Applying flow to healthcare (part 2)
The rules to follow for smooth patient flow are the same as those of the Toyota Production System:
#1: Specify timing, sequence, and outcome of all work
#2: Connect all customers and supplier relationships with “one-piece pull”
#3: Flow product or service directly one at a time
#4: Signal problems at each step through “stop the line”
#5: Start at the process owner solve problems using the scientific method
There are three main problems likely to be encountered with patient flow at any hospital.
These are: 1) scheduling, 2) inflexibility of the layout of hospital facilities, and 3) the functional or “silo” mentality between departments.
1) Smoothing out schedule of capacity of value streams across capacity constrained resources, such as operating rooms, is a theme common to all Lean implementations. One example of a barrier to flow is the lack of beds. One root cause of slow turns of beds is a delay in discharge. The root cause can be something as simple as scheduling discharge times at the convenience of the physician rather than based on the pace of customer demand or a target turn time for beds.
Not having a bed available creates the waste of waiting for the patient, motion for the nurses who must search for an available bed, transportation for the patient who must be relocated to the bed, and extra processing to make sure the charts, meds and resources are diverted to the new location. A common goal must be set to improve patient flow and increase velocity so that competing interests can be resolved and behaviors can change.
2) Compared to a factory layout where equipment and even non-structural walls can be moved with ease to accommodate improved flow, hospitals tend to be multi-story, multi-building structures with complex infrastructures that do not lend themselves to a quick rearrangement processes to accommodate patient flow. Although the best opportunities are to take advantage of new construction or remodeling, we are seeing hospitals that are willing to remove physical walls and convert room, offices, and storage space to accommodate patient flow.
3) As in any industry, a strong “silo” mentality exists in hospitals between the facilities a hospitals provide, physicians, specialists, RNs and staff all trying to optimize their part of the value stream of providing care without looking at it from the perspective of the patient. This must be addressed long-term through a team approach and conversion to value stream management.
Patient flow is an exciting area of Lean Healthcare, as it holds the promise of lower costs, improved quality of care, and a better patient experience for all of us.
For more information on implementing or learning flow through our Value Stream Mapping classes and simulation please contact us- Office- (704) 274-2050 email- firstname.lastname@example.org
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