Article 70. Enterprise Lean, Balanced Work Load, Continuous Improvement

Enterprise Lean focuses on the big picture the balanced flow of work which is periodically interrupted by improvements to the system through Continuous improvement.  Continuous improvement can come from many different sources: improvements in the way processes are done,  the purchase of new equipment and imaging machines even the addition of another doctor where one is badly needed.  Enterprise Lean sees these efficiency improvements bringing improvement in efficiency but the big picture shows that the savings may be considerably less than purported.  The reason is that the improvements are disruptive to the balanced work flow causing many processes to wait on other processes.         

Lean implementers especially highly trained black belts tend to focus on individual areas and processes known to be inefficient and are usually successful in making individual systems efficient but only cause in-balance in the work flow causing lost time due to wait time.

For Example: Lean specialists have made a Lean Study of a Cardiac Surgery Process and have made it more efficient saving the hospital thousands of dollars.  Since the study only looked at the surgery process it did not achieve its purported savings goals because it failed to include surrounding interfacing processes causing in-balance in the work flow.  If the lab supporting the surgery process was not also made efficient the Surgeon and his entire operating staff may end up waiting for lab results.

Enterprise Lean establishes employee Lean Teams in all of the facility's processes ready to conduct a throughput study that will re-balance the flow of work when disruptions occur from continuous improvements or other causes.

The Maximum Patient Throughput Method
This is a two stage process with individual employee Functional Lean Teams (including Nurses) meeting to determine the most Effective way to do their functions. Each Lean Team will layout the scheduling process on wrapping paper with taped on colored strips of paper scaled to represent the time to do each process of the Function. The objective is to find the most effective and efficient way of doing the function.

This is followed by the above Team Leaders of the several functions meeting as a higher level team with the Doctor as Team Leader to apply the data from the individual functional teams. The color of the paper represents the key person involved: a nurse or team of nurses, doctor, or patient.  Another color represents support operations which are necessary but are separate from and not dependent on the main Scheduling process.  The support operations are used to fill in where wait times are naturally occurring By staff members.  Arranging the processes in the order that they may be completed some in parallel with the Doctor’s time as key to obtaining the Maximum patient throughput Schedule. The method also determines the equipment utilization of the process.  Besides determining the maximum throughput of patients the process also establishes a cost for labor and equipment depreciation and a budget for each Function.  The data can also be used to determine the exact increase in staffing and equipment needed to meet a desired Patient appointment and processing schedule.  For an Example of this method see Article 55. Obtaining Maximum Patient Throughput with The Highest Effectiveness and Article 69. Using Enterprise Best Practices at the VA.

Government Bureaucracies both State and Federal as well as many companies in the private sector have failed to recognize the problem of a balanced work load by continuing to focus Lean studies on individual problem systems.   Enterprise Lean focuses on the big picture and provides a solution for balancing the work flow with continuous improvement.  See Article 8. Twenty Five Case Studies Using Lean in Government.

Benefits to the VA from the General Reform Model
Because of the obvious need for increased VA staffing any savings is relative to achieving the goals of the VA in meeting the needs of Veterans.  The General Reform Model generates the following benefits:  
1. Enterprise Lean provides a way to change the toxic culture of the VA to a focused positive culture.
2. Enterprise lean develops the data needed for right-sizing, and determines where staffing is needed.
3. The reforms provide a balanced work flow with continuous improvement for all systems.
4.  A bottoms up budget is made for all functions in a facility (not including Management and Overhead).
5.  The Bureaucratic organization is replaced with a Team Management organization. This is done to prevent the return of the current toxic Bureaucratic management.

All of the above implementations of the General Reform Model develops bottom line savings and reduces the cost to the VA significantly over that of not implementing the General Reform Model.  Actual savings are relative in that funding is reduced for implementing the fixes for the VA but it is not known by how much.  An estimate places the savings at more than one billion dollars.