Anticlue

Sometimes you need a pattern, a framework for rules which identify the next step. In staged improvisation, one key rule is to always accept an offer by a team mate. In other words to always say yes, this simple rule helps facilitate an enjoyable show for the audience.

In Healthcare Lean Six Sigma, there is also a fundamental pattern to identify the next step. There are always places where waste exists. These places are labeled as the Seven Categories of Waste.

1. Staffing / Over Capacity - Work fills to the hours available. A common tendency in healthcare is staff up with more resources than is needed. I've seen this practice deployed on the floors, in the billing office, in the practice. In order to staff for your capacity, census on the floors, billing lag in the billing office, scheduled appointments in the practice, you need to have a good understanding of the overall system, and information at what point your group is overwhelmed, and at what point your team is filling the time.


2. Correction - Every time you need another individual to check the work, you have a correction. In healthcare, this practice is rampant, we are always fixing things reactively and on the back end. The practice of clinical documentation coordinators, is to assure physicians documentation of a case is corrected during the time of care. Master Patient Index Corrections is devoted to the practice of fixing incorrect medical record number assignments. These are careers devoted to correcting poor quality the first time. Food for thought, in Healthcare Project Management is a project scope change a correction?


3. Overprocessing / Redundancy - Is when a process is repeated or completed multiple times. When a duplicative lab test is ordered, is an example. Another example is two different departments working on the same improvement initiative. Information Services is working on a better way to communicate with physicians during a downtime, while the physician staff office is doing the same thing. They are working in silos, and not aware of the other's practice. How about this for redundancy, three different ambulatory care applications? AllScripts, E-Clinicalworks, and NextGen. Here is another instance, how many transcription solutions do you have?


4. Inventory - An inventory waste occurs when one maintains more stock than its material management system par level table recommends. Typically, a hospital maintains inventory levels at 2% of its balance sheet, therefore this lime doesn't yield a lot of juice when squeezed.


5. Waiting - There is a lot of waiting in healthcare, patient wait in waiting rooms and holding areas. Patient's wait for rooms in the ED. Clinicians wait for test results, drugs, and transcriptions. Departments proclaim turn around goals for waited items. The waste of waiting is a clearly identifiable in healthcare.


6. Motion of Patient and Staff - This waste has to do with moving a patient from service to service. It brings the idea of exploring if the move of the patient is essential. There are good arguments to both sides of the equation here.


7. Materials and Information Management. - This waste has to do with the movement of materials from one location to another. An example of this would be end user desktop equipment, let's say a desktop laser printer. The printer would be shipped to receiving, moved to the IS logistics department, check-in, scheduled for deployment, and then picked up moved to IS desktop. The desktop technician would pick up the printer and install it over at the client. Lot of moving of 1 piece of equipment.

Further Readings:

• Four Key Approaches of Healthcare Lean Six Sigma


• Deming's 14 points for management


• Costs of Quality

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