Article 78. Its All About Leveraging Labor and Knowledge
Leveraging is a big word on Wall Street it allows a company to grow by borrowing capital. It is normally only thought of as relating to investment capital but in the real world you can also leverage labor and knowledge. This is the main principle I have used in my proposed Consulting Agreement with the VA. See Article 77. Aug 13 Proposed Consulting Agreement with VA.
To solve the problem of determining with relative accuracy how many Nurses and Doctors are needed to effectively and efficiently meet all VA patient appointment schedules I have used the following process. This also is the most efficient and least expensive approach for solving difficult and extensive problems in any large organization.
An unnamed VA staff member from the DC office expressed disbelief when he called me last month. How could a single Consultant from outside the VA make such a major impact on VA operations. The answer is in knowing how to leverage labor and knowledge to produce an effective and efficient staffing schedule for all VA Medical Facilities and to do it in Three Months. Starting with just myself a single Principle Consultant leveraging the labor of ten VA OIG Analysts to be Facilitators to employee Functional Lean Teams involving hundreds of employees. Enterprise Lean uses employee Functional Lean Teams to determine the most effective and efficient way of doing their functions (jobs). The Functional Lean Teams also compare standards such as Best Practices with the way they are currently doing their functions and make adjustments. When standardized the data is documented in a spreadsheet by the OIG Analyst acting as the Facilitator for the Lean Team.
The data from the Functional Lean Team is then passed to a higher level Lean Team lead by a Doctor and members of his nursing staff. The Doctors Lean Team lays out a detailed sequential schedule involving the activities of Doctors supporting Nursing staff and patients on a Wall Chart. The wall chart uses wrapping paper taped to a conference room wall with representations of all activities sequentially represented by taping activities on colored paper to the wrapping paper backing which can be rolled and used in other locations. The knowledge is with the employee Lean Teams who determine the best way organize the sequential events in doing a function. The wall chart is a daily plan of activities showing all processes done by staff without any staff members having to wait on other staff members.
Part 1. Of the Proposed Consulting Agreement
This Consulting Agreement develops a Throughput Schedule plan for each area where medical services are needed to meet increased VA patient loads. An OIG Analyst will be assigned to each medical area to Facilitate Hospital Employee Lean Teams in applying Best Practices to each of their Functions. The Lean Data will be captured in a spreadsheet and used in the higher level Doctor’s Lean Team to develop the Throughput document which will be captured in a staffing spreadsheet. The Throughput spreadsheet will contain a large number of repeated reiterations of the original Best Practices balanced schedule design. The Throughput Spreadsheet will contain enough reiterations to meet any VA facility’s patient appointment schedule requirements. Spreadsheets have unique capability such that a specific patient load can be identified on the spreadsheet and matched with the Patient Requirements for a VA Medical Facility before the extensive document is printed. The Names of existing staff members are added directly to the Throughput Schedule showing exactly how many new hires and their expertise are needed.
Note that the Spreadsheet itself becomes a knowledge leveraging tool. See Article 76. Detailed Description of the Throughput Process. Savings from the throughput Schedule is estimated at $3 billion largely from not over hiring staff.
Toyota Developed the Enterprise Lean process for the purpose of leveraging the knowledge of thousands of employees in making their jobs more effective and efficient. This is one reason why Toyota has grabbed market share from sloppy bureaucratic General Motors which only uses a few hundred Industrial Engineers to make manufacturing decisions.
Thursday, August 28, 2014
Tuesday, August 19, 2014
Article 77. Aug 13 Proposed Consulting Agreement with VA
This proposal was rejected by VA Bureaucrats within hours on August 14 before Secretary McDonald could review it. It would have provided the optimum staffing in all VA hospitals within three months and the Reforms would have saved Taxpayers more than $50 Billion.
To: Robert McDonald Secretary Department of Veterans Affairs
From: Lawrence Rosier Principal Consultant Government Reform
Subject: Consulting Agreement For Reforms at the Temple Texas VA Medical Facility
I recommend the that the implementation be made at the Temple VA Medical Facility because of its central location and larger facilities which will insure that all medical Functions are represented.
I have modified the Enterprise Lean approach to reduce the implementation time in my General Reform Model. I recommend that it be implemented in two parts. The first part addresses the immediate need to develop the data for determining staffing and facilities expansion for all VA facilities. This done by providing a Throughput balanced work load for each medical area with expanded steps which can match the patient requirements for any VA facility. This will be done first in the areas where increased patient services are required.
The second part completes the implementation of the modified Enterprise Lean in all remaining areas of the Temple VA Facility. The reasons for doing this is to determine where over staffing is occurring so employees can be retrained to fill the needs in under staffed areas and to develop a functional Budget for the Temple facility. This will provide the data needed for management decisions.
I also recommend the replacement of the Bureaucratic organization structure with a Team Management organization. I have found that this is a tremendous morale booster that creates excitement among employees. If this is not done all the problems of the toxic Bureaucratic organization could return.
The implementation will require Ten Office of Inspector General (OIG) Analysts trained to implement the General Reform Model at the Temple VA Facility and will be available to make the reforms at other VA Medical Facilities. The Throughput data of the first Part will be made available immediately for all VA hospitals. This will be follow by the remaining Lean data which will also be made available for all Va Hospitals.
The Consulting Agreement is expected to achieve successful returns within three months allowing most of the Team to move on to a different VA Facility, final completion of retraining of staff and the hiring of new staff members is expected to be completed within six months. The intent is to implement reforms as quickly and efficiently as possible.
Please Review the following Example Consulting Agreement. The document is intended to be used to promote understanding and to start discussion on consulting activities and not as a final document.
Kindest Regards
Lawrence Rosier Principal Consultant
Example: Consulting Agreement Update Released August 13, 2014 (No Boiler Plate included)
Consulting for the Implementation of the General Reform Model. This Consulting Agreement may be modified before signatures or afterward by written agreement between signatories.
CONSULTING AGREEMENT
US DEPARTMENT of VETERANS AFFAIRS and
LAWRENCE ROSIER & ASSOCIATES
For the Development of Data for VA Staffing and
Reporting And Reform of VA Temple Texas Facility
This Agreement is made effective as of August 13, 2014, (or an agreed upon finalized date) by and between The US Department of Veterans Affairs and Lawrence Rosier & Associates, of 12143 Cedar Grove Rd., Rolla, Missouri 65401 (573) 364 8789 cell (573) 578 4716.
In this Agreement, the party who is contracting to receive services is the Veterans Administration referred to as the “VA” and the party who will be providing the services Lawrence Rosier shall be referred to as the “Principal Consultant”.
The Veterans Administration “VA” Desires to have Lawrence Rosier “Principal Consultant” provide these services.
Therefore the Parties agree as follows:
1. DESCRIPTION OF SERVICES. Beginning on August 25, 2014 (or an agreed upon date) Principal Consultant will provide the following services (collectively, the “Services”). Consulting for the Implementation of the “General Reform Model” developed by Lawrence Rosier and the “Consolidation Model” if required for the elimination of Duplicated Services in a selected VA Agency. The Principal Consultant hereby agrees to provide and perform for the VA these Services Set forth in Exhibit’s A.
2. PERFORMANCE OF SERVICES. The manner in which the Services are to be performed and the specific weeks to be worked by the Principal Consultant Shall be Determined by the Principal Consultant. The VA will rely on the Principal Consultant to work as many weeks as may be reasonably necessary to fulfill the Principal Consultant’s obligations under this agreement.
Tasks to be Followed Upon the Signing of this Consulting Agreement
Implementation of Reforms at the Temple VA Medical Facility
The Secretary of Veterans Affairs will have oversight of this Agreement. The Principal Consultant Lawrence Rosier will manage and have complete control of the implementation of the General Reform Model at the Temple Texas VA Medical Facility separate from investigations conducted by the OIG. He will also train and supervise OIG Analysts provided by the Inspector General‘s office according to this Agreement. The Principal Consultant will be able at his discretion to identify and remove incompetent management and reduce redundant management and staff where required at the Temple Texas VA Medical Facility. He will recommend retraining of redundant employees to fill needed positions where possible. The Secretary of the Veterans Affairs and his staff shall have the authority and responsibility to hire new personnel to fill vacancies identified by the Throughput Staffing Schedules developed by the Principal Consultant and the OIG Analyst Team at the Temple VA Medical Facility
Selection of VA Analysts
The Principal Consultant will participate with the Inspector General in the selection of VA Analysts to receive training in Lean. Policies and procedures for the Analysts will be developed jointly by the VA and the Principal Consultant. Specialized training in a modified version of Enterprise Lean for all VA Analysts will be done by the Principal Consultant at no expense to the Government..
Training in Specific Technologies Provided by the Principal Consultant:
VA Analysts selected for this Agreement will receive an overview of the reform models with training in the following supporting skills and on the job training during the implementation of the reform models
1. Team Management- by the Principal consultant
2. Modified Enterprise Lean- by the Principal Consultant
3. Variable Function Analysis- by the Principal consultant
4. Time studies (a necessary basic skill)- by the Principal consultant
5. Statistical Sampling- by the Principal consultant
6. Right-Sizing (makes sure all employees have a full time job)- by the Principal consultant
7. Bottoms-up budgeting- by the Principal consultant
8. Staffing- by the Principal consultant
9. Workload Balancing (management of the work flow)- by the Principal consultant
10. Short Interval Scheduling- by the Principal consultant
11. Operation Sequence Charts- by the Principal consultant
12. Productivity Reporting Techniques- by the Principal consultant
13. Effectiveness Evaluation Team training- by the Principal consultant
Activities of the Principal Consultant
The Principal Consultant will play a key role in being sure that the employee Lean teams are properly trained and in the selection and approach of the high level Lean Teams. The Principal Consultant will insure that the activities of VA Analysts can determine the correct staffing level through Work Measurement and any expenses needed during the process. This data combined with the number of occurrences of the function over time, obtained from a daily log kept by each Lean Team, provides the basis for an accurate functional budget. The Lean data from the documentation will be kept on a spreadsheet by the VA Analysts and summarized in a database where all of the Agency’s functional data is stored. The activities of VA Analysts are important and will be followed closely by the Principal Consultant.
Modified Enterprise Lean Approach
The Principal Consultant has developed a Modified Enterprise Lean approach for implementation at VA Facilities. He has determined that simply replicating the Toyota version of Enterprise Lean takes longer than necessary to determine the most Effective and Efficient processes. His intention with this modified approach is to reduce the time to implement the General Reform Model to three months. This is done to obtain the same result and to move on to another VA facilities expeditiously (not a part of this agreement).
