Lean Healthcare One Piece Flow ExampleFaster turnaround times. Shorter lengths of stay.  Improved throughput.  These are all terms that everyone in healthcare is aware of because they define a new normal.  But how are we to meet the new goals?  To improve these measurements of performance, first, we have to understand the current state.  Do this through observation.  As you observe various work processes, ask yourself what is the batch-size of work that is moving through? More than likely you are going to see healthcare professionals sorting their work into large batches and then tackling it all at once.  After all, I should draw all my blood samples and then send them to the lab.  Or I should get all my medications form the ADC before administering to my patients. Or I should make rounds on all my patients before I document.  That is the best way isn’t it?

Maybe not.  Let’s look at moving crowds of people as an example.  Think about how you move through an airport, a convention center, or a sports stadium.  In every case, the engineers and architects have installed escalators and moving sidewalks as the preferred method of moving people through the venue. Why?  It’s a Lean concept called single piece flow.  Overall cycle time increases as batches build and increase in size.  If everyone has to use the elevator, the batch will increase while waiting for the next car.  And once the car arrives, there is no guarantee that if you enter first, you will be let out first.  In fact, often times you are first in and last out and your cycle time is the longest.  However if you had gotten on an escalator, you would not have had to wait (no batching) and you would have been transported directly to your intended destination (shorter cycle time).

Translating this back to healthcare, we have to understand that single piece flow is ideal, but may not be practical.  However, in order to meet our goals, we need to strive to process our work in smaller batches.  So, phlebotomists, send samples to the lab after every two to three patients.  Nurses, take medications from the ADC for one patient and then administer.  Physicians – see a patient then chart a patient.  In the end, the overall cycle time will be less, goals will be met, and patients will be happier.


Today’s blog was written by Dan Littlefield, director at HPP.

Dan has 30 years of healthcare experience in many clinical and leadership roles. He leads Lean and process improvement consulting engagements for HPP.  His experience includes deploying Lean across numerous healthcare disciplines including imaging, laboratory, nursing, pharmacy, and physician offices.  Dan began his healthcare career as a nuclear pharmacist and has also served as director of operations, responsible for 13 facilities.  He has been a featured speaker at a variety of healthcare industry events.

Dan holds a Master’s Degree in Business Administration from the University of Pittsburgh, a Bachelor’s Degree in Pharmacy from Purdue University and a Specialty Certification in Nuclear Pharmacy from Butler University.

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