitoes could carry yellow fever (22,000 died digging the Panama canal) rather than believing in “miasma” carried through the air, to, more recently, doctors’ long refusal to recognize that ulcers were caused by a bacteria.
With the coronavirus, we’re back to panicking about airborne contagion. Clearly, covid19 is extremely contagious and can be caught by breathing in a viral load in droplets in the air. Horrifying as may be, it remains one path to catching the virus amongst many. The most direct way is still likely to be hands to mouth or eyes (fiddling with a virus-infected mask, for in stance, appears to be a major risk for frontline caregivers in covid units).
Our countermeasure chains are failing because of difficult logistics: not enough protective equipment, not enough room in reanimation rooms, not enough nurses and doctors on the frontline (and three cheers for those who are there, carrying the load), not enough chemicals for critical medicines and – of course – neither vaccine or cure in sight. But at the root cause of any scenario, we encounter one common issue: individual hygiene practices.
Eventually, licking our wounds, we will emerge out of confinement and return to work, and will be confronted by the challenging measures imposed by social distancing: wearing masks, frequent hand-washing, disinfecting desks every couple of hours, temperature control, to, maybe, the point of smartphones beeping an alert when there is a covid-positive person in the neighborhood.
These new rules are being created now, somewhere at headquarters, but, confined as we are or pushed to go to work in critical jobs, no one is telling us anything about it!
Rules are nothing other than the imposition of the will of the dominants on the dominated: I’m the boss, here’s the new rule, follow it - or else! Rules are blind, generic and, as we know in lean, at least half the time they are counterproductive as they are 1) often misguided and 2) people invent clever ways to work around them.
Standard practices are something else altogether. They emerge from a collective process of solving problems and agreeing on the smart sequence of steps to do something because the underlying problems are well understood. Standards are: 1) the reflection of a consensus on why we need to do this to counter which issue, and 2) they evolve constantly as people look more deeply into the problem, and understand physical or biological mechanisms (or, indeed, psychological) in greater depth and come up with smarter practices.
In lean lore, standards emerge through a 5S type practice:
- Step One: Sort and eliminate – look at all elements of the problem and eliminate what has no immediate impact or use.
- Step Two: Set in order – breakdown the issue into manageable chunks and outlay how each is going to be handled.
- Step Three: Shine – Work at keeping the visual organization of these elements every day and fix issues as you find them.
- Step Four: Standardize – as people agree on the smart way to do certain things, formalize standards and think about how to maintain them in daily (or hourly) routines.
- Step Five: Sustain – Regularly review existing practices, measure their impact, challenge their application and effectiveness to motivate people to kaizen and improve the standards.
The visual management implicit in 5S is a critical element in the hygiene fight against covid-19: there is no better case for “looking with your feet and thinking with your hands.” All hygiene actions are both practical and habitual – which requires strong signals (way beyond posting funny notices in the toilets to induce people to keep them clean). We’re going to have to change our habits regarding lobbies, door handles, dressing and undressing and so forth, implementing contactless controls wherever we can – true visual management.
Arbitrarily imposing new distancing rules, confinements or lockdowns is the knee-jerk reaction of take charge, command-and-control bosses to an invisible enemy they don’t understand. Tin so doing they are not fighting the virus – they’re fighting the people. It’s high time that we get out of our deer-in-headlights bewilderment and put our lean thinking hats back on. First, we must care for the victims of covid – which means understanding how to maintain a human touch safely. Secondly, we must start preparing people to the new hygiene practices they will have to adopt no matter what, as long as covid hits us as it does.
Our time is now. If we want these changes to happen calmly and effectively, we must build these new practices collectively right now while many people are confined to avoid the rude awakening of going back to a very different workplace. This has to be a collective, collaborative effort of discussing who is doing what, who is learning what and what good ideas can be shared as well as discussion groups on the difficulties experienced in practice – to foster kaizen.
Lean leaders: the time for leadership is now. One hospital CEO I know is organizing “training brigades” to explain new protective practices to the population – a key part of the problem is people coming to the hospital with germs – and then worse, returning home with more, without thinking to wash hands, take off shoes, change clothes, etc. Hygiene is a very intimate matter, loaded with all sorts of purity/cleanliness moral connotation. It’s not an easy topic to address.
5S-like practice can uncover hidden beliefs and misconceptions, and pave the way to adopting new hygiene practices – as opposed to arbitrary imposition. In this community, we, of all people, have been trained to do so. Now is the time to start acting on it.