Some members of the Analyst Team will remain after the first three months to Supervise retaining of redundant employees and the placement of required new employees to meet schedules. And to implement new management techniques made possible by knowing the actual time a process should take. This approach will only be possible with ten Analysts. Which are intended to be split up and sent out to other facilities when adequate training has been determined. The intension is to implement employee Lean Teams and convert the Bureaucratic organization to a Team Managed organization at other VA facilities (Not a part of this Agreement).
The Modified Enterprise Lean approach implemented at the Temple VA Facility will be a new version that is in two parts. The first part addresses the immediate need to develop the data for determining staffing and facilities expansion for all VA facilities. This done by providing a Throughput balanced work load schedule for each medical area with expanded steps which can match the patient requirements for any VA facility. This will be done in all areas where increased patient services are required.
The second part completes the implementation of the modified Enterprise Lean in all remaining areas of the Temple VA Medical Facility. The reasons for doing this is to determine where over staffing is occurring so employees can be retrained to fill the needs in under staffed areas and to develop a functional Budget for the Temple facility. This will provide the data needed for management decisions. It consists of the more traditional approach for Enterprise Lean emphasizing Continuous Improvement of processes.
Goals:
The main Goal is to use the General Reform Model to provide an immediate method for determining staffing requirements for all VA facilities based on Lean data developed at the Temple VA Facility. The data from Lean Teams will be used for determining Throughput balanced work loads to meet the needs of expanded patient loads. Also to demonstrate the General Reform Model at the Temple VA Hospital that implements Sweeping reforms. That fixes Identified problems and gets the highest effectiveness and efficiency possible. The method brings cultural change by empowering VA employees through Lean Teams involving them in work process decisions and continuous improvement to their jobs.
A second Goal; is to balance the work load primarily through retraining current employees and by hiring needed staffing to meet desired service levels.
A third Goal; is the collection of Lean Team management data into a universal database of management standards (Best Practices) with the highest effectiveness and efficiency that can be applied in all VA hospitals.
A fourth Goal; of the implementation is to strengthen the VA Budgeting process by providing transparency of the Functional activities of the new organization to the VA budget leaders enabling them to control budgets through the knowledge of the correct Functional staffing and its budget.
The General Reform Model:
Phase 1. Developing Throughput Requirements For All VA Facilities
The General Reform Model begins in two parts The first part addresses the immediate need to develop the data for determining staffing and facilities expansion for all VA facilities. This done by providing a Throughput balanced work load for each medical area with expanded steps which can match the patient requirements for any VA facility. This will be done in the areas where increased patient services are required.
The second part completes the implementation of the modified Enterprise Lean in all remaining areas of the Timple VA Facility. The reasons for doing this is to determine where over staffing is occurring so employees can be retrained to fill the needs in under staffed areas and to develop a functional Budget for the Temple facility. This will provide the data needed for management decisions.
The second part involves nearly all remaining employees tasked to make all functional systems efficient and effective. The lean data will be collected and documented by VA Analysts in a spreadsheet program. When all of the data for the entire Agency has been collected it will be used to Right-Size the organization making sure all personnel have a full time job. The employee Lean Team data will also be used for staffing and to develop bottoms-up budgets which identify the actual costs of a systems functions. This is also the data needed to manage an organization’s work by balancing its work load. The lean data will also be used to determine the staffing required to meet patient appointment requirements.
The Training and Organization of Employee Enterprise Lean Teams
The principal Consultant will use a Modified Enterprise Lean approach training OIG Analysts as Lean Facilitators who will guide each employee Functional Lean Team in their tasks of finding the most effective and efficient way of doing their work. Each Functional Lean Team will elect its leader by secret ballot. A function consists of a set of processes and a Lean Team may have more than one function how ever the functions should be related to each other.
VA Management Lean Teams
There are two major Lean Team groups, high level Management Lean Teams (which will become Steering Teams) and at-the-work-place employee Functional Lean Teams. Management Lean Teams are organized and lead by members of management. They are tasked to study individual high level systems within the Temple facility and those that interact with other Agencies mostly document flows. A key element of the High level Lean Teams is their role in management when converting from the bureaucratic organization to the Team Managed organization.
The First Part of the Lean Team process
Three levels of Throughput:
1. Current Throughput (number of patients processed in specific areas) determined by hospital records.
2. Capable Throughput determined by employee Lean Team studies and a Throughput Schedule using current staffing.
3. Required level of throughput to meet Veteran schedules. This is arrived at by expanding the Capable Throughput Schedule adding staffing until the Required level is reached to satisfy appointment schedules.
How this process will be implemented
The problem: determine waiting Veterans Health Care Needs and the added impact on VA hospital capabilities followed by the increased staffing to meet requirements.
Approach for Quickly meeting Veterans’ Health Care Needs in all VA Facilities
1. Make sure all Vets Who want an appointment are added to the electronic appointment Schedule.
2. Make a detailed assessment of each patient’s medical needs to determine where and by how much the VA Medical Facility will be impacted. For example I recommend a mass screening of the 1700 new patients at the Temple VA with interviews and blood tests. By reviewing 100 patients a day the task of finding what the patients health care needs are can be completed in a month (done by others). The impact on the Medical Facility will be result in an estimate because more precise numbers are beyond the expertise of the VA.
3. For the Identification of exactly where a VA hospital is going to be impacted with the required increased staffing each OIG Analyst will be trained in the following process.
A. The Principal Consultant will Identify all systems processes affected by increased patient loads from the mass screening (done by others) and establish an employee functional Lean Team for each set of processes facilitated by an OIG Analyst. The Lean Teams in these areas will be empowered to come up with the most effective and efficient approach for doing the function (a set of processes).
B. A second level Doctors Lean Team will determine the Capable Throughput with current staffing using the data developed by the Functional Lean Team. The increased efficiency due to a balanced work load may be enough to meet the patient appointment schedule if not then the next step is to be followed.
C. To find the Required level of throughput to meet the Veteran appointment schedule we will expand the Throughput Schedule adding staffing in a balanced format until the Required level of Patient load is reached. This approach will also identify the need for equipment and machines to be purchased by the VA and will also provide a simulation of the actual floor space required.
Each VA Health Care Facility will have a different Vets appointment Schedule. Only the building of the Required level of Throughput to meet the new Facility's Veteran schedules is needed. This is arrived at by expanding the Throughput Schedule to meet the new Facilities staffing requirements level thus satisfying the new appointment schedules while providing the highest effectiveness (Best Practices) and the greatest efficiency.
If the original Throughput Schedule is expanded each time a Doctor is added we can determine the corresponding: number of nurses needed, equipment needed, and number of patients for a balanced work load. Also with each step we can determine the added floor space required. Now we have the data needed for all VA Medical facilities by matching the increased patient load for each medical area to one of the balanced steps based on the number of doctors required yielding the patient load that meets the appointment schedule requirements. This is not an estimate but an actual balanced work flow of doctors, nurses, and equipment for given patient load.
The objective of the balanced work flow is to eliminate excessive waste time due to members of a Team waiting on other members. This a staffing balance with each employee's duties rated at 75% this means that the time to do a process at 100% is increased to 125%. The reason for this is that it avoids delays caused by inexperience employees or other reasons that may impact the entire Team. The absence of a team member can significantly impact the entire Team causing all members to wait. To avoid this problem I recommend there be a standby nurse who will do routine support activities such as ordering supplies that can be available to fill the void. It is possible although not required that an experienced Team can work consistently at 100% increasing the number of patients served.
Overall Plan based on number of Doctors
First two months
Each VA Medical Facility will identify all maximum patient loads in each medical area to meet required patient appointment schedules (not a part of this Consulting Agreement). This data will be needed to staff Throughput Schedules being developed at a development VA Facility.
This Consulting Agreement develops a Throughput Schedule plan for each area where medical services are needed to meet increased VA patient loads. An OIG Analyst will be assigned to each medical area to Facilitate Hospital Employee Lean Teams in applying Best Practices to each of their Functions. The Lean Data will be captured in a spreadsheet and used in the higher level Doctor’s Lean Team to develop the Throughput document which will be captured in a staffing spreadsheet. The Throughput spreadsheet will contain a large number of repeated reiterations of the original Best Practices balanced schedule design. The Throughput Document will contain enough reiterations to meet any VA facility’s patient appointment schedule requirements.
Third month
The spreadsheet for each medical area will be test implemented at the Temple VA Medical Facility. With the success of the test implementation each spreadsheet medical area will be stored on a thumb drive.
Fourth Fifth and sixth months
Each OIG Analyst will depart The development VA Facility for another VA Medical Facility with the medical Thumb drives containing a spreadsheet Throughput Schedule for each medical area. Spreadsheets have a unique capability for selecting what gets printed. In this case the number of patients needed to meet a VA Facilities appointment Schedule can be selected from the spreadsheet before printing the Throughput Schedule for a specific VA Facility.
Approach based on Patient Diagnosis:
The above approach works in all areas where the number of Doctors is the key driving force but where Psychologists and Physical Therapists are involved an entirely different approach is needed based on the diagnosis of each individual patient and the patient's plan of recovery. I suggest the following approach:
1. Establish a high level Doctors Lean Team to develop or adapt Best Practices for patient Recovery Plans.
2. Standardize Recovery Plans.
3. Determine staffing and costs for each recovery Plan.
4. Determine the number of patients assigned to each Recovery Plan for a VA Medical Facility's staffing requirements and an annual budget.
Nation Wide VA Progress Reporting System
The proposed Nation Wide VA Progress Reporting System starts with selected manual reporting from each VA Medical Facility of patient loads and operating expenses in each medical area such as Oncology and Ophthalmology (done by others).
I have shown how the Throughput Staffing Schedule spreadsheet developed for each VA Medical Facility in specific medical areas specifies the required staffing to meet patient appointment schedules. Labor Costs and expenses in each medical area will be developed by each VA Medical Facility. When these expenditures are compared with actual patient throughput in each medical area each month you will have a partial manual reporting system that can be in place within six months. Reports from each VA Medical Facility will be compared for anomalies manually at first and then automated in the second year. (Done by others).
As Lean Data is developed using Enterprise Lean for an entire VA Medical Facility the remaining overhead cost areas (largely office areas, Pharmacies and Laboratory areas) will have standards developed which can be implemented throughout the VA Medical Facility System. The manual reporting system will be supplemented by Progress Reports on staff hiring activities and Facility Construction from each VA Medical Facility (done by others).
Automation should be delayed until all manual systems have been proven. Before new computer systems can be built to estimate Staffing requirements at VA facilities there must be a solid footing of actual data to backup the new systems. The quicker this data is generated and proven the sooner computer systems can be developed. The problem is that the data can be quickly generated within three months but the computer systems will take as much as a year to develop time that the VA does not have (Done by Others).
