Tag: Health care

Hanging from a thread – Lean Healthcare

A light blue ribbon is the symbol for prostate...
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Background

It seems that Lean Healthcare is getting a lot of exposure here as of late.  I will qualify this by saying “in practice” rather than “name”.  The Toronto Star published yet another article, Sunnybrook cuts wait for prostate diagnosis down to 72 hours, that once again demonstrates that improvements can be made if we put our minds to it.

The Need to Change

The need to change is premised on this excerpt from the article:

“But after the needle biopsy . . . it was like my future was hanging from a thread. It was hell.”

And later …

“Men have waited too long,” says Dr. Robert Nam, a Sunnybrook uro-oncologist who is spearheading the accelerated prostate protocol.

“They wait two to three weeks. And two to three weeks knowing that they could have a live-altering disease is something to me that is not acceptable.”

Why – Beyond Reducing Wait Time

Aside from the emotional strain, hidden from view or otherwise, cancers are always best treated when they are detected early:

While many prostate cancers are slow-growing – some are left completely alone — others are aggressive and benefit from immediate treatment.

“There is a big misconception that prostate cancer is such a slow-growing disease that we don’t need to rush into anything,” Nam says.

How did they do it?

The goods news is that they already had a model to work from:

In a new program that mirrors one launched two years ago for rapid breast tumour diagnoses, Toronto’s Sunnybrook Health Sciences Centre has now pledged to give men the results of prostate cancer biopsies within three days.

They also procured new equipment and found efficiencies in the way that results were processed:

The diagnostic acceleration will be accomplished mainly by “finding efficiencies” among hospital pathologists who examine the biopsied tissues and determine the presence and severity of the ailment. Nam says any priority shift in the hospital’s pathology department – which expects no staff increase — will not mean other forms of cancer get shorter shrift.

Room to Improve

As mentioned earlier, Sunnybrook had a surrogate model to follow but there is still room to improve:

Men will still have to wait three times longer for their results than women, who are promised a breast cancer diagnosis within a day of being biopsied.

It’s NOT about the money!

I share this information on the premise that we are continually reminded, at least here in Ontario, that we simply don’t have the resources or the funds to improve health care.  I become increasingly frustrated by the misconception of our government that we are already as efficient as we possibly can be.

“We made it cost neutral and . . . we did not jeopardize any other program within the pathology department,” he says.

I am thankful that Sunnybrook Hospital staff have demonstrated yet again that real opportunities for improvement can be made without incurring additional expense to the system.

It’s the Culture

The significance of the effort here is not just the idea itself but the culture that allows these ideas to flourish.  Sunnybrook Hospital clearly supports improvements from within and outside the hospital and is also quite eager to share them as evidenced in our previous post, Lean – Sunnybrook Doctors Benefit from Gaming Technology.

I am currently reading “Toyota Under Fire” by Jeffrey K. Liker and Timothy N. Ogden where once again it is confirmed that Toyota’s culture is at the very core of it’s resilience and ability to adapt and change to meet the current crisis at hand. Clearly, the economic crisis we still find ourselves having to contend with is cause to pause and reflect on how we can indeed adapt and change to meet our every day challenges in our personal lives, business, industry, and governments alike.

There is much to be learned and so much more to be gained.  We must learn to watch and listen and at the very least acknowledge that there is always a better way.

Until Next Time – STAY lean!

Vergence Analytics
Twitter:  @Versalytics
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Lean – A Race Against Time

The printer Benjamin Franklin contributed grea...
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Background

If “Time is Money”, is it reasonable for us to consider that “Wasting Time is Wasting Money?”

Whether we are discussing customer service, health care, government services, or manufacturing – waste is often identified as one of the top concerns that must be addressed and ultimately eliminated.  As is often the case in most organizations, the next step is an attempt to define waste.  Although they are not the focus of our discussion, the commonly known “wastes” from a lean perspective are:

  • Over-Production
  • Inventory
  • Correction (Non-Conformance  – Quality)
  • Transportation
  • Motion
  • Over Processing
  • Waiting

Resourcefulness is another form of waste often added to this list and occurs when resources and talent are not utilized to work at their full potential.

