I was having a conversation at the Pittsburgh airport with a man that was carrying a copy of Bruce and my book Epiphanized. He had so many questions for me and I was worried that I would miss my flight back to Georgia. I must admit that most of the questions were quite good and my answers settled a lot of issues in his mind. I thought in this posting that I would share one of the questions he had and how I answered it.
The first question he asked me had to do with Throughput Accounting. You see he was an Accountant and didn’t understand why we needed a different accounting system when we had traditional Cost Accounting available. I just smiled and thought to myself, where should I start. I followed his question with a question of my own. I asked him if he thought manpower efficiency was a good metric and he immediately replied, “Yes, of course I do!” I asked him why he thought it was a good metric and, even though he had read our book, he told me that it was a great way to check on manpower requirements. He further said that if efficiency was low, then the workers weren’t doing their job. I then took out a piece of paper and drew my infamous piping diagram.
I asked him my usual question, “If you wanted to increase the amount of water flowing through these pipes, what would you have to do? He responded by saying, “That’s simple, you would have to increase the diameter of Section E.” I asked him why not just open up Section G’s diameter? He told me that would be stupid since no additional water would flow. So I then drew a simple Emergency Department process diagram and asked him the same question about what he would have to do to increase the number of patients passing through this process.
After giving it some thought, he said that the time for consult (55 minutes) would have to be decreased. I said, “You mean like the diameter having to be increased in the piping diagram?” He said yes. He then asked me what all this had to do with efficiencies? I asked him if he thought it would be a good idea to drive this ED process’s efficiency higher and he told me it would be a great idea. I then asked him how he would do this and his simple reply was, “Have everyone run their part of the process as fast as they could.” I then asked him what would happen if he ran the first two steps in this process as fast as they could? He thought about it for a bit and simply said, “I get it!” “If you run these steps as fast as you can, you’ll just stack up people waiting to consult with the physician.” We then talked about the steps after Consult and his conclusion was that they are at the mercy of the consult step. He had a much better idea of why I dislike efficiency so very much, but when I asked him what he thought about this metric now, he looked me square in the eye and simply said, “I need to go catch my flight.”