Wednesday, December 26, 2012

Focus and Leverage Part 178

2012 has been an interesting year for me.  I have made the transition from primarily serving the Aviation Maintenance industry to the healthcare field and I must say I’m very happy I made the shift.  That’s not to say that I didn’t enjoy the aviation work because I totally did.  In fact, given the opportunity I would go back and help companies maintain military vehicles especially those working within the Department of Defense.  It’s clear to me that all governmental departments in this country and many others need to change their focus to learn how to do much more with much less.  As the politicians haggle over spending cuts and tax increases, most don’t understand how to identify and focus on the right areas.

My blog is called focus and leverage for a reason.  It doesn’t matter whether we’re talking about a manufacturing company, a hospital or a governmental agency.  There is a constraint that is limiting their overall performance and unless and until it is identified improvement efforts will simply not be as good as it could or should be.  I’ve been fortunate enough in my career to work in a variety of industries and they all share the common need to identify the system constraint, exploit it and then subordinate everything else to it.  In a manufacturing system or hospital or governmental agency or any other industry it’s all about optimizing flow.  Enhancing the flow or throughput of products, patients or maintained military vehicles all boils down to locating the constraint and ultimately breaking it.

If you’ve ever been in a hospital emergency room or have had to wait for your turn to have a surgical procedure or even received outpatient treatment, you have no doubt experienced an inordinate amount of delays.  In all three cases, there is a single point in all of these processes that causes these wait times.  If the hospital wants to reduce these delays, and they all will once the Affordable Care Act is totally implemented, then the only way to do so is to identify that part of the process that causes the delays (i.e. the constraint).  Once it’s identified, it must be exploited by eliminating (or reducing) the non-value-added waste that most certainly exists.  Attempting to eliminate waste in a non-constraint is, in my opinion, wasted effort.  Yes your efforts will reduce waste, but it won’t reduce the flow time or improve the rate at which patients flow through the hospital processes.  In like manner, if you’re trying to improve the number of say, aircraft through a maintenance process, you must find the reason why you’re falling short of the number required.  And like hospital processes, attempting to improve a non-constraint processing steps won’t help you improve throughput.

In many, many cases (as high as 90%) the constraint is not a physical process step at all that is causing the process to be slower than it should be, but rather an existing policy or other requirement in place.  It might be something as simple as an approval requirement that must be completed prior to work being initiated.  Sometimes in a union environment it could be a job classification that prevents you from performing a simple task.  The key to breaking a policy constraint is to use logic and common sense to eliminate the impediment to improved flow.  By that I mean by simply understanding the policy in common sense terms an alternative procedure can be put in place.  There are tools within the Theory of Constraints toolkit that are designed to break these types of conflicts.  The most popular of these is the Conflict Resolution Diagram or Conflict Cloud or Evaporating Cloud as it is known.  The key to using these tools is to clearly identify and define the conflict, surface the assumptions behind the conflict and then develop injections that break the conflict.

In the coming weeks I’ll report on the tools of TOC that will help everyone improve the flow of processes.  Since I have transitioned to healthcare, much of what I’ll report on will be from the healthcare industry.  Happy New Year everyone!!!

Bob Sproull

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