Tuesday, November 6, 2012

Focus and Leverage Part 162

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!


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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