I’ve gotten a lot of
emails recently about whether it’s a good idea to use an integrated Lean, Six
Sigma and Theory of Constraints (or as I now refer to it as Constraints
Management) in a Healthcare environment. My response back to these questions is no
because it’s not a good idea…..it’s a great idea!! So in today’s posting I’d like to talk a bit
about why I believe what I believe.
If I were to ask
Healthcare professionals if there were flow issues within their hospitals or
other healthcare facilities, I doubt seriously that I’d get any answer other
than yes. In my experiences, especially
during my three kid’s early lives, I’ve had to use an emergency room on more
than one occasion. And each time we were
there, we experienced an enormous amount of idle time just sitting and waiting
for my kids to be examined. I did
understand that there were probably true emergencies which caused some of this,
but even after the initial examination we always experienced long periods where
we just sat and waited. I also remember times
when one of my kids had surgery scheduled and it seemed like we had to wait
well beyond the scheduled time before they were even moved to the surgical
unit.
There are drug
mix-ups, medicine shortages and a host of other healthcare related issues
facing us. I mean let’s face it, the
healthcare system in the United States is a mess! Add to this, the Affordable Care Act could
provide health insurance coverage to 32 million currently uninsured U.S.
citizens. There’s a huge concern that there simply won’t be enough doctors and
surgeons to accommodate all of these newly insured people. According to the Association of American
Medical Colleges we could be facing a deficit of nearly 150,000 doctors over
the next 15 years. So what does this have
to do with using an integrated Lean, Six Sigma and Constraints Management you
may be wondering? My answer is
everything!
If we continue down
the same path we’re on right now, we know that our healthcare system will
simply get worse. We know that the flow
problems, drug mix-ups and shortages of medicine will only intensify unless we
do something drastically different than we are today. The solution can’t be to simply work
harder. Healthcare professionals are
working as hard as they can already and many suffer from burn-out caused by
working long hours. Lean and Six Sigma
will help solve some of the problems, but will they help fast enough before the
onslaught of new patients enter the mix.
Although both Lean and Six Sigma (or the hybrid Lean Sigma) have their
merits, in my opinion they won’t get us to where we need to be quick enough or
far enough! So ok Bob, then what do you
think is the answer to our country’s healthcare dilemma?
My answer, at least
in the short term is to radically improve the flow of patients through our
hospitals! So how do I propose we do
that you’re probably thinking? I will
give you the same answer I have to manufacturing companies who were facing
significant increases in orders. Or to
maintenance, repair and overhaul facilities that aren’t delivering enough
products to their customers and are guilty of late arriving products when they
do ship. The answer lies imbedded within
the Theory of Constraints or Constraint’s Management, whichever you prefer to
call it. Just like the name of this
blog, it’s all about focus and leverage.
Focus on the system constraint and leverage the opportunity to reduce
the cycle time of the constraint.
I’ve had many blog
postings where I’ve written about Dr. Goldratt’s 5 focusing steps. I have paraphrased his five steps as follows:
1.
Identify
the system constraint. Why and where are
patients getting hung up? Maybe it’s an
outdated policy or procedure? Maybe it’s
an actual bottleneck? But you must find
it!
2.
Decide
how to exploit the constraint. Use all
of your Lean and Six Sigma tools and focus them on the constraint you’ve just
identified. Maybe your process is totally unsynchronized? Maybe you’ll have to use
root cause analysis or TOC’s Thinking Process tools to identify a core problem,
but decide what you’re going to do.
3.
Subordinate
everything to the system constraint. It
makes no sense at all to push patients into your constraint because they’ll
just stack up. Pull your patients
through your process at the same rate that the constraint is working, but make it work faster than it is now.
4.
If
necessary, elevate the system constraint.
Before this step you shouldn’t have spent any money (or very little),
but if you haven’t broken the constraint, you might have to spend some. You might need a new machine or you might need to hire more cleaners to get rooms ready, but think of the benefits when the constraint moves. It means that you have broken it and your process is moving patients through it at a higher rate.
5.
When
the constraint moves, go back to step 1 and repeat the process. One thing to remember, the constraint will
move once you’ve applied Lean and Six Sigma to it to reduce waste and
variation, so get ready to move to the constraint’s new home.
What I’m suggesting
to you is to use this integrated methodology because it works. Will it completely solve the on-rush of new
patients coming down the road? Probably
not, but it will at least buy us some time.
The key point to remember when you focus your improvement efforts on the
system constraint is that you will improve your throughput. That is, in the case of a hospital, a much
higher rate of patients passing through the emergency room. A much higher rate of patients passing
through surgery. And probably shorter
stays in the hospital.
Bob Sproull
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