One of the joys I receive from consulting is
the chance to be able to assess new companies and new industry types and then
help them improve. For the past year or
so, most of my clients have been in the healthcare field and in the foreseeable
future I don’t see that changing much.
And with all of the recent focus on healthcare, I’m very happy to be a
part of potentially changing and improving upon the way hospitals operate. One thing that jumps out at me is the
dedication of the healthcare workers in wanting to improve their patient
experience. In the next few postings I want to
discuss how one can use a hybrid version of TOC’s Thinking Processes (TP’s) to
define potential focus areas for improvement.
Specifically, for those of you familiar with the TP’s, I will presnt how
I developed a Current Reality Tree and what I refer to as a hybrid Future
Reality Tree. For obvious reasons, I
will never divulge the name of the organizations I am helping to improve.
I have been working for two different
healthcare groups in the past two months and although each is drastically
different, both are very, very similar in terms of the problems facing them. In one organization I have been working with
is a general surgical unit while the other one is much more specialized in that
it is a clinic which treats different types of healthcare problems. It is the latter one, the clinic, that I want
to discuss in a more detail. I will say
however, that in both organizations, patient waiting times for various
procedures are considered to be excessively high, so both have essentially the
same objective of reducing patient wait times to a more acceptable level.
The actual clinic improvement initiative
began 3-4 weeks ago when I facilitated a team through a value stream
analysis. We first we developed a
Current State process map and then evaluated each of the individual steps in
terms of its value-added content. We
then created an Ideal State map, constructing it as though no waste existed and
finally a Future State map removing as much waste as possible, being limited only
by the non-value-added but necessary category.
We then identified the system constraint as being the availability of
Attending Physicians. After much
discussion, we elected to pursue two areas of this process in order to reduce
waiting times. The first area involved
the time from patient check-in until the patient was able to be examined by a
Resident Physician. Because this is a
teaching hospital, the first, second and third year Residents can only examine
patients and not actually sign them out.
The second focal point was defined as the elapsed
time between being seen by a Resident Physician and the final examination by
the Attending Physician. As mentioned
earlier, the Attending Physician is the only Physician who can sign-off and
sign-out patients from the clinic. We
discussed the potential risk of “speeding up” the front end of the process
without being able to significantly reduce the Attending Physician’s time. Because
the Attending Physician’s availability was the constraint within this clinic,
we were worried that patients might zip through the first part only to stack-up
waiting to see the Attending Physician.
But in the end, it was decided that we would pursue wait time reductions
in both parts of the process.
One area that was of major concern to us was the
scheduling process that was in place. It
was very clear to all concerned that the clinic had a chronic problem of “over-booking”
of patients. In other words, there were
simply too many patients entering the clinic (both scheduled and unscheduled)
based upon the capacity of the clinic to test and treat the patients. This clinic did schedule patients, but there
were unanticipated add-ons that were not on the original schedule which
contributed significantly to the over-booked status.
In my next posting, I'll demonstrate how we were able to identify and link all of the Undesirable Effects (UDE's) or negative symptoms we found within this clinic.
Bob Sproull
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