Naturally Lean?

            Lean in the healthcare world is certainly taking hold. And, why wouldn’t it be? Our country is facing a healthcare crisis of epidemic proportions. Certainly healthcare is a unique business. The supply and demand curve is totally inelastic. When a new technology is brought to the health care arena, the capacity in the equipment is used up almost immediately. I certainly have never been to a walk-in MRI suite.

            In the midst of all of this focused improvement, I found a diamond in the rough. The place I am referring to is not in the middle of a grandiose transformation. No consultants have been brought in. No formal training had been done. Yet, the same minor procedure I had done in a different surgical center took three to five hours, whilst this one… well, was much shorter.

Let’s start with a timeline (All times are approximate, I had sedation that day):

Time	Process Steps
9:50	Arrived onsite for a 10:00 appointment
9:57	First registered nurse escorted me to the back
10:03	Vitals signs were taken consent formed signed
10:05	Second nurse started IV for monitored sedation
10:08	Anesthesiologist performed quality check and briefed me about sedation procedure
10:15	Second nurse escorts me back to the procedure room
10:20	Monitored sedation begins
10:25	Procedure starts
10:45	Procedure complete
10:55	Discharge form signed
11:02	We exit the parking lot

How is that possible? How is it that two identical procedures have such substantially different cycle times? The second surgical center hadn’t spent any incredible amount of time working on optimizing their processes. What was the difference?

One word: Flow! For reasons unknown to me, the surgeon had placed a premium on flow. Let’s investigate the timeline a bit further.

Why did the second nurse start my IV? The first nurse called her for assistance when she saw the surgical room was about to be free. No, she didn’t pull a switch, sound an alarm or stop the line. She did, however, pull an andon. She identified that she was behind in tact and took action to correct it. The physician, whether by design or on accident, staffed the production cell with an appropriate number of people.

Lean Learnings: Cutting costs will only get you so far. What is the value of one employee if it permits you to keep you constraint from being starved? Priceless!

Additionally, I heard the first nurse talking to the second nurse, “Thanks for helping out. The doctor wants us to have the next patient ready to go as soon as the previous one walks out the door.”

Again, I don’t know if this was purposeful or not, but the doctor had figured out that he was the constraint. He knew that he could generate more revenue if he kept himself in the value added task longer and he prioritized communicating that mentality to his staff. He also knew that he was the value-added bang of the property. Not in an aloof way, it was obvious he respected his team and they respected him back.

Constraint management is an integral part of establishing flow in any organization. It doesn’t take six months of training and a purple belt to understand the concepts of flow and value. It takes a unified team focused on the right priorities!