It seems Lean is more popular than Six Sigma in healthcare. Is that true and can you tell me your take on it? – jd
Jay: Well sure. In healthcare, one of the things that the joint commission which regulates and certify a lot of hospitals on is patient flow. So part of the job is to accelerate patient flow. Now what I’ve found, I call it the 357 rule. It means that the clinician’s only working with a patient for maybe three minutes out of every hour. And the other 57 minutes is a delay. The patient is just sitting around waiting on something, all right? So, literally it does not take that long to figure out how to eliminate delays and clinicians are all worried we’re trying to make you do twice as much work. No. We just want to get the delays out of the process.
I took my mom in for a simple thing. First the nurse came in, and then later the doctor came in, and they ordered some tests and eventually somebody came in and took blood and then we waited some more. A blood test is maybe 11 minutes; it’s not that long. We literally we were there two and half hours saw a nurse or a doctor, maybe six minutes total and 11 minutes for the lab work, well that’s ridiculous.
There’s actually Robert with Johnson Hospital out in New Jersey actually set up in 1999, they established their 15, 30-minute guarantee. You would see a nurse in 15 minutes, a doctor in 30 minutes or your visit to their emergency department was free. Now this would scare the holy living stuff out of anybody that’s out there running an emergency department, but literally they actually grew at over 10 percent a year, had to add a new wing onto their hospital, because every little soccer mom figured out they could take their kid there and get them in and out in 30 minutes.
They were discharging patients about 38 minutes is the actual time and admitting patients in 90 minutes instead of four hours or more. These are the kinds of opportunities if you just eliminate all those delays and these processes then you get dramatic improvement. I’ve seen examples where people are… I worked with one hospital lab and walking is a waste, it’s one of the key phrases, walking is a waste.
We hung pedometers on the lab technicians, have them walk around, record how far they traveled. In a 2,400 square foot lab, they were walking four miles a day. Well, that’s an awful lot of travel, all right? When we redesign the lab, we cut that travel time by over 50 percent and reduced the square footage from 2400 to 2000 square feet, and it actually accelerated. We thought saved like seven hours of delay on all this stuff, and that speeds up diagnosis and treatment, discharge, and everything else you could imagine. There are tremendous opportunities in that area.
In the nursing units, we hung pedometers on the nurses and surprisingly enough… this one new hospital clinic that was built here nearby I was talking to one of the nurses there and she said, “You know we’re walking 10, 12 miles a day just to go get stuff.” Well, that means it was badly designed. You can redesign where everything is that they don’t travel as far, and I’ve seen examples where you can cut travel time in a nursing unit by 67 percent. That leads to better patient care, right? So nurses spend more time with the patient, not commuting. There is just way too much commuting going on out there. Those are just some simple examples. Go ahead.
Jay Arthur is the author of the Six Sigma System, The QI Macros SPC Software for Excel, Your Seventh Sense – How to think like a comedian, Motivate Everyone, the Motivation Profile, and has written six popular John Wiley & Sons books on software engineering.
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