Focus and Leverage Part 145

In this blog posting I’m going to shift gears from the norm and talk about how the continuous improvement methods I have discussed here can work in a medical environment.  Part of the reason for shifting gears is that on Monday I will be traveling to Chicago to lead an improvement engagement for a hospital.  When you think about it, being in a hospital atmosphere is really not much different than being in a manufacturing setting.  The patients, for example, are what goes through the various hospital processes.  The patient enters the hospital, let’s say via the emergency room, is then observed by a doctor for symptoms, has tests run to verify what the symptoms might be suggesting, the treatment plan is created and executed and the patient is discharged or is admitted to the hospital.  The bottom line here is that improvement is the focus.  That is, the doctor wants the patient to improve.

If you were to create a high-level process map of what takes place in a hospital scenario, it might look something like Figure 1:

Figure 1

This scenario is really not much different than what you might see in manufacturing setting, so doesn’t it make sense that those same tools and techniques for improving the process might work here?  Let’s add some estimated times to each of the process steps above and see what we see in Figure 2.

 

Figure 2

Let’s assume we are interested in speeding up the process for admitting the patient to the hospital or whether we treat and release the patient from the ER.  Which process step is the system constraint or maybe I should ask it this way, “Which process step would you focus your improvement effort on to improve throughput through the ER?  Clearly, the most significant amount of time in Figure 2 would be the time waiting for the test results to come back so the decision as to whether the patient is treated and released or admitted into the hospital can be made. 

So in this very simple example we see that identifying the system constraint and then focusing our improvement effort there, and only there, yields the greatest opportunity for improvement, even in a hospital environment.  Like I’ve said many times in this blog, one of the reasons many Lean Six Sigma initiatives are failing is because there is a seemingly maniacal approach that says fix everything when in reality, finding and focusing on the system constraint is the most effective.  It’s why I named my blog Focus and Leverage!

Bob Sproull