In the past months several people critized hospitals for having become ‘too lean’ and managers for ‘logistical minimalism’. It is said that hospital managers strive for low inventories to reduce cost and this is said to be a bad thing. Clearly, there have been shortages of all sorts in these corona times: nurses, masks and equipment etcetera. However, if there is minimalism of any sort in hospitals, then I think it’s better to conclude that management and coordination are minimalistic, not the capacity itself. My PhD research has shown that hospital logistics is coordinated by nurses and coordinators, who do this mostly on a voluntary basis, that management involvement is low and material management is overlooked. This is not ‘lean‘ nor ‘not lean’, it means that there pretty much does not seem to be a deliberate (management) strategy behind this all. Perhaps one should see this as great trust in professional hospital staff to arrange it all, but I am not sure that this is how it’s experienced. Hospital logistics are often not lean nor influenced by any other management philosophy. Logistics are just there.
But as we have experienced, in times of high and variable need for staff, materials and equipment this ‘letting logistics be’ attitude leads to shortages of crisis proportions. The irony, or perhaps tragedy, of hospital logistics is that generally on a hospital or region wide level there is overcapacity and at the same time there are shortages. Every department, unit, medical discipline or even person guards its ‘own’ (often invisible) negotiated or even fought-over buffers. At the same time, because of this, capacity is not always available at the right time and place, which naturally causes a lot of stress. And this leads to attempts for obtaining even more capacity or inventory locally – just in case. It’s a sort of catch-22 situation. It certainly does not have anything to do with lean either, as lean is about visibility, trust and transparency in the supply chain.
Obviously, in a crisis, negotiation is very ineffective, as it’s slow and you cannot be sure that the right priorities are set. We now see much more central command and control, which works probably well under these extraordinary circumstances. Interestingly, in my research I found that under normal circumstances, there is no direct supervision whatsoever when it comes to hospital logistics. Why is that? In hospitals the generals are all at the front, and there are many of them. Doctors fight against various diseases and determine the treatment strategy, specialized nurses take care of patients and arrange the logistics. When there is one disease to battle against, this may work, but in an average Dutch hospital normally thousands of different types of treatments are performed. And that’s where the coordination and negotiation comes in place. Is that lean? This could be very lean, if buffers are adapted through continuous alignment and coordination between those, who see what is going on in the environment of the hospital and those who coordinate the resource allocation in the hospital. Unfortunately continous or repetitive communication is sometimes considered as ‘waste’ (i.e. not lean). That, I think, is a misconception. Continous alignment and coordination, which requires communication, need to be in place in order to deal with variable environments.
Interestingly, in the past years some hospitals developed central control centres. I am under the impression that these were partly born out of a desire for more control. In the last part of my case study research I will study how the central planning centre of the hospital, which was implemented in June 2019, functions. I am guessing that the planning centre will have become part of the negotiation process. They may have either a better information position – now being at the centre of the network – or they could be worse off – acting further away from the outpatient departments, which are positioned closest to both the patients and surgeons. I will hopefully learn more about that in the upcoming months.