During a recent meeting we were discussing how we could improve a patient care process, and a nurse manager was being what we call a “Negative Nancy.” Her body language clearly showed she was thinking “this is a waste of my time.”
A few minutes into the meeting, she stated: “I don’t think what you want us to do is possible. I am short-staffed and we just don’t have the time or capacity to do it.” I gave her credit for articulating her point of view so clearly and succinctly. Not to mention, so early in the process! What I normally encounter is that even though people may be feeling exactly the same way, they do not externalize it, making it hard to address.
I gave her credit for articulating her point of view so clearly and succinctly.
Opening Up the Lines of Communication
After acknowledging her concern, I felt compelled to tell her that, as a facilitator of process improvement, I did not want her to do anything. This initiative resulted from a Value Stream Analysis and the team agreed it was important to provide the high-quality care we were aiming for.
My goal was to encourage her and the rest of the team to:
- look at the current process
- design the future state
- devise a plan to get to that future state
- identify the barriers preventing us to get to that future state
I reminded her that this initiative, to improve the whole value stream, was supported by the hospital’s leadership. If the lack of resources was preventing us from achieving our goal, we would bring it up through the appropriate channels.
We addressed her concerns and then proceeded to define the current state. We were able to identify benchmarks within our own Health System that we could use as we designed our future/improved state.
Understanding “Negative Nancy”
If you work in continuous improvement day in and day out, this story will probably sound familiar.
In every project, process and team we coach, there is always at least one person who comes off as a “Negative Nancy.” These are the naysayers. It is easy for us to think that they are just “negative” and determined to be a barrier. Yet, as I continue to coach our frontlines into daily Kaizen, it hit me that this negativity is actually a symptom as opposed to a root cause.
It occurred to me that one reason people give us all the reasons (excuses) why something will not work is when they do not feel empowered.
People give us all the reasons (excuses) why something will not work when they do not feel empowered.
Let’s think about this for a minute. For the 15, 20, 30 years they have been doing their job, they may have never been empowered and accountable for continuous improvement. They may have never been asked how their process could be improved. They have never been asked to come up with ideas for improvement. What most people hear is that “they always need more staff/resources and they are not going to get any.” If we put ourselves in their shoes for a minute, we can appreciate why they might feel this way.
Developing an Army of Problem-Solvers
Lean culture is about two things:
- Respect for people and
- Continuous improvement
Our vision is to develop our frontline staff into an army of daily problem solvers. For this, they must be empowered. Empowered to look at their work with a different set of eyes. Empowered to stop and think of a better way to do what they do. Empowered to try new ways and new approaches. We talk about respect for the people; empowering people is part of respecting people. And it is our job and the job of leadership to empower them.
Empower Everyone (Including Negative Nancy)
So, how do we empower our team members?
First of all, we have to give them the knowledge. We have to open up their eyes to all the waste around them. We educate them on how to define and provide value from the patient’s point of view.
Once they can see that, we show them how to see the value stream to identify how that value is flowing all the way through to the patient. We help them see the waste along that value stream so that they can focus on eliminating it through their actions, ownership and accountability.
And herein lies the key: we must hold them accountable for improvement.
And herein lies the key: we must hold them accountable for improvement. It is not enough just to say it is okay to improve. It should be expected. They must continuously look for opportunities for improvement. This is how we empower our staff!
This is the never-ending journey in pursuit of perfection. This is the leader’s role in a Lean enterprise: to remove barriers and empower the frontlines to remove waste and improve every day. Until we do this, our efforts to improve our quality, and our patient care will fall short because there will always be “Negative Nancys.”