Focus and Leverage Part 173

Recently I have been working on a new account for a healthcare organization in the Chicago area.  My company, NOVACES, performed what we refer to as a JumptStart initiative which is a full-blown needs assessment.  Needless to say this assessment uncovered many, many opportunities for improvement.  Our next step was to interview the organization’s leadership team and begin the selection of the most impactful opportunities that can help them become a more successful world class organization.  I might add that this healthcare group had just undergone a significant reduction in force in an attempt to save their way to profitability.  Since this had just taken place prior to my arrival, it was clear that many of the employees were kind of frightened for their jobs.  And then here comes Bob Sproull with a message of how to do much more in terms of process throughput without adding additional labor!  You can imagine how that reception was……

One of the first orders of business was to select potential Green Belt candidates for training in what we refer to as SystemCPI^® which is an integrated Lean, Six Sigma and Constraints Management improvement methodology.    Our contract called for Green Belt and Champion training followed by at least three Value Stream Analysis (VSA) initiatives and up to three Rapid Improvement Workshops (RIW) or additional VSAs instead of RIW's.  The VSAs would be selected and scheduled after the Green Belt and Champion training was complete.  The selection process would be based upon individual interviews with the Project Champions and then presented to the leadership team for final approval.  The selection criteria would be a combination of potential financial payback and which problems were most pressing for the organization.  With the new Affordable Care Act looming, things like hospital re-admissions, patient satisfaction, infection rates, and other criteria had to be in the mix for project selection.

The first project selected was in the Radiology Department and it was a flow issue which is perfect for a VSA initiative.  In fact several of the projects selected were intended to improve the flow of the processes which is a great place for both Lean and Constraints Management.  The second project, for example, was in the Emergency Department with the objective being to reduce the “Door to Doc” time.  As these projects are initiated, I’ll try to post the progress made here in my blog.

With the Green Belt candidates selected and a significant list of improvement projects in our portfolio, we were now ready to deliver our week-long training.  The Green Belt training went off as planned for twenty-four students as they learned a variety of tools and techniques during the week.  Of particular interest was a simulation that we include in our training that involves simulated physicians, patients, pharmacy technicians, a pharmacist, nurses, etc. intended to demonstrate how a process full of waste and error prevents the distribution of needed medication to patients.  There were two teams competing against each other with the winner being declared based upon the number of patients receiving their medication.  The simulation has three rounds with the first round requiring the teams to run their operation based upon predetermined guidelines with no changes permitted.  At the end of Round 1 of this simulation, neither team had distributed a single medication to any of their patients.

The Green Belt training included a variety of tools like Process Mapping and Value Analysis to determine whether each process step was value added, non-value added or non-value added but necessary.  They also learned the true meaning of a value added activity, the seven Lean deadly wastes and various other Lean tools like SIPOC diagrams, Spaghetti Diagrams, and others.  They also learned various Six Sigma tools and techniques, but the most useful piece of the training was how Constraints Management (CM) works in this integration.  I say CM is the most useful simply because, as I’ve written about many times on this blog, it provides the focusing mechanism needed for application of Lean and Six Sigma at the right location within the process being improved.  This part of the training included a discussion of Goldratt’s Five Focusing Steps and it was very well received by all of the students.  As a side note, I’m happy to report that all twenty-four of the students passed the exam at the end of the training.

Armed with their new training, round two of the simulation progressed with the students being required to perform a Value Stream Analysis of the process used to distribute medication to patients.  In this round the students were only permitted to remove the non-value-added steps in the medication distribution process.  The teams were amazed by the number of steps that added no value and as a result of this exercise, both teams improved their results significantly over the first round of the simulation.   One team distributed meds to 24 patients and the other distributed meds to 26 patients.  Both teams were amazed with the significant improvements they had achieved by simply removing the apparent waste.

In the third round of the simulation both teams created both an Ideal State and a Future State map of the meds distribution process.  Using Constraints Management, both teams were able to identify the system constraint and focus their improvement efforts on that constraint.  I told them in this round they could use their creative juices to produce a streamlined process.  For example, one part of the process was the notification to the pharmacy of the need for meds and both teams established an on-line notification process.  Both teams established their new processes and the results even astonished me.  In this third round, I cut the Rounds 1 and 2 time from 20 minutes to only 10 minutes which both teams thought was unfair until they ran their new processes and saw their results. Team 1 led the way by distributing meds to 41 patients while Team 2 was able to distribute meds to 36 patients!  Think about that…..they had significantly exceeded the results of simulation Round 2 in only half the time!!

In my next posting I’ll discuss a couple of breakthroughs achieved by several Green Belt students just after receiving this initial training and some follow-up training on a Constraints Management case study that I gave them a couple of weeks later.

Bob Sproull