Phase 2. Data Collection and Implementation of Reforms
The second part of the Lean Team Process
After a period of about one months most Functional Lean Teams, those that were organized and trained by VA Analyst Facilitators, should have their Analyses completed. I have had success with doing the flow of the current method on long white butcher or brown wrapping paper tapped around a conference room on the walls. The steps of the current method is completed first followed by the proposed improved method done directly under it. This is done to highlight the differences between the two methods. I suggest that some Functional Lean Teams with significant savings present their improved method to management. After the presentation the rolled document is given to a VA Analyst to document the savings from the proposal in a spreadsheet.
Details of the Data Collection and Reform Process
The technical reform process begins after the decision to implement Enterprise Lean and after the functional Lean teams have completed their Lean Team Data development. The important data that is necessary for reform is the functional cost data developed by the Functional Lean Teams from their individual functions. The data will be collected in electronic tablets using a spreadsheet program specifically designed for this process. All tablet spread sheets will be continuously updated using a special Google App (application). The Principal Consultant will provide on the job training of VA Analysts in the collection of this data and all subsequent reform steps.
Lean Team Data that is collected and allowed to accumulate
The following steps show how the Lean Team Data is collected and allowed to accumulate in the spreadsheet program and how the summarized data is used. This approach to reform meets all of the VA’s criteria for an Agency: efficient, effective, ethical, equitable and responsive .
1. Best Practices for each function will be documented in the spreadsheet.
2. All labor and expense cost data will be documented and allowed to accumulate as functions are added to the spreadsheet until all of the Agency’s functions have been accounted for.
3. The names of the employees working on the function will be documented with any special expertise they are using in performing the function. Each employee’s labor hours expended in doing the function will be documented and allowed to accumulate. This data will be used during the Right-Sizing process.
4. Where there is interaction between several employees during the performance of the function a work load balancing chart will be a part of the documentation. This work load chart can be used later in a high level Doctors Team to develop a Throughput staffing schedule balancing the function’s work load.
5. When all of an Agencies Functions have been logged into the spread sheet the final labor hours and expense numbers will have been automatically tallied in the spread sheet along with the total hours worked by each employee in the particular function.
6. A key question asked of employees is the estimate for the number of times that the function is done per week and recorded in the spread sheet. This number is authenticated by history and other knowledgeable personnel including the enumeration of purchased goods consumed by the function.
7. The total annual accumulated functional hours is at 100% productivity and must be converted to provide a realistic number at 75% productivity. To make this conversion you will add 25% more time to the total or multiply the total time by 125%. This becomes the labor hours for staffing and budgeting and is what is referred to as a Gross Load among consultants. When all of the Agency’s functional labor hours have been accumulated at 125% and we add in the total annual expenses we have what I call a Bottoms-up Functional Budget.
8. Next we want to compare the Bottoms-up Budget with the current Top-Down Agency Budget. To do this we remove all management and overhead expenditures from the Agency’s Top-Down Budget to obtain an equal expenditure. Then we compare the Bottoms-up Budget with the Top-Down Budget. The Bottoms-up Budget should be 20% or more less than the Top-Down Budget. If this is not the case then we have introduced an error more than likely in the number of times that a Function is being performed annually. This should be resolved by reviewing the Lean data in the Agency’s spreadsheet.
9. We can now do Right-Sizing using the employee accumulated Lean data from the spreadsheet. As a rule of thumb the employee accumulated hours is separated between those who have accumulated more than 20 hours per week average and those who have accumulated less than 20 hours per week. Those who have accumulated less than 20 hours per week are considered to be redundant and slated for layoff. Their accumulated hours are spread among those with more than 20 hours per week increasing their hours to at least 37 hours per week. This involves reviewing each function and reassigning tasks to employees according to their capability and availability.
10. We now need to review the spreadsheet for those jobs noted as occurring on a random basis. These special jobs need to be separated form those jobs that occur on a continuing basis. An individual employee is specially trained to do the job of Work Planning, forecasting scheduling these jobs on a weekly basis.
11. The spreadsheets are stored on thumb drives for each Agency and protected. The labor data for each function is stored in a Database at 100% to be used for calculating productivity where required. The Database also includes the staffing and bottoms-up budgeting data. I recommend that the data be protected by an independent organization such as the VA. This allows availability of the data for all who want to review the actual labor and expense cost of an Agency function including the Agency’s Bottoms-up Budget.
Phase 3. Organization Reform
In the final step of the General Reform Model the Principal Consultant will begin the process of organizational reform by replacing the Bureaucratic organization with a Team Management organization with top management managing the Agency’s activities through Group Teams with each managing several Functional Teams. The Lean Teams at the Functional level will become self managed Functional Teams with each of their elected leaders reporting directly to a Group Managed team. Group Managed Teams will assume their management role from the pre-organized high level Lean Teams. There is some flexibility in how this process actually occurs but it is necessary in order to eliminate the problems caused by the Bureaucratic organization. The important advantage in changing from a Bureaucratic organization to a Team Managed organization is that the savings continues annually for years.
This is also the period of time for the reduction of redundant management and staff. To attain a balanced work load is the primary objective where retraining employees to fill needed vacancies is pursued. Once it is known where staffing can be reduced temporary reassignments should be completed within a month. It is recommended that supervisors and other redundant staff be reassigned to new VA Facilities.
Enterprise Lean Support Requirements provided by the VA.
1. The secretary of Veterans Affairs will have oversight of this Agreement and is the Client of Lawrence Rosier & Associates.
2. The VA will provide preliminary results of the medical need areas for Vets who have not been served at the Temple Texas VA Facility. I recommend that this be followed by determining the results of a mass screening of new patients at the Temple Texas VA Medical Facility with interviews and blood tests. By reviewing 100 patients a day the task of finding what the patients health care needs are can be completed in a short time (done by others).
3. Ten VA Analysts will be provided by the VA Inspector Generals Office and will be trained and lead by the Principal Consultant in the implementation of the General Reform Model of this Agreement.
The number of VA Analysts provided will impact the length of time required to complete this Agreement.
4. The VA Analysts will also act as Facilitators during the implementation of Enterprise Lean to work with Functional Lean Teams where required. Each Functional Lean Team will meet once a week to do their Value Steam Mapping of their function or functions. Each Analyst Facilitator can meet with about 30 Functional Lean Teams each week for about 4 weeks.
5. All VA Medical Facilities shall have the authority and responsibility to hire new personnel to fill vacancies identified by the Throughput Staffing Schedule developed by the Principal Consultant and the OIG Analyst Team.
6. The VA will provide supplies such as markers and wrapping paper for the Lean Teams. The VA will also provide Tablets or Lap-Top Tablets for the collection of data by each Analyst. At the conclusion of this Agreement the Tablets or Lap-Top Tables will remain as property of the VA.
This proposal was rejected by VA Bureaucrats within hours on August 14 before Secretary McDonald could review it. It would have provided the optimum staffing in all VA hospitals within three months and the Reforms would have saved Taxpayers more than $50 Billion.
Lawrence Rosier & Associates
Management Consultants Government Reform
Phone 573 578 4716
Cover Letter August 13, 2014Management Consultants Government Reform
Phone 573 578 4716
To: Robert McDonald Secretary Department of Veterans Affairs
From: Lawrence Rosier Principal Consultant Government Reform
Subject: Consulting Agreement For Reforms at the Temple Texas VA Medical Facility
I recommend the that the implementation be made at the Temple VA Medical Facility because of its central location and larger facilities which will insure that all medical Functions are represented.
I have modified the Enterprise Lean approach to reduce the implementation time in my General Reform Model. I recommend that it be implemented in two parts. The first part addresses the immediate need to develop the data for determining staffing and facilities expansion for all VA facilities. This done by providing a Throughput balanced work load for each medical area with expanded steps which can match the patient requirements for any VA facility. This will be done first in the areas where increased patient services are required.
The second part completes the implementation of the modified Enterprise Lean in all remaining areas of the Temple VA Facility. The reasons for doing this is to determine where over staffing is occurring so employees can be retrained to fill the needs in under staffed areas and to develop a functional Budget for the Temple facility. This will provide the data needed for management decisions.
I also recommend the replacement of the Bureaucratic organization structure with a Team Management organization. I have found that this is a tremendous morale booster that creates excitement among employees. If this is not done all the problems of the toxic Bureaucratic organization could return.
The implementation will require Ten Office of Inspector General (OIG) Analysts trained to implement the General Reform Model at the Temple VA Facility and will be available to make the reforms at other VA Medical Facilities. The Throughput data of the first Part will be made available immediately for all VA hospitals. This will be follow by the remaining Lean data which will also be made available for all Va Hospitals.
The Consulting Agreement is expected to achieve successful returns within three months allowing most of the Team to move on to a different VA Facility, final completion of retraining of staff and the hiring of new staff members is expected to be completed within six months. The intent is to implement reforms as quickly and efficiently as possible.
Please Review the following Example Consulting Agreement. The document is intended to be used to promote understanding and to start discussion on consulting activities and not as a final document.
Kindest Regards
Lawrence Rosier Principal Consultant
Example: Consulting Agreement Update Released August 13, 2014 (No Boiler Plate included)
Consulting for the Implementation of the General Reform Model. This Consulting Agreement may be modified before signatures or afterward by written agreement between signatories.
CONSULTING AGREEMENT
US DEPARTMENT of VETERANS AFFAIRS and
LAWRENCE ROSIER & ASSOCIATES
For the Development of Data for VA Staffing and
Reporting And Reform of VA Temple Texas Facility
This Agreement is made effective as of August 13, 2014, (or an agreed upon finalized date) by and between The US Department of Veterans Affairs and Lawrence Rosier & Associates, of 12143 Cedar Grove Rd., Rolla, Missouri 65401 (573) 364 8789 cell (573) 578 4716.
In this Agreement, the party who is contracting to receive services is the Veterans Administration referred to as the “VA” and the party who will be providing the services Lawrence Rosier shall be referred to as the “Principal Consultant”.
The Veterans Administration “VA” Desires to have Lawrence Rosier “Principal Consultant” provide these services.
Therefore the Parties agree as follows:
1. DESCRIPTION OF SERVICES. Beginning on August 25, 2014 (or an agreed upon date) Principal Consultant will provide the following services (collectively, the “Services”). Consulting for the Implementation of the “General Reform Model” developed by Lawrence Rosier and the “Consolidation Model” if required for the elimination of Duplicated Services in a selected VA Agency. The Principal Consultant hereby agrees to provide and perform for the VA these Services Set forth in Exhibit’s A.
