Home >    Community    > Forums
Topic Title: Using TAKT time in Hospital Setting
Topic Summary: Training Simulations & materials requested
Created On: 05/17/2011 04:04 PM
Linear : Threading
Send to a Friend Send to a Friend
Search Topic Search Topic
Topic Tools Topic Tools
View similar topics View similar topics
View topic in raw text format. Print this topic.
05/17/2011 05:21 PM
Print this message

Author Icon
wilderwildman
Debbie Wilder



Hello!

Our hospital is trying to take a deeper dive into our capacity vs. demand issue and so we have a deeper need to figure out how to tackle TAKT time in healthcare. (seems more straightforward to do in lab and pharmacy but not so much into multidisciplinary type setting like ED or the inpatient units)

I'm trying to teach our nurse managers about TAKT time and we're all stuck in a paradigm about how to apply it in healthcare.

If someone has some examples of how they applied it to healthcare and/or some training simulations around application in healthcare I would be super excited to hear from you! Can you please post here so others can see as well?

Debbie
05/18/2011 09:23 AM
Print this message

Author Icon
leanblog
Mark Graban



Hi Debbie-

From my experience, takt time doesn't apply as well in healthcare because we often don't have known demand that we are trying to spread evenly across a production period, as a manufacturer would.

There are applications, such as laboratory morning draws - if you know you have to X number of specimen collections in Y hours, then takt can be helpful in determining phlebotomy staffing levels. It might apply in food services where you know you have X number of meals to make in a certain period of time and you can spread out the production of meals.

The key with takt is to make sure your capacity matches up with customer needs.

But when you have "on-demand" services like patient care, I think takt isn't necessarily the most useful concept. If we "spread out" or even out patient care and patient arrivals are very uneven, we'll have long waiting room times, which is bad.

When you said you "want to tackle TAKT time," I think that's putting the cart before the horse. What are you really trying to improve? Are you trying to improve flow? Reduce waiting times, improve quality?

I'd like to hear what the primary question is other than "how do we apply the concept of takt"?

Best regards,
Mark
05/19/2011 09:54 AM
Print this message

Author Icon
wilderwildman
Debbie Wilder



Thanks for your reply Mark!

We have been in our lean journey for 4 years now and done extensive work in reducing waste in several value streams. The ultimate burning platform in our facility is that we continue to have challenges with more demand than capacity (20 patients holding in the ED for an inpatient bed is not atypical)

Our Sensei is trying to guide us into understanding the TAKT time (based on historical volumes) and our actual TAKT time (lots of data collection and GEMBA observation to document). I believe the ultimate goal here is to understand the gap between TAKT and actual TAKT so that we can bridge it with process improvements. Our first focus (to learn by doing) is in the emergency room. We'll then apply those learnings to the inpatient units.

Does that help explain a bit better?
05/19/2011 09:54 AM
Print this message

Author Icon
Robert_ELSE_Inc
Robert Drescher



Hi Debbie

Takt Time calculation is really only for highly repetitive situations, thus its value in Emergency or Inpatient Units would be rather limited if not detremental, as most of the work is closer to that of job shops very specialized to the current job.

I would focus more on other Lean concepts and quality concepts, and just ignore Takt Time in non-repetitive areas it really adds no value to even try to figure it out as there are too many possible options to calculate and situations to account for.

I hope that helps, just remember not every Lean Concept can be applied every where, in some situations applying a concept in the wrong place is worse than ignoring it.

All my Best to you on your journey.

Robert Drescher
ELSE Inc.
05/19/2011 09:54 AM
Print this message

Author Icon
RSkiff
Richard Skiff



It is more challenging, because patient arrivals do vary from day to day. But over a longee period of time, patterns can be seen. In an Emergency Department Setting, we looked at arrivals by hour over a several month period of time. We found that we needed to adjust our triage staffing (by time studying a large number of triages, we determined an "average" triage time). Matching this (how many can we do an hour) vs arrivals, we found that we needed to open a second triage station earlier - arrivals tended to increase about 2 hours before we staffed for that demand. We also studied the discharge time of patients by hour, and adjusted our patient registration personnel to be able to make sure that no patient left the ED without having the proper information for us to collect payment. We found that we were downstaffing registration people at one of the peak times for discharges.

You will probably never be able to match takt and demand as well as in manufacturing, but by using the concepts with wisdom and care, benefits can be found.
05/19/2011 09:54 AM
Print this message

Author Icon
Silverado2
Eric Rohrbacher



Hi Debbie,

I have found "takt capability" to be more helpful in healthcare. Using historical information you can estimate customer demand and calculate takt based on the estimate. This will give you a number that you can build your capability around. This is very similar to what you might use in a job shop environment in manufacturing where demand is very unpredictable.

What I also find helpful is to use several levels of takt cabability in order to handle the variability in demand in healthcare. This means I may have standard work for a takt cabability of 15 minutes and 10 minutes in case the demand load increases. You will need visual controls in place to indicate when "plan B" needs to be initiated. This type of environment is common in call centers where demand on the nurses increases in the morning but decreases as the day goes on.

I agree with Mark in that the underlying question is not takt but what are you trying to solve. Takt is really only a design parameter that helps you develop the standard work that will meet customer demand. As indicated above you may need several different designs in order to meet the variability of demand based on the cyclical nature of your business.

Hope this help.
Eric
05/19/2011 06:53 PM
Print this message

Author Icon
wilderwildman
Debbie Wilder



Thanks everyone for your responses!