Where did the Time go?

As a lean practitioner, I acknowledge these wastes exist but there must have been an underlying element of concern or thinking process that caused this list to be created.  In other words, lists don’t just appear, they are created for a reason.

As I pondered this list, I realized that the greatest single common denominator of each waste is TIME.  Again, from a lean perspective, TIME is the basis for measuring throughput.  As such, our Lean Journey is ultimately founded on our ability to reduce or eliminate the TIME required to produce a part or deliver a service.

As a non-renewable resource, we must learn to value time and use it effectively.  Again, as we review the list above, we can see that lost time is an inherent trait of each waste.  We can also see how this list extends beyond the realm of manufacturing.  TIME is a constant constraint that is indeed a challenge to manage even in our personal lives.

To efficiently do what is not required is NOT effective.

I consider Overall Equipment Effectiveness (OEE) to be a key metric in manufacturing.  While it is possible to consider the three factors Availability, Performance, and Quality separately, in the context of this discussion, we can see that any impediment to throughput can be directly correlated to lost time.

To extend the concept in a more general sense, our objective is to provide our customers with a quality product or service in the shortest amount of time.  Waste is any impediment or roadblock that prevents us from achieving this objective.

Indirect Waste and Effectiveness

Indirect Waste (time) is best explained by way of example.  How many times have we heard, “I don’t understand this – we just finished training everybody!”  It is common for companies to provide training to teach new skills.  Similarly, when a problem occurs, one of the – too often used – corrective actions is “re-trained employee(s).”  Unfortunately, the results are not always what we expect.

Many companies seem content to use class test scores and instructor feedback to determine whether the training was effective while little consideration is given to developing skill competency.  If an employee cannot execute or demonstrate the skill successfully or competently, how effective was the training?  Recognizing that a learning curve may exist, some companies are inclined to dismiss incompetence but only for a limited time.

The company must discern between employee capability and quality of training.  In other words, the company must ensure that the quality of training provided will adequately prepare the employee to successfully perform the required tasks.  Either the training and / or method of delivery are not effective or the employee may simply lack the capability.  Let me qualify this last statement by saying that “playing the piano is not for everyone.”

Training effectiveness can only be measured by an employee’s demonstrated ability to apply their new knowledge or skill.

Time – Friend or Foe?

Lean tools are without doubt very useful and play a significant role in helping to carve out a lean strategy.  However, I am concerned that the tendency of many lean initiatives is to follow a prescribed strategy or formula.  This approach essentially creates a new box that in time will not be much different from the one we are trying to break out of.

An extension of this is the classification of wastes.  As identified here, the true waste is time.  Efforts to reduce or eliminate the time element from any process will undoubtedly result in cost savings.  However, the immediate focus of lean is not on cost reduction alone.

Global sourcing has assured that “TIME” can be purchased at reduced rates from low-cost labour countries.  While this practice may result in a “cost savings”, it does nothing to promote the cause of lean – we have simply outsourced our inefficiencies at reduced prices.  Numerous Canadian and US facilities continue to be closed as workers witness the exodus of jobs to foreign countries due to lower labor and operating costs. Electrolux closes facility in Webster City, Iowa.

I don’t know the origins of multi-tasking, but the very mention of it suggests that someone had “time on their hands.”  So remember, when you’re put on hold, driving to work, stuck in traffic, stopped at a light, sorting parts, waiting in line, sitting in the doctors office, watching commercials, or just looking for lost or misplaced items – your time is running out.

Is time a friend or foe?  I suggest the answer is both, as long as we spend it wisely (spelled effectively).  Be effective, be Lean, and stop wasting time.

Let the race begin:  Ready … Set … Go …

Until Next Time – STAY lean!

Vergence Analytics

Twitter:  @Versalytics