“It looks as if we are back to classical Lean, Curmudge. No more sophisticated mattresses.”
“Matrices, Jaded Julie. Despite using the wrong word, you have the right idea. The team made a current state map of a patient’s route through pulmonary testing and treatment. They estimated value added and non-value added times and the patient’s walking distance. In addition, they used a spaghetti diagram to depict the walking required of various types of patients.”
“When showing a current state, a spaghetti diagram really hits you in the eye. If you want to impress someone with the need for improvement, that diagram ought to do the job. It’s too bad that we can’t show one in the blog.”
“Our space is too narrow, Julie. The value of the maps and diagrams was to inspire the team to think of opportunities to improve patient privacy, travel distance, and wait time as well as staff productivity and waiting. So the next logical step was to go to gemba—the pulmonary area—and measure the actual times of patients as they passed through each step in their appointments.”
“Another cool move, Curmudge. As I understand it, staff members recorded times on a time study template based on a current state map. This was attached to the charge sheet that accompanied each patient that visited the department in a typical week. The template made the time study irresistibly easy for the staff.”
“It gets even more cool, Julie. For every timed step in the patient visits, statistical software was used to plot frequency (i.e., number of patients within a given time interval) vs. time. The times studied in this manner included the total visit overall, patient wait time, registration, nurse rooming and vitals, provider exam and treatment, nurse follow-up, and scheduling the next appointment. Studies of provider times suggested that long appointments should rarely be needed. Providers should be able to see more patients in a week and log more relative value units (RVUs).”
“I see tears in your eyes, Curmudge. Is that because back when you were doing statistics there wasn’t Minitab software to do the hard work?”
“Good observation, Julie. Not only was there no Minitab, there was no computer. All I had was a slide rule and a pencil, paper, and ruler to draw histograms. Now, in addition to Minitab, teams use an electronic whiteboard and modeling and simulation software to test possible configurations of their future space. It’s like building the building, trying it on for size and efficiency, and then tearing it down and trying it again—all in the computer.”
“Curmudge, the elegance of this process boggles my mind as much as it does yours. So what was the result of this effort?”
“The insights gained by the team served as the basis of the new construction. The biggest innovation was that providers come to the patient instead of patients’ moving from place to place. To increase efficiency, each computer in the department has an electronic map of the area. It shows the progress of a patient, rooms that are vacant or in use, who is doing what, and signals when a scheduler is needed to plan the patient’s next appointment. This system serves as a workflow, and it significantly increases staff efficiency.”
“And so, Senescent Storyteller, your tale is told and everyone lived happily ever after.”
“That’s essentially true, Julie, but remember that the Lean story never ends because perfection is never achieved. This process will be repeated for each remodeling and construction project. A team will listen to the voices of their customers, prioritize customer inputs, select and perform measurements of their current state, analyze their data, and model and select their most efficient future state. It’s a great development, but as Lean suggests of any process, it will eventually be improved.”
Affinity’s Kaizen Curmudgeon
Check out the latest posting in Curmudge and Jaded Julie’s personal blog, Curmudgeon’s Wastebasket.
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