by Lee Fried, on 16 May 2007 07:10 am
The Journey
Today’s Work Today Continued
Yesterday I received the following question from Marlan, a blog reader, about backlogs that I thought I would answer in a post:
What I’m wondering is how often backlogs are due to the assumptions of people in the system that the cause is due to insufficient resources to meet the demand. I have certainly found that assumption to be almost universal with managers and providers I have worked with to eliminate appointment backlog in behavioral health outpatient clinics.
To the extent this is true in a particular situation, then backlogs may exist more by default rather than by design. Thoughts? Was/is this a factor in your situation?
When we first start working with a team it is almost always that case that we are told that the team is understaffed. As we begin to collect data and uncover variation most of the time we find that this is not the case. I can’t think of a single example where once the current state was understood the team still asked for more staffing. Often times there will be certain team members that have way to much work while other are sitting idle. You may also find that there are day of the week or hours of the day where demand is greater then capacity and others that are idle.
If you go to Gemba and collect the data I would be willing to bet that by applying Lean principles you can do more with less and eliminate backlogs. A backlog as well as thefeeling of being overwhelmed are symptoms of processes that are not stable, balanced and under control. Teams often feel like they have to much work to complete, because they are not able to view the progress that they are making.
A good place to start is to look at your backlogs over time as well as your variation in demand. If backlogs stay fairly consistent you know that your are doing about as much each day/week as is coming in, but maintaining the security of inventory (in Marlan’scase patients). When there is large variation in demand of incoming work it can often feel like a team is not staff correctly even though they have the capacity. I am working with a team right now that gets twice as much work on Monday’s as any other day in the week. As a countermeasure the team has implemented a hejunika, which means they still have a small backlog during the beginning of the week, but by leveling production the team feels far more in control and productivity has gone way up.
Do other readers have a perspective?
on 17 May 2007 at 7:05 am 1.Anand said …
One principle of Lean is that Management does not PUSH work. The workers PULL work from a backlog. Continuous flow (no backlog) can be achieved only if the rate of work coming in is the same as the rate of work being completed.
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.
on 20 May 2007 at 10:28 pm 2.Marlan Crosier said …
Well, I hadn’t expected quite such a thorough reply — thanks Lee! And thank you too Anand for your thoughts.
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.
on 28 May 2007 at 12:26 am 3.Lisa said …
I saw some really useful articles about cutting patient waiting times and Leaning healthcare systems at http://www.leanhealthcareservices.com/blog.html