Metrics is one of the cornerstones of Lean implementation. A common saying by Lean practitioners is, “What gets measured gets done.” However, we also need to be careful when choosing what to measure. If you choose an incorrect metric you might end up making unintentional or unwanted changes to the value streams they are supposed to reflect.
One quick litmus test for choosing proper metrics is a tool called SMART. SMART stands for Specific, Measurable, Accurate, Reliable and Timely. When looking at a proposed metric for a value stream, ask the following line of questions about it.
Is it Specific? You should choose metrics that directly relate to the processes encountered in the value stream. For example, if you are seeking to improve the number of verifiable pharmacy orders entered into your system on the first try, you would select the ratio of first time verified orders divided by the total number of verified orders for a given period of time. In contrast, just using the total number of verified orders would not be specific enough.
Next, ask is it Measurable? Metrics must be derived from actual numbers. They should not be an estimate. Seek metrics that are easily obtained from either the Health Information Management System or from a simple tool such as a tally sheet used on the floor. A good example would be if you are trying to cut down on the number of interruptions a unit secretary has while performing their job. A simple tick sheet next to the secretary is more accurate than an estimated quantity at the end of the day.
Is the metric Accurate? Accuracy is important to improving the processes encountered in a value stream. For example, I have often seen patient wait time as being one of the most inaccurate measurements within healthcare facilities. Patient wait time begins the second that a person walks into the area for service. Usually the only wait time that is recognized by a metric is the time staff notices and records them as being encountered. In actuality, there are usually several minutes that pass while a person is waiting before they are recognized. I have seen the number of minutes being from 5 to 50. For it to be accurate, it should measure the total time from the patient’s or customer’s perspective not the staff’s. Another example would be the time the physician order is made until it is complete. Often, several minutes or even hours pass before the physician order is entered into a system. An inaccurate metric would measure the time of order entry until complete. A more accurate metric would include the time of order until entered.
Is the metric Reliable? A good example of this metric is in turn around time (TAT) for an operating room. I have seen one person report the turn around for an OR to be 15 minutes between cases while another person reports the turn around for the same instance to be 35 minutes. For a metric to be reliable, it must be able to be clearly defined as to what it is, how it is to be measured and then understood by all. In this particular example, one person was reporting the time from patient being wheeled out to the time the next patient was wheeled in. The second person was reporting from the time the procedure ended until the next procedure began. A reliable metric is one that can be clearly defined, communicated and raw data gathered and reported in the same manner by all the staff involved.
Is the metric Timely? In Lean, metrics are used for continuous improvement. Unlike wine, metrics do not get better with age. They only become less useful. Most importantly, front line leading indicator quality metrics are time sensitive. Reporting those 90 days after the fact does not facilitate improvement. One example is Point Of Use (POU) supplies. In a quarterly report, I found one department had reported that they had been out of stock on EKG pads 5 times. The materials director had increased the PAR level for the department so they would not run out again. At the next quarterly report (now 6 months after the problem first occurred), the report showed that the department had been out of EKG pads 3 times. The director asked if they needed to increase the PAR level some more. Instead of increasing the PAR level, I requested that they place an Out of Stock communication sheet at the POU scanner so the materials tech could investigate the root cause during their daily rounds. There was only one more instance of the EKG pads being out of stock. Metrics should be reported back as soon as possible to the staff that are directly in control and have an understanding of the process. If a leading metric is not capable of immediate communication, choose another one or find another way.
Try using the SMART tool the next time you select your metrics for continuous improvement. It will save you frustration, time and lead to continuous improvement over a much shorter period.
David Pickens is the author of this week’s article. David is an HPP Lean Healthcare facilitator, consultant, trainer, and certified lean six-sigma Master Black Belt. Dave has a B.A in Statistics and M.B.A., and is currently working on his DBA. Dave has worked with HPP healthcare clients throughout the USA by assisting them with their Lean transformations. Dave has years of industry experience from his time in the automotive and consumer goods industry, including time with Panasonic, Allied Signal and BOSCH. He has trained with Matsushita in Hong Kong, Japan and Singapore in Japanese Manufacturing Management.