It sounds like the answer is a resounding yes that the people in the system almost always feel the problem is insufficient resources. Yes, this seems to be a tough assumption to change.

What’s particularly interesting is that working in a process that is stable and balanced may not necessarily result in a change in how much work people do but rather the difference may be in what it feels like to work in that process.

That’s certainly the experience we had in reducing appointment backlog. Providers are seeing the same number of patients but their workload is more predictable. (Other people in the process however are doing much less to manage the process.)

Thanks again - it’s great how engaging in these sorts of dialogues helps deepen understanding of using Lean to improve in our system.

Some reasons why backlogs are formed:

1. The amount of work coming in is more than the amount of work being completed.
2. The team is not a high performance team.
3. Other limitations (system issues, earthquakes, etc).

Theoretically, if you have a work that takes 1 hour to complete, that work can be done by three people working 20 mins each. (Please humor me in this example). The reality is that not all three people will be able to do their task in the assigned 20 mins. Designing a good system or staffing for demand gets you closer to the target but you may not necessarily reach your target. It is the people who can help you reach the target.

We can’t control the amount of work coming in. We can’t avoid system issues or other acts of nature. What we can control/change are the people. I do agree with you Marlan that backlogs may exist more by default rather than by design. It is hard to change people’s assumptions or attitudes but that is why many of us at GH are learning/practicing Lean.