Dean Moore

I have been in the workplace a long time. To quote Steve Martin, “If I had saved better, I would not be here.”

Over the past year, the long-term care industry has faced monumental challenges related to the pandemic. I hear our current situation described as unprecedented, and on the disease management front, that may or may not be true. 

However, some of the business challenges COVID-19 has created are very familiar to me. They are not unprecedented or even new; they are just common problems faced by anyone operating a manufacturing operation.

These are problems with which the application of lean manufacturing tools has helped the St. John’s leadership team manage the health of our employees and residents.

Opportunity 1: Entrance screening and the seven wastes of lean

In March 2020, it became apparent to all of us that we had to change our business processes in order to continue operations in this pandemic environment. The skilled nursing segment was determined to be an essential function and having all employees work remotely was not an option for most of our workforce. We began to wear masks and cancel anything we could that grouped people together. We established a health screening function for employees as they reported for work.

I don’t believe anyone on the St. John’s team, even those with deep clinical backgrounds, had ever given a lot of thought to managing thousands of entrance health screenings every week. Within a month, we had a model in place that could effectively handle 600 screening activities each day without disrupting work times.  

But by assigning associated costs to Human Resources, our annualized budget went up by 84%, and the number of employees in the group more than doubled. 

We looked at our entrance screening as if it were a screening factory and applied some simple lean tools.  We used the “5 Whys” of the Toyota production system to challenge every assumption about what we were doing in the process and attacked the waste of over processing.

Screening is a good tool in that it encourages people to inform us on issues concerning their health, but at the same time we need to recognize the limitations.  We are not the TSA. We cannot check travel records or search employee pockets for lozenges and used tissues to determine if a person might be ill. We rely fully on the honesty of people being screened. If the TSA did screening like us, it would work like this: The agent would ask, “Good morning miss, do you have any bombs with you today?” You would say, “No, I do not have any today.” The agent would then say, “Have a nice flight.”

In time, we identified that having paid screeners ask every person about health status and take temperature readings was in fact an over-processing waste. We could display the screening questions in print and ask people to let us know if they had symptoms or travel that might concern us. We also mounted touchless thermometers for temperature self-checks. 

Additional efforts resulted in a 70% reduction of screening costs — bringing us a lot closer to a cost structure we could sustain.

Opportunity 2: Using statistics to understand vaccine behaviors

If you visit any modern manufacturing facility, you may notice everything is measured and plotted. I have spent most of my life in this world and have come to appreciate the value of statistical applications in problem solving.

St. John’s was one of the fortunate healthcare facilities offered COVID-19 vaccines beginning in December. We spent time trying to decide how to prioritize limited vaccine availability among our workforce, but then something happened that surprised us. Despite 20% of employees testing positive for COVID in 2020, only 40% signed up for the vaccine when it was first offered.

In some way this was great because it saved us from the horrible dilemma of rationing supplies, but we had certainly hoped for more interest.

We ran a number of communication and education events in an attempt to increase vaccine interest. We wondered why people did not want the vaccine. 

Then we noticed some trends. Older people signed up in greater numbers for the vaccine, which was not surprising. People of color in our workforce, representing 60% of our employees, seemed to be much less interested. I thought maybe what we were seeing was simply that our Caucasian employees tended to be older. We turned to statistics for help.

The statistics we used grew out of the lean discipline of making decisions based on data. We were required to collect and report all kinds of data on our employees concerning the vaccine. 

We employed a statistical tool to look at relationships among variables concerning vaccine interest. Among our regression results below, we found the greatest factor influencing employees’ vaccine decision was not age, but race and ethnicity.

Vaccine Predictive Regression Analysis
Factor% of Variance Explained (R2)
Zip Code0%

Our learning was valuable in focusing our communication on groups of our workforce who may need more information to get comfortable with a vaccine decision. 

Opportunity 3: Safety compliance

The pandemic presented another new problem to St. John’s in the area of safety compliance. We have entered a period where our employees need to wear masks, face shields, gowns and gloves to protect themselves and our residents. Wearing all this gear is not comfortable, and therefore, we have chronic worries over compliance. The objective is to get as close as possible to 100% compliance. Again, statistical process-control tools can help.

Staffing was critically short in 2020, and this will continue well into 2021. When your staffing is at crisis levels, some of the normally available tools for PPE compliance (such as discipline measures) are not readily available. 

Having upset employees who are motivated to leave is an intolerable outcome. So, what can be done?

PPE compliance is a very old problem in both manufacturing and construction, with its safety glasses, lock-out tag-out systems, fork truck speed management and machine guarding. A statistical based tool commonly used in these types of businesses is something known as behavioral-based safety. It relies on observation of behaviors, tracking data trends, problem solving based on data and coaching.

So we implanted a very old tool from manufacturing and construction in our skilled nursing facility. We are observing and collecting data and then addressing problems with coaching. It is not a complete panacea, however, we do have a tool to work with and develop. 

In some instances, St. John’s has achieved remarkable cost reductions. In other areas, we do not have full results yet. We have, however, grown a sense of confidence and perhaps, found a silver lining in the fact that we, as providers, do have tools to help us approach the challenges that emerged as a result of the pandemic. 

Dean Moore is vice president of Work Life at St. John’s, a full-service senior care provider with options that range from independent living to skilled nursing and hospice in Rochester, NY. He has previous human resources experiences with major automotive, medical imaging and logistics firms.