The Art of Lean Healthcare IT - Empowering the pull concept by Anticlue

Often in Healthcare IT, we have a push mentality. To get work processed through our department, it is pushed not pulled. A request is received through various queues - email, phone call, hallway conversation, formal work/change request. It is followed up upon by the requestor, sometimes the requestor's director, and when the fire really starts your director. The work request is pushed all the way through the system.

The other truth is we are highly interdependent in Healthcare IT. There are desktop specialists, server admins, dbas, integration architects, telecom specialists, business analysts, developers, report writers, and project managers. A simple request to install a new discharge calling service will include all of these individuals at different times. Each one will have the task pushed upon them, and often the urgency of the day is who is pushing loudest.

How to Test Out the Pull Concept

So let's go about this another way, in lean there is the concept of Just in Time. This concept relies on a pull mechanism for work, instead of a push. Often with knowledge deliverables are our inventory. A "kanban card" can be created for each deliverable, for explaining purposes try a couple of post-its. My recommendation is to use the same color post-its for each project or service request.

Now, let's setup the framework of the cards placement or the Heijunka Box. Its pretty simple based upon your process flow. There are the phases, qualification, initiation, planning, design, purchase, install, configure, test, and deploy as columns. Have the teams of specialists as horizontal rows.

	Qualify	Select	Contract	Install	Configure	Test	Deploy
Legal
Sponsor
Network
PM

You might want to break the boxes up a bit more into waiting, and working classifications.

As you can see this is easier on a white board than in a two dimensional representation, but I believe you get the idea. As the deliverable works its way through the system, move the post it notes. Viola you have your production flow.

Now the key step to a pull work queue, it to allow the specialist to pull the work from waiting to in-process, then place it in the next waiting queue. As post-its pile on up, you will see the bottlenecks.

The Take Away

Looking at the process flow with a pull approach, opportunities will present themselves in two key forms, additional steps which do not bring overall value to the creation of the deliverable and bottlenecks for production. In both of these instances, some process improvements are awaiting discovery.

The other key concept is that people are now taking the amount of work which will fulfill their day or week. It empowers achievement.

I would love to hear your suggestions on this post, if you have tried something similar and how it worked out. Also Iplease take a couple of moments and check out these other posts on the Art of Lean Healthcare IT.

• Understanding the 5 key main principles


• Talking the Lean Jargon

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