Thursday, October 18, 2012

Focus and Leverage Part 149

I’ve gotten a lot of emails recently about whether it’s a good idea to use an integrated Lean, Six Sigma and Theory of Constraints (or as I now refer to it as Constraints Management) in a Healthcare environment.  My response back to these questions is no because it’s not a good idea…’s a great idea!!  So in today’s posting I’d like to talk a bit about why I believe what I believe.

If I were to ask Healthcare professionals if there were flow issues within their hospitals or other healthcare facilities, I doubt seriously that I’d get any answer other than yes.  In my experiences, especially during my three kid’s early lives, I’ve had to use an emergency room on more than one occasion.  And each time we were there, we experienced an enormous amount of idle time just sitting and waiting for my kids to be examined.  I did understand that there were probably true emergencies which caused some of this, but even after the initial examination we always experienced long periods where we just sat and waited.  I also remember times when one of my kids had surgery scheduled and it seemed like we had to wait well beyond the scheduled time before they were even moved to the surgical unit.

There are drug mix-ups, medicine shortages and a host of other healthcare related issues facing us.  I mean let’s face it, the healthcare system in the United States is a mess!  Add to this, the Affordable Care Act could provide health insurance coverage to 32 million currently uninsured U.S. citizens. There’s a huge concern that there simply won’t be enough doctors and surgeons to accommodate all of these newly insured people.  According to the Association of American Medical Colleges we could be facing a deficit of nearly 150,000 doctors over the next 15 years.  So what does this have to do with using an integrated Lean, Six Sigma and Constraints Management you may be wondering?  My answer is everything!

If we continue down the same path we’re on right now, we know that our healthcare system will simply get worse.  We know that the flow problems, drug mix-ups and shortages of medicine will only intensify unless we do something drastically different than we are today.  The solution can’t be to simply work harder.  Healthcare professionals are working as hard as they can already and many suffer from burn-out caused by working long hours.  Lean and Six Sigma will help solve some of the problems, but will they help fast enough before the onslaught of new patients enter the mix.  Although both Lean and Six Sigma (or the hybrid Lean Sigma) have their merits, in my opinion they won’t get us to where we need to be quick enough or far enough!  So ok Bob, then what do you think is the answer to our country’s healthcare dilemma?

My answer, at least in the short term is to radically improve the flow of patients through our hospitals!  So how do I propose we do that you’re probably thinking?  I will give you the same answer I have to manufacturing companies who were facing significant increases in orders.  Or to maintenance, repair and overhaul facilities that aren’t delivering enough products to their customers and are guilty of late arriving products when they do ship.  The answer lies imbedded within the Theory of Constraints or Constraint’s Management, whichever you prefer to call it.  Just like the name of this blog, it’s all about focus and leverage.  Focus on the system constraint and leverage the opportunity to reduce the cycle time of the constraint.

I’ve had many blog postings where I’ve written about Dr. Goldratt’s 5 focusing steps.  I have paraphrased his five steps as follows:

1.    Identify the system constraint.  Why and where are patients getting hung up?  Maybe it’s an outdated policy or procedure?  Maybe it’s an actual bottleneck?  But you must find it!

2.    Decide how to exploit the constraint.  Use all of your Lean and Six Sigma tools and focus them on the constraint you’ve just identified.  Maybe your process is totally unsynchronized?  Maybe you’ll have to use root cause analysis or TOC’s Thinking Process tools to identify a core problem, but decide what you’re going to do.

3.    Subordinate everything to the system constraint.  It makes no sense at all to push patients into your constraint because they’ll just stack up.  Pull your patients through your process at the same rate that the constraint is working, but make it work faster than it is now.

4.    If necessary, elevate the system constraint.  Before this step you shouldn’t have spent any money (or very little), but if you haven’t broken the constraint, you might have to spend some.  You might need a new machine or you might need to hire more cleaners to get rooms ready, but think of the benefits when the constraint moves.  It means that you have broken it and your process is moving patients through it at a higher rate.

5.    When the constraint moves, go back to step 1 and repeat the process.  One thing to remember, the constraint will move once you’ve applied Lean and Six Sigma to it to reduce waste and variation, so get ready to move to the constraint’s new home.

What I’m suggesting to you is to use this integrated methodology because it works.  Will it completely solve the on-rush of new patients coming down the road?  Probably not, but it will at least buy us some time.  The key point to remember when you focus your improvement efforts on the system constraint is that you will improve your throughput.  That is, in the case of a hospital, a much higher rate of patients passing through the emergency room.  A much higher rate of patients passing through surgery.  And probably shorter stays in the hospital.

Bob Sproull

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