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03/13/2012 10:04 PM
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Hi all,
I'm currently doing some lean work in an outpatient blood collection clinic in which the team is trying to reduce waiting time of patients. What I have observed from my first Gemba walk is a lot of imbalance in the different work processes. Originally when the project was kicked off most everyone thought the registration was the bottleneck. However based on the first observations it appears that blood draw performed by the phlebotimist can't keep up with the registration (and I guess the arrival rate of patients - inventory). We are still in the very early stages and need to do much more problem solving.
I was wondering anyone has ever done a Value Stream Map for outpatient blood collections. I would certainly appreciate if you would share.
Thanks
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03/16/2012 12:58 PM
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It sounds like you are on the right path in terms of observing the process and seeing what really happens in the value stream.
Good luck with the continued problem solving?
I'm curious how seeing somebody else's value stream map is helpful when you have the opportunity to draw the current state map of your own process?
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03/16/2012 12:58 PM
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I've done a lot of work with outpatient phlebotomy and the fundamental problem you have to deal with is takt vs cycle time. Due to differences in patients and differences in phlebotomy skills, the distribution of cycle times for just the value-added piece (the blood draw) is usually non-normal, often Poisson. It also usually takes longer than the non-value added but necessary steps like registration. Focus on the phlebotomist, they are most likely the bottleneck resource, and make sure they are doing only value-added steps. Then determine the takt and phlebotomy cycle times and balance resources accordingly.
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03/16/2012 09:32 PM
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Thanks gentleman for the feedback.
I spent a couple more days at the Gemba and it has been very interesting to say the least. Been collecting arrival rates with my team. Looks like staffing is not aligned properly with the peak periods, so may be some opportunity there but we are not there yet, don't want to jump to the solutions just yet. While the collection of the sample appears to be the bottleneck, I still have to look at takt time to be sure, it might just be an imbalance. Once we determine takt time ( we are just working on the actual demand because don't quite trust the database) we will use the balance chart to verify the bottleneck.
Mark I'm glad you asked that question. I guess it was some sort of validation as I am new to healthcare. But upon reflection I couldn't agree with you more. I have what I need and have validated the VSM with the team.
Once again thanks for your advise it is greatly appreciated.
Cheers
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03/23/2012 11:04 AM
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Justin - good luck with the efforts. Staffing to demand is a really useful concept for labs and phlebotomy.
Another thing to dig into is to ask why demand isn't more level. Are there policies or upstream scheduling (from clinics, etc.) that cause uneven demand throughout the day or week? Sometimes what seems like "natural" variation is really caused by policies that somebody has control over... just a thought, because I've seen opportunities to make things at least a bit more level (even if not perfectly level loaded).
Mark
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03/26/2012 12:04 PM
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Mark
Great point
We find 2 issues. Planned blood draws (scheduled)
And unplanned (result of Provider visit).
The more you can predict demand then level load schedule, the better you can focus on the process.
Have Providers schedules been level loaded?
John
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03/28/2012 05:46 PM
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Thanks everyone.
So to date we are going to staff according to arrival rate and 'check' to see if there is an improvement. We currently don't load level or work with physicians to schedule appointments. I agree that if we can smooth our demand we could potentially reduce our wait times even further. That may be phase 2 of our work and we maybe able to team up with a physician who sends a lot of patients to our clinic. Thinking about that now I think I will be able to pareto those doctor clinics to determine a potential partner.
I'll keep you posted.
Thanks again
Justin
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