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Are You Prioritizing Efficiency Over Value?

by Cameron Ford
May 18, 2017

Are You Prioritizing Efficiency Over Value?

by Cameron Ford
May 18, 2017 | Comments (10)

Lean healthcare has made tremendous progress in an industry once known for nightmarishly long wait times. A new generation of clinics is coming onto the scene, faster and more productive than their older counterparts.

Now, for those of you lean healthcare folks currently thinking, “Lean healthcare is a good thing? Fascinating, Cam…and in equally groundbreaking news, water is wet!”, a recent experience reminded me that success with lean is not entirely about speed. 

I was at an orthopedic clinic after being referred there for a possible broken wrist (trampoline park injury…don’t ask). I’d never been to an orthopedic surgeon before, but my hopes weren’t high. After all, every other specialist I’d ever visited for any health ailment – be it a dermatologist, ophthalmologist, or chiropractor – had been a stereotypically slow and frustrating experience. All I wanted was to get an X-ray, find out if my wrist was broken and if I needed surgery, and be on my merry way.

I went through eight steps:

  1. Check-in and new patient registration
  2. Getting temporary dressing removed
  3. Getting X-rays
  4. Consultation and X-ray interpretation with doctor (confirmed scaphoid fracture)
  5. Getting casted with fiberglass
  6. Final inspection of cast
  7. Scheduling surgery
  8. Check-out

I was pleasantly surprised. I never waited for longer than two minutes, nor did any step take longer than five minutes. I was in and out in less than 20, with X-rays of my first-ever broken bone, my first-ever cast and an appointment card for my first-ever surgery. It should be noted too that the place definitely incorporated some aspects of lean. There were kanban boards, matrixes to show staff availability on certain days, thoroughly labeled and color-coded supplies, and more.

I was happy to have been through such a painless process. But at the end of it all something odd happened. I didn’t feel good about the experience I’d just had. I felt lost, unassured and unconfident. Reflecting back on my experience, it started to feel less like being efficient and more like being rushed. The doctor had raced through our consultation, given me minimal-at-best information on the fracture and surgery and even, after handing me the Consent for Surgery contract, stood there eyeing me expectantly, with a clear Just sign it and let me get on with my life! look on his face. I ended up having to call him multiple times in the weeks leading up to the surgery to get my lingering concerns and questions answered. All things that we could have done in our initial appointment.

So yes, it was a highly efficient process. But at the end of the day, it was not a good customer experience. It wasn’t a great feeling for me, as a customer, particularly given that I was about to undergo a surgery on my dominant (i.e. writing) hand. 

This experience is a good reminder of one of the cornerstones of lean, and one of the first things I learned when I first came to LEI – efficiency does not equal lean. When I first started learning about lean it certainly SOUNDED like lean was about getting more efficient, and it is. But that’s not what it’s all about. It’s about creating more value for the customer, through focusing on their needs.

So did I want an efficient process for going through my appointment? Of course. They got that part right. 

Did that make the experience high-quality and value add for me, the customer? Not entirely. 

Would I be okay spending more time at the clinic in favor of a more value add experience? Absolutely. 

Just another reminder that the customer is king – never lose sight of yours!

The views expressed in this post do not necessarily represent the views or policies of The Lean Enterprise Institute.
Keywords:  customer focus,  healthcare,  musings
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10 Comments | Post a Comment
Claire Everett May 18, 2017
1 Person AGREES with this comment

Hi Cameron

Thanks for sharing your experience.

It brings to my mind "Easier, Better, Faster, Cheaper, in that order" (sorry I don't remember where this comes from). 

In your case it seems they skipped better in favor of faster.  I've seen a few process changes that reminded me that following this order is important for customers, employees and the business.



Reply »

Cam Ford May 22, 2017

Thanks for the comment Claire! And that's one of my favorite lean quotes, from Shigeo Shingo himself: "There are four purposes of improvement: easier, better, faster and cheaper. These four goals appear in the order of priority." Always pays to keep that order in mind



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Tim Kane May 19, 2017
2 People AGREE with this comment

Hey Cam,

Great article, great insights.  As far as old adages go, for some providers "follow the money" might reonate more than "the customer is king".  As long as docs are compensated on a transactional basis (and not on outcomes), assembly line experiences like yours will persist, and we'll keep reading in the Globe about surgeons performing concurrent surgeries on multiple patients.  It's all about volume.

Hope your wrist is feeling better.

Tim



Reply »

Cam Ford May 22, 2017

Well said, Tim. And thanks for the kind words. Fully healed as of two weeks ago!



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Mark Graban May 26, 2017

Lean, of course, isn't only about efficiency. It's about focusing on the customer, quality, and more.

If you arrive at the E.R. with chest pain, efficiency (actually "flow" is the better word) could mean the difference between life and death.

The two pillars of TPS are, essentially, flow and quality at the source. "Efficiency" is usually a measure of keeping people and resources busy... queuing theory teaches us that really high utilization and efficiency often means really poor flow.

Cam, is there any evidence that this ortho clinic was practicing Lean? Healthcare has tried to race patients through without the Lean methodology. 

When we introduce Lean in healthcare, people often say "Don't turn us into a factory." The irony is that healthcare organizations often have "assembly line medicine" and it's a BAD assembly line. Lean is a great countering force to the healthcare norms of focusing on utilization and cost.

Focus instead on flow and quality.



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Bella Englebach May 22, 2017
1 Person AGREES with this comment

Hi Cam,

Sorry to hear about your accident, but thanks for this blog post.  It remindd me of this article i recently read in the Phialdelphia Inquirer.  http://www.philly.com/philly/health/For-an-exhausted-caregiver-relief-came-in-a-1200-hospital-nap.html

The author of the article is a caregiver (and wife) of a cancer patient.  Her experience of lean healthcare (which I sure she's never even heard of) came to a head with this encounter, as she tried to catch a much-needed nap in the emergency room. "Then a woman in high heels came by to inform me that she was in charge of “facilitating patient flow.” I was blocking her flow."  Once again, efficiency superseded value.  

I think it's really important to include customers in the redesign and improvement activites.  In healthcare, of course, that means patients and family members (not all of whom will define value in the same way.) In all our businesses that is going to require a really big shift in thinking and behavior.

Stay off the trampoline!

 



Reply »

Cam Ford May 22, 2017

Excellent read Bella - there were definitely a few moments where I could relate to Ms. Louwers. And agree 110% on the customer involvement in redesign activities. Wonder if it would be rude of me to bring an article on design thinking to my next appointment...?



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Mark Graban May 26, 2017
1 Person AGREES with this reply

Cam wrote:  

"Wonder if it would be rude of me to bring an article on design thinking to my next appointment...?"

It might not be rude, but it might be a waste of paper. If you're bringing a solution (design thinking) to something the clinic doesn't view as a problem, I'm not sure what that will lead to...



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Mark Graban May 26, 2017

How do we know that encounter was with "Lean healthcare?" Where is the evidence of that?

Having a well-dressed administrator barking at people exists in healthcare before or without Lean. 

Why would Lean be blamed for that awful scenario?

 



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Lev Ono May 23, 2017
2 People AGREE with this comment

When false efficiency cuts into value, it's not lean or efficient. 



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