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Lean and mean healthcare

Catherine Gendron

February 17, 2015

Saskatchewan is the first in Canada to introduce the method of “lean” to its healthcare system. Described by the provincial government as a system that “empowers employees to generate and implement value-added innovative solutions to problems. Everything else is waste and should be eliminated, simplified, reduced or integrated.” This “waste” has had a major impact of staffing levels, especially in support services. Yet healthcare workers must be wary of this seemingly new system for more reasons than cuts, for lean has the power to fracture the most important tool for workers to gain real autonomy—solidarity.  
Lean production is described as an energetic and accommodating system. It is intended to react speedily to oscillating production quotas, equipment malfunctions, shortages, and uneven workloads. This is completed by means of regular line speed alterations, overtime, and virtually continuous job rebalancing within team-based system. “Continual improvement” is an essential factor for this system to function properly. Lean derives from the growth in teamwork since the 1980s and is largely inspired by Toyotaist production practices.
In line with the Saskatchewan government’s description, lean relies on the use of teamwork and employee ingenuity. However, while this system produces an image of worker autonomy and content, there are many underlying tensions surrounding this system.
Costs and cuts
The experiences of Saskatchewan workers in who work in healthcare has not gone amiss; in fact the opposition have been consistently bombarding the Sask. Party government with its use of lean.
The primary reasons for opposition rests on the amount of tax dollars being spent on this system: the cost rests at about $40 million over four years for lean consultants, who fly first class and receive consulting fees of $3400 per day. As NDP leader Cam Broten said of consultant John Black, he “is going to be milking this cash cow for every last drop.”
Lean has severely impacted safe staffing levels—workers are forced to work in increasingly demanding environments, with fewer resources. The consultants making millions from lean take as a given the limited healthcare resources created by federal and provincial government cuts, and then impose their “efficiency” to make workers work harder—including internalizing exploitation.
Self-exploitation and surveillance
It is argued that lean production is the employer’s newest form of controlling workers, known as concertive control. Evolving from bureaucratic control, a fundamental shift is occurring whereby the manner of control has passed from management to the workers themselves who act as a team to create the means of their own control; concertive control thereby exploits workers as it compels workers to control themselves, but under their employer’s objectives. Contrasting to the image of worker autonomy who labour in a teamwork environment, employers are able to “put the collective ingenuity of labour to work on behalf of capital,” as sociologists Sewell and Winkinson argue in “Someone to Watch Over Me”: Surveillance, Discipline and the Just-in-Time Labour Process. In so doing, it seems natural to abide by workers “own” method of control. 
Due to high demand and pressure, workers are encouraged to watch over their fellow colleagues, resulting in self-discipline. This is because lean production is comprised of “fast work pace and heavy workloads”, making it necessary for all members of a team to be present and work diligently each day. Characteristically, teams are compelled to pick up the slack for any team member not pulling their weight and consequently, workers pressure one another to keep up and work hard.
Workers respond that the combined pressure and surveillance from their employer and their colleagues causes mounting stress levels as the divide between sensible and unreasonable expectations become blurred. Healthcare workers who work in long-term care have especially been hard-hit by increasing demands, resulting in scrutiny. For example, many healthcare providers are not able to take their negotiated breaks; the people that demand the use of their break become ostracised from their colleagues due to the general feeling of being let down and not contributing to the team effort. Employers would be delighted with such reactions as they are able to take advantage of healthcare workers’ attachment to provide care. It is also made clear that surveillance is a hidden force within lean as workers indicate the pressure they feel, stemmed from group scrutiny. 
The intentional use of lean must be reviewed from all angles. Understaffing and declining quality health care is a major concern for all people in Saskatchewan, and the tax dollars spent on consultants who encourage cuts is appalling. Workers must also become engaged with how this system is affecting their experiences at work with their colleagues. We cannot let lean impose self destruction on rank and file solidarity.

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