In my last posting we
discussed two examples of why it’s so important to look at the entire process
rather than isolated parts. If we don’t
do this, we could end up with a localized improvement that could have a
negative effect on other parts of the process.
Today I want to discuss this same situation and how it could negatively
impact the next step in this particular process. Once again this is a healthcare example that
I was personally involved with.
This scenario
took place in a Radiology Department of a hospital in the Chicago area. When the project charter was written, I
questioned its scope because what they had chosen to improve was a middle part
of the process in question. Specifically
the Champion had elected to improve the part of the process from registration
being completed to the start of the radiologic exam. In addition, the Champion had limited the
process to CT Scans, only one of many test that were routinely done in this
part of the process. My concern was that
if only this part of the process was improved, and I had no doubt that it would
be, then patients would end up being “pushed” to the exam area creating an
excessive queue of patients waiting to be tested. My concern was heard and considered, but in
the end the leadership decided to continue on with their original charter scope.
The team
leader’s first order of business was to review the project charter with the
embers of the team, making sure they understood the boundaries of the process
being studied and the targets this team was supposed to achieve. The team reviewed existing cycle time data
and found that, on average, the time required from registration complete to
exam start was 26 minutes with the goal set by the project champion being .15 minutes. The team received our customary training in
the basics of Lean, Six Sigma and Constraints Management and began the hard
work to reduce the cycle time by nearly 50% (i.e. 26 to 15 minutes).
The team chose
to walk the process to better understand its flow and to gather any potentially
meaningful information. This information
would be used later to create a current state process map of the process from
registration being completed to the start of the patient’s CT exam. The team noted that even though the process
was relatively simple in nature, there were still two separate waiting
rooms. This observation would become an
interesting and useful bit of information.
The team next created a SIPOC Diagram to better understand the process
flow from a high level. Based upon the
estimated times collected during the Gemba Walk, the team determined that the
patients actually spent a total of 19 minutes between the two waiting rooms. Because patient satisfaction was another
important performance metric, it was clear to the team that the extended
waiting room times was an important factor to consider as they designed a
future state. Figure 1 is their SIPOC
which has both the original estimated times and what they believed their future
state could be. The team used the SIPOC
to identify their system constraint and worked to remove time from it.
Using the current state process map, the team then completed
a value stream analysis and color-code each step as either green (value-added),
red (non-value-added) or yellow (non-value-added but necessary). The team then created their ideal state map
by eliminating all steps that didn’t add value which theoretically reduced the
average process time from twenty-six minutes to about seven minutes. They then created a future state map which
came in with a cycle time of just under 12 minutes. Even though they had met their project target
of less than 15 minutes, the team understood that they had made a localized
improvement that could have a negative impact on patient satisfaction. Their concern was that the constraint had
probably moved to the actual exam and that by reducing the processing time, the
number of patients entering the exam areas would probably increase.
Figure 2 is
the team’s current state Process Map after completing their value stream
analysis and as you can see there were 18 activities coded red as
non-value-added (NVA), 6 non-value-added but necessary, coded as yellow and
only 6 value-added (VA) activities coded as green.
Figure 3 is
the Ideal State developed by the team and Figure 4 is their future state map.
In Figure 4
you’ll see that there were 0 reds, 5 yellows and 7 greens. The anticipated cycle time improvement moves
from 26 minutes to only 12 minutes. One
of the most noticeable difference is the complete elimination of one of the two
waiting rooms which should have a positive impact on patient satisfaction.
As the team
implements their future state recommendations, I’ll follow their project and
see if their concern was valid or not.
No matter what, this team now understands the potential danger of making
localized improvements without considering the possible negative impact on the
system.
Bob Sproull
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