2. PERFORMANCE OF SERVICES. The manner in which the Services are to be performed and the specific weeks to be worked by the Principal Consultant Shall be Determined by the Principal Consultant. The VA will rely on the Principal Consultant to work as many weeks as may be reasonably necessary to fulfill the Principal Consultant’s obligations under this agreement.
Exhibit A. Description of Services Supplied to the VA by Lawrence Rosier & Associates
Prepared by Lawrence Rosier Principal ConsultantTasks to be Followed Upon the Signing of this Consulting Agreement
Implementation of Reforms at the Temple VA Medical Facility
The Secretary of Veterans Affairs will have oversight of this Agreement. The Principal Consultant Lawrence Rosier will manage and have complete control of the implementation of the General Reform Model at the Temple Texas VA Medical Facility separate from investigations conducted by the OIG. He will also train and supervise OIG Analysts provided by the Inspector General‘s office according to this Agreement. The Principal Consultant will be able at his discretion to identify and remove incompetent management and reduce redundant management and staff where required at the Temple Texas VA Medical Facility. He will recommend retraining of redundant employees to fill needed positions where possible. The Secretary of the Veterans Affairs and his staff shall have the authority and responsibility to hire new personnel to fill vacancies identified by the Throughput Staffing Schedules developed by the Principal Consultant and the OIG Analyst Team at the Temple VA Medical Facility
Selection of VA Analysts
The Principal Consultant will participate with the Inspector General in the selection of VA Analysts to receive training in Lean. Policies and procedures for the Analysts will be developed jointly by the VA and the Principal Consultant. Specialized training in a modified version of Enterprise Lean for all VA Analysts will be done by the Principal Consultant at no expense to the Government..
Training in Specific Technologies Provided by the Principal Consultant:
VA Analysts selected for this Agreement will receive an overview of the reform models with training in the following supporting skills and on the job training during the implementation of the reform models
1. Team Management- by the Principal consultant
2. Modified Enterprise Lean- by the Principal Consultant
3. Variable Function Analysis- by the Principal consultant
4. Time studies (a necessary basic skill)- by the Principal consultant
5. Statistical Sampling- by the Principal consultant
6. Right-Sizing (makes sure all employees have a full time job)- by the Principal consultant
7. Bottoms-up budgeting- by the Principal consultant
8. Staffing- by the Principal consultant
9. Workload Balancing (management of the work flow)- by the Principal consultant
10. Short Interval Scheduling- by the Principal consultant
11. Operation Sequence Charts- by the Principal consultant
12. Productivity Reporting Techniques- by the Principal consultant
13. Effectiveness Evaluation Team training- by the Principal consultant
Activities of the Principal Consultant
The Principal Consultant will play a key role in being sure that the employee Lean teams are properly trained and in the selection and approach of the high level Lean Teams. The Principal Consultant will insure that the activities of VA Analysts can determine the correct staffing level through Work Measurement and any expenses needed during the process. This data combined with the number of occurrences of the function over time, obtained from a daily log kept by each Lean Team, provides the basis for an accurate functional budget. The Lean data from the documentation will be kept on a spreadsheet by the VA Analysts and summarized in a database where all of the Agency’s functional data is stored. The activities of VA Analysts are important and will be followed closely by the Principal Consultant.
Modified Enterprise Lean Approach
The Principal Consultant has developed a Modified Enterprise Lean approach for implementation at VA Facilities. He has determined that simply replicating the Toyota version of Enterprise Lean takes longer than necessary to determine the most Effective and Efficient processes. His intention with this modified approach is to reduce the time to implement the General Reform Model to three months. This is done to obtain the same result and to move on to another VA facilities expeditiously (not a part of this agreement).
Some members of the Analyst Team will remain after the first three months to Supervise retaining of redundant employees and the placement of required new employees to meet schedules. And to implement new management techniques made possible by knowing the actual time a process should take. This approach will only be possible with ten Analysts. Which are intended to be split up and sent out to other facilities when adequate training has been determined. The intension is to implement employee Lean Teams and convert the Bureaucratic organization to a Team Managed organization at other VA facilities (Not a part of this Agreement).
The Modified Enterprise Lean approach implemented at the Temple VA Facility will be a new version that is in two parts. The first part addresses the immediate need to develop the data for determining staffing and facilities expansion for all VA facilities. This done by providing a Throughput balanced work load schedule for each medical area with expanded steps which can match the patient requirements for any VA facility. This will be done in all areas where increased patient services are required.
The second part completes the implementation of the modified Enterprise Lean in all remaining areas of the Temple VA Medical Facility. The reasons for doing this is to determine where over staffing is occurring so employees can be retrained to fill the needs in under staffed areas and to develop a functional Budget for the Temple facility. This will provide the data needed for management decisions. It consists of the more traditional approach for Enterprise Lean emphasizing Continuous Improvement of processes.
Goals:
The main Goal is to use the General Reform Model to provide an immediate method for determining staffing requirements for all VA facilities based on Lean data developed at the Temple VA Facility. The data from Lean Teams will be used for determining Throughput balanced work loads to meet the needs of expanded patient loads. Also to demonstrate the General Reform Model at the Temple VA Hospital that implements Sweeping reforms. That fixes Identified problems and gets the highest effectiveness and efficiency possible. The method brings cultural change by empowering VA employees through Lean Teams involving them in work process decisions and continuous improvement to their jobs.
A second Goal; is to balance the work load primarily through retraining current employees and by hiring needed staffing to meet desired service levels.
A third Goal; is the collection of Lean Team management data into a universal database of management standards (Best Practices) with the highest effectiveness and efficiency that can be applied in all VA hospitals.
A fourth Goal; of the implementation is to strengthen the VA Budgeting process by providing transparency of the Functional activities of the new organization to the VA budget leaders enabling them to control budgets through the knowledge of the correct Functional staffing and its budget.
The General Reform Model:
Phase 1. Developing Throughput Requirements For All VA Facilities
The General Reform Model begins in two parts The first part addresses the immediate need to develop the data for determining staffing and facilities expansion for all VA facilities. This done by providing a Throughput balanced work load for each medical area with expanded steps which can match the patient requirements for any VA facility. This will be done in the areas where increased patient services are required.
The second part completes the implementation of the modified Enterprise Lean in all remaining areas of the Timple VA Facility. The reasons for doing this is to determine where over staffing is occurring so employees can be retrained to fill the needs in under staffed areas and to develop a functional Budget for the Temple facility. This will provide the data needed for management decisions.
The second part involves nearly all remaining employees tasked to make all functional systems efficient and effective. The lean data will be collected and documented by VA Analysts in a spreadsheet program. When all of the data for the entire Agency has been collected it will be used to Right-Size the organization making sure all personnel have a full time job. The employee Lean Team data will also be used for staffing and to develop bottoms-up budgets which identify the actual costs of a systems functions. This is also the data needed to manage an organization’s work by balancing its work load. The lean data will also be used to determine the staffing required to meet patient appointment requirements.
The Training and Organization of Employee Enterprise Lean Teams
The principal Consultant will use a Modified Enterprise Lean approach training OIG Analysts as Lean Facilitators who will guide each employee Functional Lean Team in their tasks of finding the most effective and efficient way of doing their work. Each Functional Lean Team will elect its leader by secret ballot. A function consists of a set of processes and a Lean Team may have more than one function how ever the functions should be related to each other.
VA Management Lean Teams
There are two major Lean Team groups, high level Management Lean Teams (which will become Steering Teams) and at-the-work-place employee Functional Lean Teams. Management Lean Teams are organized and lead by members of management. They are tasked to study individual high level systems within the Temple facility and those that interact with other Agencies mostly document flows. A key element of the High level Lean Teams is their role in management when converting from the bureaucratic organization to the Team Managed organization.
The First Part of the Lean Team process
Three levels of Throughput:
1. Current Throughput (number of patients processed in specific areas) determined by hospital records.
2. Capable Throughput determined by employee Lean Team studies and a Throughput Schedule using current staffing.
3. Required level of throughput to meet Veteran schedules. This is arrived at by expanding the Capable Throughput Schedule adding staffing until the Required level is reached to satisfy appointment schedules.
How this process will be implemented
The problem: determine waiting Veterans Health Care Needs and the added impact on VA hospital capabilities followed by the increased staffing to meet requirements.
Approach for Quickly meeting Veterans’ Health Care Needs in all VA Facilities
1. Make sure all Vets Who want an appointment are added to the electronic appointment Schedule.
2. Make a detailed assessment of each patient’s medical needs to determine where and by how much the VA Medical Facility will be impacted. For example I recommend a mass screening of the 1700 new patients at the Temple VA with interviews and blood tests. By reviewing 100 patients a day the task of finding what the patients health care needs are can be completed in a month (done by others). The impact on the Medical Facility will be result in an estimate because more precise numbers are beyond the expertise of the VA.
3. For the Identification of exactly where a VA hospital is going to be impacted with the required increased staffing each OIG Analyst will be trained in the following process.
A. The Principal Consultant will Identify all systems processes affected by increased patient loads from the mass screening (done by others) and establish an employee functional Lean Team for each set of processes facilitated by an OIG Analyst. The Lean Teams in these areas will be empowered to come up with the most effective and efficient approach for doing the function (a set of processes).
B. A second level Doctors Lean Team will determine the Capable Throughput with current staffing using the data developed by the Functional Lean Team. The increased efficiency due to a balanced work load may be enough to meet the patient appointment schedule if not then the next step is to be followed.
C. To find the Required level of throughput to meet the Veteran appointment schedule we will expand the Throughput Schedule adding staffing in a balanced format until the Required level of Patient load is reached. This approach will also identify the need for equipment and machines to be purchased by the VA and will also provide a simulation of the actual floor space required.
Each VA Health Care Facility will have a different Vets appointment Schedule. Only the building of the Required level of Throughput to meet the new Facility's Veteran schedules is needed. This is arrived at by expanding the Throughput Schedule to meet the new Facilities staffing requirements level thus satisfying the new appointment schedules while providing the highest effectiveness (Best Practices) and the greatest efficiency.
If the original Throughput Schedule is expanded each time a Doctor is added we can determine the corresponding: number of nurses needed, equipment needed, and number of patients for a balanced work load. Also with each step we can determine the added floor space required. Now we have the data needed for all VA Medical facilities by matching the increased patient load for each medical area to one of the balanced steps based on the number of doctors required yielding the patient load that meets the appointment schedule requirements. This is not an estimate but an actual balanced work flow of doctors, nurses, and equipment for given patient load.
