The concept of value underpins all other aspects of Lean Healthcare.  Since value should always be defined from the patient or customer perspective, it can be thought of as those benefits or features for which the patient or customer would be willing to invest money, time, or energy.

For today, let’s focus on the time dimension of value.  Time – how quickly, how long, how frequently – has a great impact on the perception of value.  In 1990, George Stalk and Thomas Hout published the book Competing Against Time: How Time Based Competition is Reshaping Global Markets.  The premise of this seminal book is that there are a number of things leaders can measure and try to manage – so many in fact that leaders can be overwhelmed.  However, one big thing leaders can measure and manage that will positively impact all others is the total elapsed time from beginning to end of any work process.

In healthcare, time is measured in a number of ways, including:

  • Cycle times
  • Turnaround times
  • Wait times
  • Length of stay

Note that this list does not contain anything about man-hours, productivity, or utilization of people and equipment.  It’s just about the minutes, hours, shifts, days, and even weeks of elapsed time it takes from the start of an activity to its end.

Think about patient experience at your hospital.  Have you ever had patient wait times increase and quality of care get better?  How about patient satisfaction with those longer wait times?  Ever had a care delivery process take longer than necessary and the clinical outcomes improve?  Or what about your administrative processes?  Have you ever improved decision making by taking longer and having multiple sign-offs?  Ever had an IT project go longer than expected and the costs go down?

Eliminating the waste of time in any form can provide significant benefits.  There is a solid argument to be made that at a fundamental level, the value diamond represents four levers under a leader’s control.

Stalk and Hout assert that if the first element you pay attention to is time, the other value diamond elements will take care of themselves.

Consider your hospital’s work in process.  One of the things I look for when visiting hospitals is the number of patients sitting in waiting rooms/areas or being held in the ED.  In most instances patients waiting are not getting any better.  In fact, they’re waiting to be forgotten, get lost, or to become frustrated enough to get up and leave without treatment.  In an ideal world, a patient should never wait anywhere from arrival time until care is completed.

Now consider the inventory in your hospital.  Have you ever seen anything good happen to materials or supplies that sat in inventory too long?  Like me, I’m sure you’ve seen too many medications, reagents and other products get thrown out or have to be destroyed because their expiration dates passed before they could be used.  Not only are those supplies and materials wasted, but think of the cost incurred to order them in the first place, store them, and dispose of them.

How can you apply a “competing against time” mindset to your organization?  Begin by looking at the patient flow through your ED and hospital.  I’ll bet there’s at least one area in which your patients (and most likely the staff too!) wish happened faster.  Then go back to the basics.  First, map the process—what are the steps and sequences of steps required to accomplish the work?  Next, measure and document the value-added time for each of the steps. Then, capture the “wait” times between steps.  You’ll likely find that the total wait time is more than twice the total value-added time.  In many instances, non-value adding time approaches 70-80% of the total time.  Have a laser-beam focus on reducing that non-value added time.

How about the time a decision (or a team) waits for approval, order entry, validation, etc.?  That is time people are waiting and wondering what’s happening.  And, in almost every case, time to make a mistake, lose the paperwork, for the patient to change his/her mind, or even perhaps go to a competitor.

All the dimensions on the value diamond are important and must be addressed.  But if you have to choose only one of several balls to juggle, make it time.  Look at everyday processes within your hospital, measure the total elapsed time of each from beginning to end, and then set a goal to reduce the time by half.  In many cases you’ll find you can save even more time than that.  You’ll also be amazed how many other things will improve by having successfully competed against time.


Aaron Fausz, Director for Lean Healthcare and Process Improvement at HPPToday’s blog was written by Aaron Fausz, Ph.D., senior consulting director at HPP.

Aaron has 25 years of experience helping organizations align and improve their personnel and technical systems to accomplish strategic business objectives.  He has consulted with leading healthcare organizations across the country and has proven success guiding organizations through strategically driven changes and enhancing business performance.  Aaron also has significant experience in needs assessment, best practice analysis, performance measurement, process improvement, and behavioral change management.

Aaron holds a Ph.D. in Industrial/Organizational Psychology from the University of Tennessee with a minor in Industrial Engineering.

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