Sunday, October 25, 2020
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What does Toyota have to do with our hospitals?



A fellow social media management activist from the human resources field is complaining of the continuing, pernicious lack of nurses in the healthcare industry. Jay (not his real name) was venting his frustration on Facebook: “When will this government step in to regulate the registered nurses’ (RNs) brain-drain? Practically all hospitals are experiencing lack of RNs.”

Jay has extensive work experience in the hospital industry and I’m not sure why he’s professing his innocence by asking government help, which to me is a long shot, if not impossible to achieve. I mean, the government is facing many complex problems and the lack of nurses could be the least of its concern. After all, our nurses have many options like going overseas or swallow their pride by accepting minimum pay in this jurisdiction.


We can’t passively wait for the government to help us. Jay and the rest of us must not wait that long. We must do something within our personal capacity and resources to solve such problem which we’ve known since time immemorial.

What’s the cause or causes of the lack of nurses, in the first place? For one, our nurses are underpaid, overworked, stressed-out and under-appreciated. This practice is also prevalent in major hospitals that pay luxurious compensation package to their supposed-to-be bright management professionals — the same “professionals” who exploit their nurses.

I know as I have a daughter who studied and worked hard to be an RN. She worked for more than six years in a government hospital until she left the country to accept a lucrative offer to work for a government hospital in Dubai. After one year, her foreign employer offered to downgrade her pay and perks by transferring her to a private hospital. So after two years, she decided to come back to this country and settled for a meager P17,000 monthly pay working for an eye clinic less than a kilometer away from her residence in BF Parañaque.

At least, she doesn’t have to brave the daily hassles of metro traffic as she spends only little for a short tricycle ride. Still, her salary is way below from the entry-level monthly pay of P30,531 that was upheld by the Supreme Court in accordance with the Philippine Nursing Act of 2002.

Unlike Jay, I’m not hopeful on the assistance of the government in the short or long-term horizon. For one, our hospitals are part of the problem. They offer starvation wages. This forces RNs to go abroad. There’s at least one major hospital that doubles as a recruitment agency for foreign hospitals. And they flaunt their partnership with foreign hospitals as if it’s a medal of honor.

Can you believe that? If our hospitals could only offer P30,000 as required by law, many of our nurses would prefer to stay at home with their families. What I’m trying to say here is that hospitals should not wait for government assistance. It is already saddled with so many problems that it can’t solve on its own.

Jay agrees with a qualified answer: “We have to factor (in) the salary to the cost of medical services. The hospital industry is an important component of civil society. Increase the medical cost and it will impact on the community.” He’s also complaining against the delayed payment of the Philippine Health Insurance Corp. (PhilHealth), its many restrictive requirements, plus the competition of medical clinics.

That’s why we should focus solving problems that are within the capacity and capability of our hospitals. We can’t do much against the bureaucratic processes at PhilHealth and other related government bodies. Hospitals can’t compete with other entities. They’re not within our control, regardless of the amount of criticisms we hurl against them. The most that the industry can do is to think of better ideas and implement them.

German statesman Helmut Schmidt (1918-2015) was right when he said: “The biggest room in the world is the room for improvement.” There are many things that we can do at least on a daily basis no matter how little our steps are. That’s what kaizen (continuous improvement) is all about — never-ending progress by everyone, everywhere and every day. But that’s only possible, if we’re actively conscious of discovering problems and recognizing them as such.

From the organizational perspectives, the high turnover rate of nurses is also costly for hospitals with the tremendous amount of cyclical hiring, training needed, onboarding, etc.
That’s why whenever I hear problems like this in the hospital industry, the first thing that comes to my mind is the principles of Lean Healthcare to help reduce, if not eliminate, invisible wastes in clinic and hospital operations, just like what they’re doing in other dynamic countries.

The word “lean” was invented to describe the principles of the Toyota Production System that means the continuing aspiration of stakeholders to eliminate non-value adding steps in any work procedure. It all started when Henry Ford created a stir in the manufacturing world by creating a better workflow in producing vehicles. Since then, it has become a universal principle that applies to other industries as well.

Lean Healthcare can be explained by solving many problems according to the DOWNTIME classification: 1) Defects resulting in giving wrong medication to patients due to unreadable handwriting; 2) Overproduction, like having unnecessary, excessive medical tests; 3) Waiting time of patients from an inefficient system. Sometimes, waiting is created by doctors to put up a semblance they’re preoccupied with too many patients;

4) Non-utilization of talents of other hospital personnel whose ideas are not actively solicited by management, even the non-use of less expensive hospital equipment or procedure; 5) Transportation like the movement of machines or patients to and from different rooms; 6) Inventory of too many expensive medicines resulting in their expiration with the cost systematically passed on to the patients; 7) Motion like excessive movement of nurses going back and forth to the patient’s room and nurses’ station; and 8) Extra-processing like asking repetitive patient’s information by doctors and nurses.

If these issues are known to the patients, would they agree to spend for them? That’s the real medical test for hospital managers, doctors and nurses.

Rey Elbo is a business consultant specializing in human resources and total quality management as a fused specialty. Send feedback to or via


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