The objective of the balanced work flow is to eliminate excessive waste time due to members of a Team waiting on other members. This a staffing balance with each employee's duties rated at 75% this means that the time to do a process at 100% is increased to 125%. The reason for this is that it avoids delays caused by inexperience employees or other reasons that may impact the entire Team. The absence of a team member can significantly impact the entire Team causing all members to wait. To avoid this problem I recommend there be a standby nurse who will do routine support activities such as ordering supplies that can be available to fill the void. It is possible although not required that an experienced Team can work consistently at 100% increasing the number of patients served.
Overall Plan based on number of Doctors
First two months
Each VA Medical Facility will identify all maximum patient loads in each medical area to meet required patient appointment schedules (not a part of this Consulting Agreement). This data will be needed to staff Throughput Schedules being developed at a development VA Facility.
This Consulting Agreement develops a Throughput Schedule plan for each area where medical services are needed to meet increased VA patient loads. An OIG Analyst will be assigned to each medical area to Facilitate Hospital Employee Lean Teams in applying Best Practices to each of their Functions. The Lean Data will be captured in a spreadsheet and used in the higher level Doctor’s Lean Team to develop the Throughput document which will be captured in a staffing spreadsheet. The Throughput spreadsheet will contain a large number of repeated reiterations of the original Best Practices balanced schedule design. The Throughput Document will contain enough reiterations to meet any VA facility’s patient appointment schedule requirements.
Third month
The spreadsheet for each medical area will be test implemented at the Temple VA Medical Facility. With the success of the test implementation each spreadsheet medical area will be stored on a thumb drive.
Fourth Fifth and sixth months
Each OIG Analyst will depart The development VA Facility for another VA Medical Facility with the medical Thumb drives containing a spreadsheet Throughput Schedule for each medical area. Spreadsheets have a unique capability for selecting what gets printed. In this case the number of patients needed to meet a VA Facilities appointment Schedule can be selected from the spreadsheet before printing the Throughput Schedule for a specific VA Facility.
Approach based on Patient Diagnosis:
The above approach works in all areas where the number of Doctors is the key driving force but where Psychologists and Physical Therapists are involved an entirely different approach is needed based on the diagnosis of each individual patient and the patient's plan of recovery. I suggest the following approach:
1. Establish a high level Doctors Lean Team to develop or adapt Best Practices for patient Recovery Plans.
2. Standardize Recovery Plans.
3. Determine staffing and costs for each recovery Plan.
4. Determine the number of patients assigned to each Recovery Plan for a VA Medical Facility's staffing requirements and an annual budget.
Nation Wide VA Progress Reporting System
The proposed Nation Wide VA Progress Reporting System starts with selected manual reporting from each VA Medical Facility of patient loads and operating expenses in each medical area such as Oncology and Ophthalmology (done by others).
I have shown how the Throughput Staffing Schedule spreadsheet developed for each VA Medical Facility in specific medical areas specifies the required staffing to meet patient appointment schedules. Labor Costs and expenses in each medical area will be developed by each VA Medical Facility. When these expenditures are compared with actual patient throughput in each medical area each month you will have a partial manual reporting system that can be in place within six months. Reports from each VA Medical Facility will be compared for anomalies manually at first and then automated in the second year. (Done by others).
As Lean Data is developed using Enterprise Lean for an entire VA Medical Facility the remaining overhead cost areas (largely office areas, Pharmacies and Laboratory areas) will have standards developed which can be implemented throughout the VA Medical Facility System. The manual reporting system will be supplemented by Progress Reports on staff hiring activities and Facility Construction from each VA Medical Facility (done by others).
Automation should be delayed until all manual systems have been proven. Before new computer systems can be built to estimate Staffing requirements at VA facilities there must be a solid footing of actual data to backup the new systems. The quicker this data is generated and proven the sooner computer systems can be developed. The problem is that the data can be quickly generated within three months but the computer systems will take as much as a year to develop time that the VA does not have (Done by Others).
Phase 2. Data Collection and Implementation of Reforms
The second part of the Lean Team Process
After a period of about one months most Functional Lean Teams, those that were organized and trained by VA Analyst Facilitators, should have their Analyses completed. I have had success with doing the flow of the current method on long white butcher or brown wrapping paper tapped around a conference room on the walls. The steps of the current method is completed first followed by the proposed improved method done directly under it. This is done to highlight the differences between the two methods. I suggest that some Functional Lean Teams with significant savings present their improved method to management. After the presentation the rolled document is given to a VA Analyst to document the savings from the proposal in a spreadsheet.
Details of the Data Collection and Reform Process
The technical reform process begins after the decision to implement Enterprise Lean and after the functional Lean teams have completed their Lean Team Data development. The important data that is necessary for reform is the functional cost data developed by the Functional Lean Teams from their individual functions. The data will be collected in electronic tablets using a spreadsheet program specifically designed for this process. All tablet spread sheets will be continuously updated using a special Google App (application). The Principal Consultant will provide on the job training of VA Analysts in the collection of this data and all subsequent reform steps.
Lean Team Data that is collected and allowed to accumulate
The following steps show how the Lean Team Data is collected and allowed to accumulate in the spreadsheet program and how the summarized data is used. This approach to reform meets all of the VA’s criteria for an Agency: efficient, effective, ethical, equitable and responsive .
1. Best Practices for each function will be documented in the spreadsheet.
2. All labor and expense cost data will be documented and allowed to accumulate as functions are added to the spreadsheet until all of the Agency’s functions have been accounted for.
3. The names of the employees working on the function will be documented with any special expertise they are using in performing the function. Each employee’s labor hours expended in doing the function will be documented and allowed to accumulate. This data will be used during the Right-Sizing process.
4. Where there is interaction between several employees during the performance of the function a work load balancing chart will be a part of the documentation. This work load chart can be used later in a high level Doctors Team to develop a Throughput staffing schedule balancing the function’s work load.
5. When all of an Agencies Functions have been logged into the spread sheet the final labor hours and expense numbers will have been automatically tallied in the spread sheet along with the total hours worked by each employee in the particular function.
6. A key question asked of employees is the estimate for the number of times that the function is done per week and recorded in the spread sheet. This number is authenticated by history and other knowledgeable personnel including the enumeration of purchased goods consumed by the function.
7. The total annual accumulated functional hours is at 100% productivity and must be converted to provide a realistic number at 75% productivity. To make this conversion you will add 25% more time to the total or multiply the total time by 125%. This becomes the labor hours for staffing and budgeting and is what is referred to as a Gross Load among consultants. When all of the Agency’s functional labor hours have been accumulated at 125% and we add in the total annual expenses we have what I call a Bottoms-up Functional Budget.
8. Next we want to compare the Bottoms-up Budget with the current Top-Down Agency Budget. To do this we remove all management and overhead expenditures from the Agency’s Top-Down Budget to obtain an equal expenditure. Then we compare the Bottoms-up Budget with the Top-Down Budget. The Bottoms-up Budget should be 20% or more less than the Top-Down Budget. If this is not the case then we have introduced an error more than likely in the number of times that a Function is being performed annually. This should be resolved by reviewing the Lean data in the Agency’s spreadsheet.
9. We can now do Right-Sizing using the employee accumulated Lean data from the spreadsheet. As a rule of thumb the employee accumulated hours is separated between those who have accumulated more than 20 hours per week average and those who have accumulated less than 20 hours per week. Those who have accumulated less than 20 hours per week are considered to be redundant and slated for layoff. Their accumulated hours are spread among those with more than 20 hours per week increasing their hours to at least 37 hours per week. This involves reviewing each function and reassigning tasks to employees according to their capability and availability.
10. We now need to review the spreadsheet for those jobs noted as occurring on a random basis. These special jobs need to be separated form those jobs that occur on a continuing basis. An individual employee is specially trained to do the job of Work Planning, forecasting scheduling these jobs on a weekly basis.
11. The spreadsheets are stored on thumb drives for each Agency and protected. The labor data for each function is stored in a Database at 100% to be used for calculating productivity where required. The Database also includes the staffing and bottoms-up budgeting data. I recommend that the data be protected by an independent organization such as the VA. This allows availability of the data for all who want to review the actual labor and expense cost of an Agency function including the Agency’s Bottoms-up Budget.
Phase 3. Organization Reform
In the final step of the General Reform Model the Principal Consultant will begin the process of organizational reform by replacing the Bureaucratic organization with a Team Management organization with top management managing the Agency’s activities through Group Teams with each managing several Functional Teams. The Lean Teams at the Functional level will become self managed Functional Teams with each of their elected leaders reporting directly to a Group Managed team. Group Managed Teams will assume their management role from the pre-organized high level Lean Teams. There is some flexibility in how this process actually occurs but it is necessary in order to eliminate the problems caused by the Bureaucratic organization. The important advantage in changing from a Bureaucratic organization to a Team Managed organization is that the savings continues annually for years.
This is also the period of time for the reduction of redundant management and staff. To attain a balanced work load is the primary objective where retraining employees to fill needed vacancies is pursued. Once it is known where staffing can be reduced temporary reassignments should be completed within a month. It is recommended that supervisors and other redundant staff be reassigned to new VA Facilities.
Exhibit B. The VA Employee Support for this Agreement
This Agreement requires the VA to follow the Principal Consultant’s General Reform Model and the requirements therein as outlined below:Enterprise Lean Support Requirements provided by the VA.
1. The secretary of Veterans Affairs will have oversight of this Agreement and is the Client of Lawrence Rosier & Associates.
2. The VA will provide preliminary results of the medical need areas for Vets who have not been served at the Temple Texas VA Facility. I recommend that this be followed by determining the results of a mass screening of new patients at the Temple Texas VA Medical Facility with interviews and blood tests. By reviewing 100 patients a day the task of finding what the patients health care needs are can be completed in a short time (done by others).
3. Ten VA Analysts will be provided by the VA Inspector Generals Office and will be trained and lead by the Principal Consultant in the implementation of the General Reform Model of this Agreement.
The number of VA Analysts provided will impact the length of time required to complete this Agreement.
4. The VA Analysts will also act as Facilitators during the implementation of Enterprise Lean to work with Functional Lean Teams where required. Each Functional Lean Team will meet once a week to do their Value Steam Mapping of their function or functions. Each Analyst Facilitator can meet with about 30 Functional Lean Teams each week for about 4 weeks.
5. All VA Medical Facilities shall have the authority and responsibility to hire new personnel to fill vacancies identified by the Throughput Staffing Schedule developed by the Principal Consultant and the OIG Analyst Team.
6. The VA will provide supplies such as markers and wrapping paper for the Lean Teams. The VA will also provide Tablets or Lap-Top Tablets for the collection of data by each Analyst. At the conclusion of this Agreement the Tablets or Lap-Top Tables will remain as property of the VA.
