Wednesday, March 12, 2008

Finding Waste

Imagine you’re clinic experience from the patient’s perspective. Better yet, come in one day after lunch, when the clinic is filling up and walk through the door. Sit down and watch what happens. There are all number of clinics and health care providers reading this around the world so experiences will differ.

Some will have just a few patients and a quick reception, others will stand in front of a glasses partition waiting to be acknowledged and others will be welcomed and brought right in. The desirable experience from the patient’s point of view is the latter but few clinics run this way unless they are underutilized.

Why don’t they run this way? Imagine a clinic where every step of the process ran at exactly the same speed. Check-in was 2 minutes, review of the medical history and vital signs was 5 minutes, time with clinician is 10 minutes and check-out was 2 minutes. There is zero variation to each step. Since the rate limiting step is the clinician at 10 minutes patients can be booked every 10 minutes and booked to arrive 7 minutes prior to their appointment with the clinician. Since patient 1 has check-out just prior to patient 3 check-in only one person is needed at each process (one administrator).

But life is rarely so pretty. Having different appointments take unplanned amounts of time is called variation. For instance a 10 minutes block of time may be 7 minutes or it could be 14 minutes (or 40!). This is what causes wait and waste to occur. In a service industry it is not the person having the appointment that experiences the waste – it is the people down-stream. For instance, the person that requires 15 minutes of time in a 10 minute appointment block has no waste; it is the next and subsequent people.

But waiting will happen whenever there is a bottle neck or a high degree of variation. Most people understand intuitively why a bottle causes a problem (e.g. the provider spends 30 minutes with everyone and all other steps are 2 minutes each) but they don't always notice why variation causes the issue.

So what can be done about it? The answer is found in looking at it from the patient’s perspective. Some clinics will put up a sign saying “one problem per visit”. From the patients perspective this is extremely wasteful (even though it may help the clinic run on time). The other solution is better screening to build a better schedule. If someone needs 30 minutes to go through their “problem list” they must be willing to wait longer to get in but get it all done at once (see the block booking blog).

I would ask that you take a look at your clinic and think of one sequence of events (or processes) that a patient goes through and write it down in sequential order. I am always looking for examples and suggestions so please post any to the comments page for everyone to review. Create an a simple flow map of the process that the patient goes through, either booking a procedure or follow-up or when they walk in the door.

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