Our intial focus is going to be on staffing to demand for Triage.

Richard, would love if you could email me any documentation or plus/deltas you have from going through the TAKT time exercise with Triage.

My email addy is deborah.wilder@stjoe.org
05/20/2011 07:26 AM
Print this message

Author Icon
leanblog
Mark Graban



A few thoughts:

1) 20 patients holding for an inpatient bed.... that screams out to me as a value stream problem. Are you sure that's going to be fixed in the E.D.? Try a 5 whys on "why is there not a bed available in the inpatient unit?"

1b) How does "staffing to demand in triage" address the 20 patients waiting for inpatient beds?

2) There's no such thing as "actual takt." Takt is a calculated (or conceptual) rate of customer/patient demand. I think what you mean to say by "actual takt" is the "cycle time" for a process. You're correct to want to balance supply and demand, capacity and demand. Looking at historical volumes is a great way of staffing to demand... I think that's the right direction.

An excellent resource on all of this is a new book:

The Definitive Guide to Emergency Department Operational Improvement: Employing Lean Principles with Current ED Best Practices to Create the "No Wait" Department [Paperback]

Jody Crane MD MBA (Author), Chuck Noon PHD (Author)

You can find it on Amazon.com.


Edited: 05/20/2011 at 07:28 AM by leanblog
05/20/2011 09:38 AM
Print this message

Author Icon
MarlonWilson
Marlon Wilson



I also recommend the Crane Noon book. It is written very clearly and with a very practical voice
05/20/2011 04:00 PM
Print this message

Author Icon
ThomasPersoon
Thomas Persoon



We have seen the same thing in our ED as Richard has. Takt time in the ED is predictable over long times, with some seasonal variation (i.e. if we have a bad flu season).

Tom
05/20/2011 04:00 PM
Print this message

Author Icon
wilderwildman
Debbie Wilder



Mark: Yes, 20 holds in the ED is definitely a symptom of a value stream issue in the inpatient units which we're addressing separately.

In the meantime we need a containment strategy to manage the flow of the "true" ED patients who are coming in. (several of the ED beds are being taken up by the admitted patient who is holding for a spot in our inpatient unit. thus the flow issue in the ED that needs addressing...how can we triage, do a rapid medical exam, etc.) We're designing flow cells to triage, do RME, etc. but need to understand TAKT for staffing levels, etc.

Does that help explain?
05/20/2011 04:00 PM
Print this message

Author Icon
wilderwildman
Debbie Wilder



Off to order the book you recommended!
Thanks!!!
05/23/2011 01:29 PM
Print this message

Author Icon
MarlonWilson
Marlon Wilson



Sounds like we are experiencing some of the same issues. Our focus to deal with the true ED patiens is to decrease dorr to doc time and this process tarts with triage (the arrival time is before triage). the demand capacity analysis discussed in the Crane- Noon book has been very helpful That may be a more accurate term than takt time. There are some clear daily trends that can show up that will allow you to modify your staffing to meet the demand and eliminate bottlenecks.
07/15/2011 04:18 PM
Print this message

Author Icon
223565
Theresa Ledesma



Richard,

Interesting application of Takt in the triage setting. Can you please send me any additional information you may have as well? I am new to healthcare, coming from manufacturing and the two industries are definitely not the same for applying these tools. You can send any response to theresa_ledesma@yahoo.com.

Thank you

Theresa Ledesma
07/22/2011 10:11 AM
Print this message

Author Icon

Tom Robinson



I would also endorse this book, having worked directly with Jody and Chuck. They really know their stuff.
10/11/2011 03:08 PM
Print this message

Author Icon
74346
Jamal Siddiqi



In e-letter - October 2011, Dan Jones (co-author of Lean Thinking) writes "that patient demand (both for admission and discharge) is in fact very predictable". Which means that we can plan our capacity to meet the demand.
The e-letter is attached for the benfit of all Lean practitioners.
Regards,
Jamal


10/17/2011 09:27 AM
Print this message

Author Icon
--Caroline--
Caroline Glus



Thanks for sharing. I wasn't aware of this web site and the article hits squarely on the issues and reinforces the focus of our lean journey.
10/21/2011 12:04 PM
Print this message

Author Icon
Jeff_Logan
Jeff Logan



This is a great discussion!! Very timely in the fact that this issues is more common than not in most ED across the country.

I am dealing with the same challenges and focusing on reducing our left with being seen (LWBS) in the ED and improving flow in the inpatient setting by improving the care continuum through discharge.

Richard, could you send me the information too or post it here?
jeff.logan@samc.com

Thx!
10/22/2011 04:24 PM
Print this message

Author Icon
RSkiff
Richard Skiff



Jeff. I would love to be able to do this, but I am no longer at that facility. I was working there, but living 450 miles from my family. I had an opportunity to move back to live with them, but it was not in the Healthcare arena. It was a great choice for my family. However, I would love to get back into healthcare.

That said, I really don't have access to that piece of the information. If you would like, we can have an evening discussion sometime and I could share some of what little wisdom I may have picked up. Let me know by my direct email (richard_skiff@hotmail.com) and we can set up a time.

I was able to post some short versions of some of my healthcare projects on my LinkedIn profile. I would also be happy to become a connection, if you so desire.

My best to you and your team. It is exciting and greatly rewarding to be able to help patients get more effective and efficient care.
Note: These forums are moderated by the Lean Enterprise Institute. All posts are reviewed prior to appearing on the site. Views expressed in these forums do not necessarily represent the views of the Lean Enterprise Institute.