The concepts of lean manufacturing work well in a linear production environment. What specialties in the medical practice are the production environment? Perhaps dermatology, ophthalmology, radiology . . . but after that, most other specialties have a significant amount of variety in the types of patients seen. So what do we do? We are not creating Toyotas here
We are in the job-shop environment, a place where there is a great degree of variety, low volume related to one specific type diagnosis setting. A job-shop is not an assembly line. . . . placement of people and machines cannot as easily be structured. Value stream mapping simply does not work.
Differences in the job shop vs assembly line setup-are extreme.
- Increased inventory
- Greater work in progress
- Hard to standardize or even generate the standards for quality, time, etc. (ever try to get your physicians to agree on one way to treat patients?)
- Limited resources to commit full-time to training and roll-out (we dont have time to train our nurses one way to do things)
- Extreme volatility in incoming order demand (some days more ear aches, some days more copd, some days more htn.)
The similarities that exist are:
- Quality is very important
- On time Delivery – patients hate to wait
- Cost containment – we have a limited amount of resources
- Flexibility – we have to be able to change to meet patient needs
- Re-configurability – systems must change to meet the demands of our patient type load.
So what can be done? Scheduling, Scheduling, Scheduling. Having a scheduler that can anticipate personnel needs and physician time needs will allow the practice to achieve better patient flow. How many offices have schedulers that can handle that task while on the phone with a demanding patient and several other lines ringing? Very few.
Offices also need to quantify the time and cost components associated with various types of visits as well as the profitability of each visit type and set schedules to meet the same. By developing protocols or at least time and day guidelines, practices can begin to operate a bite more “lean”
If you are interested in the research being done on small-run job shop lean manufacturing techniques, check out the writings of Shahrukh Irani at The Ohio State University or contact us about evaluating your practice’s workflow processes.