In my last blog posting I
introduced the concept of the system constraint as well as the late Dr. Eli
Goldratt’s Process of On-Going Improvement (POOGI). In this posting I want to begin to apply this
5-Step Process to areas where hospitals have their largest wait times, the
Emergency Department (ED), Clinics, or Surgical Units (SU).
If you’ve ever spent time in
an ED, then you have probably experienced a significant amount of wait time. That’s why hospitals have waiting rooms isn’t
it? It seems like it takes forever for
the decision to admit or treat and release the patient. For many people, this is an enormous
dissatisfier and as we discussed in my last posting, this could have a very
negative impact on Medicare reimbursements.
Nobody likes to wait in a check-out line, a bank and most assuredly in a
hospital emergency department.
Another concept that I’ve
written about numerous times in this blog is something I refer to as Active Listening. Active Listening is really not a new concept
in terms of how it works, but I have changed the rules just a bit. Active Listening is really based upon the
concept of employee involvement and it works like this. When I go into a client’s operations, one of
the first things I do is form a Core Team made up of Subject Matter Experts (SMEs).
The SMEs are the employees who perform the actual work in companies to
produce a part or provide a service. If
it’s in an Aviation Maintenance, Repair and Overhaul (MRO) organization, the
SMEs are the mechanics, flight line employees, logistics people, engineers, etc.
who are responsible for delivering the MRO work. If it’s a hospital setting, it’s the nurses,
lab techs, doctors, etc. who deliver patient care.
The first thing the Core
Team completes is a mapping of the entire process to create either a Value
Stream Map (VSM) or a Process Map (PM) with
estimated times for each step in the process. The ultimate intention here is to execute the
first step of Eli Goldratt’s 5 focusing steps, identify the system
constraint. With the identification of
the system constraint completed, the core team must now decide how to exploit
the system constraint. Exploitation
simply means getting the most out of the constraint using Lean and Six Sigma to
reduce waste and variation, but only within the constraint. So what makes active listening different than
the more traditional Employee Involvement?
Active listening is
different in that the leadership team is instructed to implement potential solutions
exactly as the core team presents them
as long as company rules, customer requirements, and safety concerns are not
violated. The purpose of this approach
is that if the core team’s ideas are implemented as presented, the core team
will own them and when the team owns them, they will make them work. I have used this technique many times and
each time it has worked to perfection. In using this approach, it is possible to
rapidly remove waste and variation to the point that capacity increases are
seen in a matter of days and not weeks or months.
I want to give you an
example from an industry segment not related to healthcare to demonstrate what
can happen if TOC’s 5 focusing steps are combined with true employee
involvement (i.e. Active Listening).
This example comes from the Aviation industry and it involves the
assembly of Boeing’s massive 777 aircraft.
What if I told you that Boeing can now assemble a 777 in just 2.5
days? Would you believe that is
possible? I want you to watch a video
from Boeing (click on the link below) and please pay particular attention to the comments about employee
involvement and where the improvement ideas came from. Boeing has been an avid user of the Theory of
Constraints for years and the results speak for themselves. If Boeing can assemble a 777 in 2.5 days,
imagine what the healthcare field might be able to do in an Emergency
Department or Surgical unit or a hospital out-patient clinic in terms of
improving flow and synchronization with the outcome being much less waiting
time!
http://www.aviationweek.com/Blogs.aspx?plckBlogId=Blog%3A7a78f54e-b3dd-4fa6-ae6e-dff2ffd7bdbb&plckController=Blog&plckScript=blogScript&plckElementId=blogDest&plckBlogPage=BlogViewPost&plckPostId=Blog%253a7a78f54e-b3dd-4fa6-ae6e-dff2ffd7bdbbPost%253a778152c0-de91-4089-a167-c9413bb5cebb&goback=%2Egde_50895_member_181883508
In my next posting, we’ll
come back to our hospital environment and see how we can do similar things that
Boeing has done. No, we’re not
assembling aircraft, but we do have processes and systems that need to be
improved, just like Boeing.
Bob Sproull
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