Friday, August 15, 2014
Article 76. Detailed Description of the Throughput Process
Note: On August 13, 2014 Lawrence Rosier & Associates submitted a proposal for a Consulting Agreement to Secretary Robert McDonald of Veterans Affairs. The main plan was to implement a unique approach by Lawrence Rosier Principal Consultant to develop a detailed optimum Staffing Schedule for all VA Medical Facilities within three Months, filling the need of each facility to meet its patient appointment schedule. The proposal continues to make significant reforms in VA Facilities. Savings from preventing over staffing and other reforms could be more than $5 billion.
This article was written to promote understanding of the Throughput development process. The throughput process was designed by Lawrence Rosier to specifically meet the needs of the VA to expediently determine with effectiveness and efficiency the staffing number and expertise required to meet each VA Medical Facility’s patient appointment schedule.
What is a Throughput Schedule?
A Throughput Staffing Schedule is a visual graphic representation of functional processes where the staff members name can be assigned to the process. The interaction of the processes of the function is depicted such that a sequential representation is maintained showing the activities of nurses, doctors and patients. The objective is to balance the activities of the function such that no staff member is delayed by having to wait for another staff member to complete his job. This is a team effort with all staff members working together according to the Throughput Schedule. The Throughput Schedule is a depiction on a large wall chart designed to allow visibility and understanding of the process by all of the team members. The Throughput Schedule is a “staffing schedule” meaning that it provides allowances for delays from: equipment and supplies and inexperienced staff members. It does this by increasing the standard time for each process by 25%.
The Throughput Development Project
My most recent proposal to the Secretary of the VA to develop the Throughput Process specifies that a contingent of ten OIG Analysts be assigned to the Development Project at the Temple Texas VA Medical Facility as early as in the next few weeks (August or September 2014). The OIG Analysts will be given overview of the project followed by background training before being assigned to a specific medical area such as Cardiology and Endocrinology. The medical areas receiving prompt attention are those that have been identified in a review of all Vets that have been excluded from the Temple VA Medical Facility's appointment Schedule and represent an overload of patients on the VA Facility.
The Quality Management Service focuses on the Veteran and organizational functions that promote positive patient outcomes by standardizing processes. Temple, Building 204, Room 1G25 254-743-2422
The Quality Management Team has identified the functions and standardized the processes within each function.
The intent is to use their Standardized data first to identify functions so we can organize Functional Lean Teams of those who do the processes. Then the OIG Analysts as Facilitators will test each Function Lean Team to see if they are following the standardized processes and make updates as required. The standardized processes will then become Best Practices. This is followed by building the graphic representation of the functions and their relationships.
The first assignment for the OIG Analysts is to act as Facilitators for the Employee Functional Lean Teams in their medical areas.
The Facilitator will organize the Functional Lean Team and aid in the election of the team leader by secret ballot. The Team will meet once a week for one hour. After they have been organized and orientated by the Facilitator the Lean Team will review and verify the quality process standards. Each Functional Lean Team may have several functions they do but these are the only functions that they do. The next step is to graphically study the relationships of the functions to each other and and those doing the work including nurses, doctors and patients.
I recommend that the Team be brought in on a Saturday to jump start the process of putting together the graphic representation of the functions and their relationships.The OIG Analyst will capture the data developed by the Functional Lean Team on a spreadsheet including the graphical representation of functional relationships.
The graphic representations created by the Functional Lean Teams is given to a higher level Doctor’s Lean Team, Facilitated by the OIG Analyst, to be used as the foundation for the development of the Throughput Staffing Schedule. The Lean Data will be captured in a spreadsheet and used in the higher level Doctor’s Lean Team to develop the Throughput document which will be captured in a staffing spreadsheet. The Throughput spreadsheet will be expanded to contain a large number of repeated reiterations of the original Best Practices balanced schedule design. The Throughput Document will contain enough reiterations to meet any VA facility’s patient appointment schedule requirement. The spreadsheet for each medical area will be test implemented at the Temple Texas VA Medical Facility. With the success of the test implementation each spreadsheet medical area will be stored on a thumb drive. Spreadsheets have a unique capability for selecting what gets printed. In this case the number of patients needed to meet a particular VA Facilities appointment Schedule can be selected from the spreadsheet before printing the Throughput Schedule for the VA Facility.
Each OIG Analyst will depart The development VA Facility for another VA Medical Facility with the medical Thumb drives containing a spreadsheet Throughput Schedule for each medical area. At the VA new medical facility the OIG Analyst will select the required patient appointment schedule matching the number of patients on the spreadsheet and print that number. This will be done from the staffing spreadsheet thumb drive in each medical area. The spreadsheets are expected to be quit large and will have to be assembled and taped on a back ground sheet of wrapping paper. The reason for this is to allow the staff at the new VA facility to become familiar with the staffing plan by assigning staff member names to the staffing Schedule. The staffing schedule will determine the required staff yet to be hired. The Staffing Schedule can be conveniently rolled up and used again as necessary.
OIG Analysts will be on a tight schedule and expected to move to the next assigned VA Medical Facility until all of the VA Facilities have the their needed Throughput Staffing Schedules for critical medical areas.
The second part of my proposed Consulting Agreement with the VA using Enterprise Lean specifies that the entire Temple Texas VA Facility will use Functional teams in the remaining non critical medical areas (Those not identified as needing immediate increased staffing). The areas will also have Throughput Staffing Schedules however these staffing schedules may show that a medical area has too many staff members. If this is the case then the redundant staff can be retrained to fill areas of need at the Temple Texas VA Medical Facility.
The Throughput spreadsheets on thumb drives for the remaining non critical medical areas can be sent to all VA Facilities by snail mail. This will allow all VA facilities to use redundant staff by retraining them to fill needed jobs.
The second part of the Consulting Agreement implements Team Management replacing the current toxic Bureaucracy. The result of this in my experience has been an increased excitement among employees by allowing them to participate in the management of their work areas. This will result in fewer supervisory personnel being required. These supervisors will remain in the Functional Teams and will have the opportunity to relocate to a new facility being built by the VA.
The implementation of Team Management in all VA Facilities can be done by OIG Analysts over the next year.
Note: On August 13, 2014 Lawrence Rosier & Associates submitted a proposal for a Consulting Agreement to Secretary Robert McDonald of Veterans Affairs. The main plan was to implement a unique approach by Lawrence Rosier Principal Consultant to develop a detailed optimum Staffing Schedule for all VA Medical Facilities within three Months, filling the need of each facility to meet its patient appointment schedule. The proposal continues to make significant reforms in VA Facilities. Savings from preventing over staffing and other reforms could be more than $5 billion.
This article was written to promote understanding of the Throughput development process. The throughput process was designed by Lawrence Rosier to specifically meet the needs of the VA to expediently determine with effectiveness and efficiency the staffing number and expertise required to meet each VA Medical Facility’s patient appointment schedule.
What is a Throughput Schedule?
A Throughput Staffing Schedule is a visual graphic representation of functional processes where the staff members name can be assigned to the process. The interaction of the processes of the function is depicted such that a sequential representation is maintained showing the activities of nurses, doctors and patients. The objective is to balance the activities of the function such that no staff member is delayed by having to wait for another staff member to complete his job. This is a team effort with all staff members working together according to the Throughput Schedule. The Throughput Schedule is a depiction on a large wall chart designed to allow visibility and understanding of the process by all of the team members. The Throughput Schedule is a “staffing schedule” meaning that it provides allowances for delays from: equipment and supplies and inexperienced staff members. It does this by increasing the standard time for each process by 25%.
The Throughput Development Project
My most recent proposal to the Secretary of the VA to develop the Throughput Process specifies that a contingent of ten OIG Analysts be assigned to the Development Project at the Temple Texas VA Medical Facility as early as in the next few weeks (August or September 2014). The OIG Analysts will be given overview of the project followed by background training before being assigned to a specific medical area such as Cardiology and Endocrinology. The medical areas receiving prompt attention are those that have been identified in a review of all Vets that have been excluded from the Temple VA Medical Facility's appointment Schedule and represent an overload of patients on the VA Facility.
Central Texas VA Quality Management Services Depart
As the Principal Consultant on the project I will work closely with the VA Quality Management Services department using their data and expertise to expedite the project.The Quality Management Service focuses on the Veteran and organizational functions that promote positive patient outcomes by standardizing processes. Temple, Building 204, Room 1G25 254-743-2422
The Quality Management Team has identified the functions and standardized the processes within each function.
The intent is to use their Standardized data first to identify functions so we can organize Functional Lean Teams of those who do the processes. Then the OIG Analysts as Facilitators will test each Function Lean Team to see if they are following the standardized processes and make updates as required. The standardized processes will then become Best Practices. This is followed by building the graphic representation of the functions and their relationships.
The first assignment for the OIG Analysts is to act as Facilitators for the Employee Functional Lean Teams in their medical areas.
The Facilitator will organize the Functional Lean Team and aid in the election of the team leader by secret ballot. The Team will meet once a week for one hour. After they have been organized and orientated by the Facilitator the Lean Team will review and verify the quality process standards. Each Functional Lean Team may have several functions they do but these are the only functions that they do. The next step is to graphically study the relationships of the functions to each other and and those doing the work including nurses, doctors and patients.
I recommend that the Team be brought in on a Saturday to jump start the process of putting together the graphic representation of the functions and their relationships.The OIG Analyst will capture the data developed by the Functional Lean Team on a spreadsheet including the graphical representation of functional relationships.
The graphic representations created by the Functional Lean Teams is given to a higher level Doctor’s Lean Team, Facilitated by the OIG Analyst, to be used as the foundation for the development of the Throughput Staffing Schedule. The Lean Data will be captured in a spreadsheet and used in the higher level Doctor’s Lean Team to develop the Throughput document which will be captured in a staffing spreadsheet. The Throughput spreadsheet will be expanded to contain a large number of repeated reiterations of the original Best Practices balanced schedule design. The Throughput Document will contain enough reiterations to meet any VA facility’s patient appointment schedule requirement. The spreadsheet for each medical area will be test implemented at the Temple Texas VA Medical Facility. With the success of the test implementation each spreadsheet medical area will be stored on a thumb drive. Spreadsheets have a unique capability for selecting what gets printed. In this case the number of patients needed to meet a particular VA Facilities appointment Schedule can be selected from the spreadsheet before printing the Throughput Schedule for the VA Facility.
