Article 69. Using Enterprise Best Practices at the VA

My General Reform Model begins step one with the implementation of a modified Enterprise Lean implementation which may be better explained as Enterprise Best Practices or the determination of Best Practices for ALL VA Health Care processes at a VA Medical Facility.  I refer to Best Practices as getting the “Highest  Effectiveness possible”.  This is followed by the determination of the “most efficient method” of doing the processes. Established Best Practices will be reviewed to verify the actual implementation in current practices in each Function. 

Step 1. of the General Reform Model, Implementation of Modified Enterprise Lean
A.  Establish a breakdown of the entire VA Medical Facility into sets of processes we will call Functions.
B.  Organize Employee Lean Teams based on who does a Function or related Functions.
C.  Trained Facilitator Analysts will assist each Lean Team in determining the Best Practice and the most efficient way of doing each Function.
D.  The Maximum Patient Throughput Method
This is a two stage process with individual Lean Teams (Nurces) 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 determine the most effective and efficient way of doing the function.

This is followed by the Team Leaders of the several functions meeting as a higher level team with the Doctor's Team to apply the data from the individual functional teams. The color of the paper represents the key person involved being: 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.  By 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 for 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.

Step 2. Documentation and Collection of Lean Team Data by Analysts
A.  Documentation of the Lean Team’s Data: the improved method, the time to do each Function, the employee’s name labor rate and time involved in the function, and the equipment and its depreciation cost. The Documentation and collection is done by each Facilitator Analyst.  The Lean Team Data is Collected on a spread sheet for each Function.  As the Data is collected the sum of the data is accumulated using a Google App on a tablet and is available for all facilitators to see.

B. The employee work force is Right-Sized to fit the workload (making sure each employee has a full time job). this step uses the Lean Team Data to Right-size the organization. If an employee does not have a full time job an effort is made to increase the employees tasks.  It is important that redundant employees must be removed from the work environment and retrained for new jobs.  Every effort to retrain employees from overstaffed areas and move them to where they are needed will be done.

C. Improving the Efficiency of variable workloads through the use of Workload Planning and Scheduling methods.  This is done by developing a weekly Work Load Plan. As actual data is developed the plan is revised for continuous improvement. 

Step 3.
The Bureaucratic organization is replaced with a Team Managed organization. The conversion is a simple process because we already have Lean Teams in place at the lower level and in Management.  Many of the lower level teams will be self managed with their leaders being elected by secrete ballot.  How ever many Professional Teams such as doctors with attending nurses are already in place. Top management of the VA Medical Facility may be selected by the Secretary of Veterans Affairs.

This step addresses the problem of the Bureaucratic management head on. It spreads decision making powers among top management as well as at the bottom of the organization.  The Lean Teams which become Functional Teams are empowered to find the most effective way of doing their jobs with the most efficiency.  Note that when the bureaucratic organization is converted to a Team Management organization most supervisors at the bottom of the organization are placed back into the Functional Teams which elects their own leaders.  Obviously Bullying and Incompetent supervisors will not be elected as Team Leaders. The reasons why they are not elected will be investigated by the implementers of the reforms on a case by case basis.  However every effort will be made to find appropriate jobs for redundant supervisors.  Note that most if not all of the current toxic bureaucratic problems simply disappear with Team Management.