Saturday, November 16, 2013

Focus and Leverage Part 277

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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