Each OIG Analyst will depart The development VA Facility for another VA Medical Facility with the medical Thumb drives containing a spreadsheet Throughput Schedule for each medical area. At the VA new medical facility the OIG Analyst will select the required patient appointment schedule matching the number of patients on the spreadsheet and print that number. This will be done from the staffing spreadsheet thumb drive in each medical area. The spreadsheets are expected to be quit large and will have to be assembled and taped on a back ground sheet of wrapping paper. The reason for this is to allow the staff at the new VA facility to become familiar with the staffing plan by assigning staff member names to the staffing Schedule. The staffing schedule will determine the required staff yet to be hired. The Staffing Schedule can be conveniently rolled up and used again as necessary.
OIG Analysts will be on a tight schedule and expected to move to the next assigned VA Medical Facility until all of the VA Facilities have the their needed Throughput Staffing Schedules for critical medical areas.
The second part of my proposed Consulting Agreement with the VA using Enterprise Lean specifies that the entire Temple Texas VA Facility will use Functional teams in the remaining non critical medical areas (Those not identified as needing immediate increased staffing). The areas will also have Throughput Staffing Schedules however these staffing schedules may show that a medical area has too many staff members. If this is the case then the redundant staff can be retrained to fill areas of need at the Temple Texas VA Medical Facility.
The Throughput spreadsheets on thumb drives for the remaining non critical medical areas can be sent to all VA Facilities by snail mail. This will allow all VA facilities to use redundant staff by retraining them to fill needed jobs.
The second part of the Consulting Agreement implements Team Management replacing the current toxic Bureaucracy. The result of this in my experience has been an increased excitement among employees by allowing them to participate in the management of their work areas. This will result in fewer supervisory personnel being required. These supervisors will remain in the Functional Teams and will have the opportunity to relocate to a new facility being built by the VA.
The implementation of Team Management in all VA Facilities can be done by OIG Analysts over the next year.
Thursday, August 14, 2014
Article 75. Savings From Lawrence Rosier VA Reforms
The rejected Proposal to make the VA more effective and efficient through my General Reform Model was estimated to save more than $5 billion.
The savings from the Lawrence Rosier Approach to the VA comes as a result of implementations of my Government Reform Model which is based on Enterprise Lean. Lean provides a vehicle for generating dollar savings and quality improvement over time through the continuous improvement of the processes and services delivered. These savings deliver real value in reduced expenditure and in better service to Veterans but are difficult to put a dollar amount on.
The main area for immediate savings comes from the General Reform Model using the data from the Enterprise Lean Team studies to do Work Measurement where the work performed by each Function’s processes are measured and documented. The process continues with the employee Functional Lean Team putting their processes together so that the work load is balanced (meaning no employee must wait on another employee to do his job). The result is the known number of hours required to do each Function which also determines the staffing required. Note that a balanced work load depends upon a team effort working together, each member doing his assigned part. Wasted time of employees waiting on other employees to do their jobs is a big reason for waste in government.
The General Reform Model as proposed to the Secretary of Veteran’s Affairs is in two parts the first part focusing on the problem of identifying the number of increased staff required to quickly meet patient appointment schedules in all VA Medical Facilities. By presenting a balanced work load plan for each medical area showing their work assignments and exactly how many staff members and their skills are needed to form a team that meets the required patient appointment schedule. Note that just adding another Doctor to the staff would probably result in wasted time without adding the nursing support needed by the doctor. Savings from this activity because of the large impact on all VA facilities is estimated to be more than $3 billion.
Implementation of the second part of the General Reform Model which completes the implementation in the Temple Texas VA facility in the remaining portion the enterprise. It continues the process begun in the first part but in non-critical medical areas. This part implements right-sizing and work load balancing in all remaining functions. The result is the identification of where over staffing is occurring with retraining and reassignment of employees to areas where they are needed. The savings in the development Facility is estimated to be more than $10 million and in all VA Facilities more than $1 billion.
A major benefit of this approach is that a new positive culture results focusing the Functional Lean Teams on their work processes replacing the toxic old culture.
The General Reform Model ends with the implementation of Team Management replacing the current Bureaucratic organization. This is more of a formal declaration since the Temple Texas VA Medical Facility is already organized around functional Lean Teams and existing Doctor’s Teams. The process creates self organized Functional Teams which elect their on leader by secret ballot eliminating all bottom level supervisory positions. Each supervisor will become a member of the Functional Team. Other higher level Teams will eliminate some management positions. All redundant Supervisors will have the opportunity to reapply for management positions in the new medical facilities that the VA will be building. The savings from the change to Team Management is estimated to be more than $10 million at the Temple Texas VA Facility. When implemented throughout all VA facilities the savings could be more than $1 billion.
Savings From Over staffing
All Bureaucracies are wasteful when it comes to over staffing many government positions are designed to fill a box on an organization chart without any thought to the amount of work required to do the job the result is that what appears to be a full time job may only require half of the employee’s time. Over staffing in the private sector has been verified by data from Alexander Proud foot (the leading downsizing consulting firm) implementations which found that from 17% to 20% over staffing occurs in private companies. Government over staffing may be significantly higher than 20%.
Total Savings
Total savings from the implementation the General Reform Model in all VA Facilities is expected exceed $5 billion.
ROI
Enough about savings equally important is the Return On Investment. The implementation of the General Reform model is largely done by the VA’s own resources: Ten OIG Analysts acting as facilitators for Functional Lean Teams meeting for one hour per week. My estimate for an ROI for the current Consulting Agreement For determining staffing for all VA facilities and the General reform implementation at the Development Facility is about $3,000 return for each $1 invested. The ROI for implementation of the General Reform Model for all VA facilities is about $5,000 for each $1 invested.
Note on Government Lean Studies
Government Lean Studies which focus on a single process do not return much of the savings they purport to save because even though they can show a significant savings. The process is done with out considering the process done before and after the studied process. The main problem is that these implementations are aimed at the trees in a forest of waste which is occurring all around them But there is a second problem much of the savings is never realized because bureaucracies are reluctant to reduce the staffing identified by the Lean implementations. Enterprise Lean avoids this problem by evaluating all the functions in an entire enterprise.
Lean Six Sigma
Lean Six Sigma focuses on an entire system rater than individual Lean studies avoiding the problem found in individual lean studies by balancing all the processes in the entire system. Enterprise lean is complementary to Lean Six Sigma because it is focused on making the sub-systems efficient which flow into the high level Lean Six Sigma system.
The rejected Proposal to make the VA more effective and efficient through my General Reform Model was estimated to save more than $5 billion.
The savings from the Lawrence Rosier Approach to the VA comes as a result of implementations of my Government Reform Model which is based on Enterprise Lean. Lean provides a vehicle for generating dollar savings and quality improvement over time through the continuous improvement of the processes and services delivered. These savings deliver real value in reduced expenditure and in better service to Veterans but are difficult to put a dollar amount on.
The main area for immediate savings comes from the General Reform Model using the data from the Enterprise Lean Team studies to do Work Measurement where the work performed by each Function’s processes are measured and documented. The process continues with the employee Functional Lean Team putting their processes together so that the work load is balanced (meaning no employee must wait on another employee to do his job). The result is the known number of hours required to do each Function which also determines the staffing required. Note that a balanced work load depends upon a team effort working together, each member doing his assigned part. Wasted time of employees waiting on other employees to do their jobs is a big reason for waste in government.
The General Reform Model as proposed to the Secretary of Veteran’s Affairs is in two parts the first part focusing on the problem of identifying the number of increased staff required to quickly meet patient appointment schedules in all VA Medical Facilities. By presenting a balanced work load plan for each medical area showing their work assignments and exactly how many staff members and their skills are needed to form a team that meets the required patient appointment schedule. Note that just adding another Doctor to the staff would probably result in wasted time without adding the nursing support needed by the doctor. Savings from this activity because of the large impact on all VA facilities is estimated to be more than $3 billion.
Implementation of the second part of the General Reform Model which completes the implementation in the Temple Texas VA facility in the remaining portion the enterprise. It continues the process begun in the first part but in non-critical medical areas. This part implements right-sizing and work load balancing in all remaining functions. The result is the identification of where over staffing is occurring with retraining and reassignment of employees to areas where they are needed. The savings in the development Facility is estimated to be more than $10 million and in all VA Facilities more than $1 billion.
A major benefit of this approach is that a new positive culture results focusing the Functional Lean Teams on their work processes replacing the toxic old culture.
The General Reform Model ends with the implementation of Team Management replacing the current Bureaucratic organization. This is more of a formal declaration since the Temple Texas VA Medical Facility is already organized around functional Lean Teams and existing Doctor’s Teams. The process creates self organized Functional Teams which elect their on leader by secret ballot eliminating all bottom level supervisory positions. Each supervisor will become a member of the Functional Team. Other higher level Teams will eliminate some management positions. All redundant Supervisors will have the opportunity to reapply for management positions in the new medical facilities that the VA will be building. The savings from the change to Team Management is estimated to be more than $10 million at the Temple Texas VA Facility. When implemented throughout all VA facilities the savings could be more than $1 billion.
Savings From Over staffing
All Bureaucracies are wasteful when it comes to over staffing many government positions are designed to fill a box on an organization chart without any thought to the amount of work required to do the job the result is that what appears to be a full time job may only require half of the employee’s time. Over staffing in the private sector has been verified by data from Alexander Proud foot (the leading downsizing consulting firm) implementations which found that from 17% to 20% over staffing occurs in private companies. Government over staffing may be significantly higher than 20%.
Total Savings
Total savings from the implementation the General Reform Model in all VA Facilities is expected exceed $5 billion.
ROI
Enough about savings equally important is the Return On Investment. The implementation of the General Reform model is largely done by the VA’s own resources: Ten OIG Analysts acting as facilitators for Functional Lean Teams meeting for one hour per week. My estimate for an ROI for the current Consulting Agreement For determining staffing for all VA facilities and the General reform implementation at the Development Facility is about $3,000 return for each $1 invested. The ROI for implementation of the General Reform Model for all VA facilities is about $5,000 for each $1 invested.
Note on Government Lean Studies
Government Lean Studies which focus on a single process do not return much of the savings they purport to save because even though they can show a significant savings. The process is done with out considering the process done before and after the studied process. The main problem is that these implementations are aimed at the trees in a forest of waste which is occurring all around them But there is a second problem much of the savings is never realized because bureaucracies are reluctant to reduce the staffing identified by the Lean implementations. Enterprise Lean avoids this problem by evaluating all the functions in an entire enterprise.
Lean Six Sigma
Lean Six Sigma focuses on an entire system rater than individual Lean studies avoiding the problem found in individual lean studies by balancing all the processes in the entire system. Enterprise lean is complementary to Lean Six Sigma because it is focused on making the sub-systems efficient which flow into the high level Lean Six Sigma system.
Wednesday, August 13, 2014
Article 74. Nation Wide VA Progress Reporting System
This article proposes a Nation Wide VA Progress Reporting System which starts with selected manual reporting from each VA Medical Facility of patient loads and operating expenses in each medical area such as Cardiology and Endocrinology.
In Articles 72. And 73. I have shown how the Throughput Staffing Schedule spreadsheet developed for each VA Medical Facility in specific medical areas provides a balanced work load and specifies the required staffing to meet patient appointment schedules. Labor Costs and expenses in each medical area can be developed in each VA Medical Facility. When these expenditures are compared with actual patient throughput in each medical area each month you will have a partial manual reporting system that can be in place within six months. Reports from each VA Medical Facility can be compared for anomalies manually at first and then automated in the second year.
As Lean Data is developed using Enterprise Lean for an entire VA Medical Facility the remaining overhead cost areas (largely office support areas, Pharmacies and Laboratory areas) will have balanced work load schedules developed which can be implemented throughout the VA Medical Facility System. The manual reporting system can be supplemented by Progress Reports on staff hiring activities and Facility Construction from each VA Medical Facility. Automation of the reporting system should be delayed until all manual systems have been proven.
Overall Plan:
Obtaining the Critical Management data Needed by the VA
I recommend that my General Reform Model be implemented in two parts. The first part addresses the immediate need to develop the data for determining staffing and facilities expansion for all VA facilities. This done by providing a Throughput balanced work load for each medical area with expanded steps which can match the patient requirements for any VA facility. This will be done in the areas where increased patient services are required.
The second part completes the implementation of the modified Enterprise Lean in all remaining areas of the development VA Facility.
Part One:
Overall Plan based on number of Doctors From Article 72.
First two months
Each VA Medical Facility will identify all maximum patient loads in each medical area to meet required patient appointment schedules (not a part of this Consulting Agreement). This data will be needed to staff Throughput Schedules being developed at a development VA Facility.
This Consulting Agreement develops a Throughput Schedule plan for each area where medical services are needed to meet increased VA patient loads. An OIG Analyst will be assigned to each medical area to Facilitate Hospital Employee Lean Teams in applying Best Practices to each of their Functions. The Lean Data will be captured in a spreadsheet and used in the higher level Doctor’s Lean Team to develop the Throughput document which will be captured in a staffing spreadsheet. The Throughput spreadsheet will contain a large number of repeated reiterations of the original Best Practices balanced schedule design. The Throughput Document will contain enough reiterations to meet any VA facility’s patient appointment schedule requirements.
Third month
The spreadsheet for each medical area will be test implemented at the development VA Medical Facility. With the success of the test implementation each spreadsheet medical area will be stored on a thumb drive.
Fourth Fifth and sixth months
Each OIG Analyst will depart The development VA Facility for another VA Medical Facility with the medical Thumb drives containing a spreadsheet Throughput Schedule for each medical area. Spreadsheets have a unique capability for selecting what gets printed. In this case the number of patients needed to meet a VA Facilities appointment Schedule can be selected from the spreadsheet before printing the Throughput Schedule for a specific VA Facility.
Approach based on Patient Diagnosis
The above approach works in all areas where the number of Doctors is the key driving force but where Psychologists and Physical Therapists are involved an entirely different approach is needed based on the diagnosis of each individual patient and the patient's plan of recovery. I suggest the following approach:
1. Establish a high level Doctors Lean Team to develop or adapt Best Practices for patient Recovery Plans.
2. Standardize patient recovery plans (may be available from other sources).
3. Determine staffing and costs for each recovery plan.
4. Determine the number of patients assigned to each Recovery Plan for a VA Medical Facility's staffing requirements and an annual budget.
Part Two:
The second part begins in the third month and completes the implementation of the modified Enterprise Lean in all remaining areas of the development VA Facility. The reasons for doing this is to determine where over-staffing is occurring so employees can be retrained to fill the needs in under staffed critical medical areas and to develop a functional Budget for the development VA Facility. This will provide the data needed for management budget decisions as well as machine and floor space utilization for the entire development VA facility.
Part two should be implemented at all VA facilities this will take some time but trained OIG Analysts should be able to make these implementations in a few years. As new VA medical facilities are built any over-staffing identified by the full implementation of the General Reform Model in existing VA Facilities can be transferred to the new VA Facilities.
About Automated System Reporting:
The problem in past years and to some extent today is that there are few government leaders who have the knowledge to make the proper decisions related to IT implementations. The result is that they most always rely on their own IT personnel to make the decisions on future implementations. These are the vary people one should not ask because these are the people who have spent years working on their obsolete hardware. 95% of all government IT programs are obsolete but even worse government continues to build or add to the present obsolete systems using the same obsolete software approach.
Most government systems use an obsolete IBM Base Systems Application from which all other application programs must be compatible. These government systems have never been up graded and are more than 50 years old. Most of these systems were coded before the present Systems Analysts were born. These systems are similar in function to Microsoft’s Windows 7 where all application programs must be compatible with it but it gets periodically up graded to Windows 8 etc. With cell phones becoming obsolete within a year, one can only begin to see the inefficiency of these obsolete systems. See Article 22. Why Government Screws-up Almost Everything it Touches.
I recommend avoiding obsolete IT systems by using Cloud technology and implement modern Relational Databases in a new facility using the SQL language and dump the obsolete systems.
Washington State is one of the few states who has come to grips with this IT problem. A few years ago while planning for the new IT facility at Olympia Washington. The then IT State Manager was planning on reinstalling their current obsolete application programs into the new facility. Fortunately a computer knowledgeable Congressman got wind of the scheme and persuaded the Governor to implement modern Relational Databases into the new facility using the SQL language. Unfortunately it was too late for failed systems installed in: Indiana, Virginia, Texas and others. The Indiana and Texas failures were catastrophic yet they were able to spend enough money to make the systems work. But the biggest failure was in Virginia where nearly a $billion was spent just for the develop a statewide email system which they could have had for next to nothing using Google's Gmail.
This article proposes a Nation Wide VA Progress Reporting System which starts with selected manual reporting from each VA Medical Facility of patient loads and operating expenses in each medical area such as Cardiology and Endocrinology.
In Articles 72. And 73. I have shown how the Throughput Staffing Schedule spreadsheet developed for each VA Medical Facility in specific medical areas provides a balanced work load and specifies the required staffing to meet patient appointment schedules. Labor Costs and expenses in each medical area can be developed in each VA Medical Facility. When these expenditures are compared with actual patient throughput in each medical area each month you will have a partial manual reporting system that can be in place within six months. Reports from each VA Medical Facility can be compared for anomalies manually at first and then automated in the second year.
As Lean Data is developed using Enterprise Lean for an entire VA Medical Facility the remaining overhead cost areas (largely office support areas, Pharmacies and Laboratory areas) will have balanced work load schedules developed which can be implemented throughout the VA Medical Facility System. The manual reporting system can be supplemented by Progress Reports on staff hiring activities and Facility Construction from each VA Medical Facility. Automation of the reporting system should be delayed until all manual systems have been proven.
Overall Plan:
Obtaining the Critical Management data Needed by the VA
I recommend that my General Reform Model be implemented in two parts. The first part addresses the immediate need to develop the data for determining staffing and facilities expansion for all VA facilities. This done by providing a Throughput balanced work load for each medical area with expanded steps which can match the patient requirements for any VA facility. This will be done in the areas where increased patient services are required.
The second part completes the implementation of the modified Enterprise Lean in all remaining areas of the development VA Facility.
Part One:
Overall Plan based on number of Doctors From Article 72.
First two months
Each VA Medical Facility will identify all maximum patient loads in each medical area to meet required patient appointment schedules (not a part of this Consulting Agreement). This data will be needed to staff Throughput Schedules being developed at a development VA Facility.
This Consulting Agreement develops a Throughput Schedule plan for each area where medical services are needed to meet increased VA patient loads. An OIG Analyst will be assigned to each medical area to Facilitate Hospital Employee Lean Teams in applying Best Practices to each of their Functions. The Lean Data will be captured in a spreadsheet and used in the higher level Doctor’s Lean Team to develop the Throughput document which will be captured in a staffing spreadsheet. The Throughput spreadsheet will contain a large number of repeated reiterations of the original Best Practices balanced schedule design. The Throughput Document will contain enough reiterations to meet any VA facility’s patient appointment schedule requirements.
Third month
The spreadsheet for each medical area will be test implemented at the development VA Medical Facility. With the success of the test implementation each spreadsheet medical area will be stored on a thumb drive.
Fourth Fifth and sixth months
Each OIG Analyst will depart The development VA Facility for another VA Medical Facility with the medical Thumb drives containing a spreadsheet Throughput Schedule for each medical area. Spreadsheets have a unique capability for selecting what gets printed. In this case the number of patients needed to meet a VA Facilities appointment Schedule can be selected from the spreadsheet before printing the Throughput Schedule for a specific VA Facility.
Approach based on Patient Diagnosis
The above approach works in all areas where the number of Doctors is the key driving force but where Psychologists and Physical Therapists are involved an entirely different approach is needed based on the diagnosis of each individual patient and the patient's plan of recovery. I suggest the following approach:
1. Establish a high level Doctors Lean Team to develop or adapt Best Practices for patient Recovery Plans.
2. Standardize patient recovery plans (may be available from other sources).
3. Determine staffing and costs for each recovery plan.
4. Determine the number of patients assigned to each Recovery Plan for a VA Medical Facility's staffing requirements and an annual budget.
Part Two:
The second part begins in the third month and completes the implementation of the modified Enterprise Lean in all remaining areas of the development VA Facility. The reasons for doing this is to determine where over-staffing is occurring so employees can be retrained to fill the needs in under staffed critical medical areas and to develop a functional Budget for the development VA Facility. This will provide the data needed for management budget decisions as well as machine and floor space utilization for the entire development VA facility.
Part two should be implemented at all VA facilities this will take some time but trained OIG Analysts should be able to make these implementations in a few years. As new VA medical facilities are built any over-staffing identified by the full implementation of the General Reform Model in existing VA Facilities can be transferred to the new VA Facilities.
About Automated System Reporting:
The problem in past years and to some extent today is that there are few government leaders who have the knowledge to make the proper decisions related to IT implementations. The result is that they most always rely on their own IT personnel to make the decisions on future implementations. These are the vary people one should not ask because these are the people who have spent years working on their obsolete hardware. 95% of all government IT programs are obsolete but even worse government continues to build or add to the present obsolete systems using the same obsolete software approach.
Most government systems use an obsolete IBM Base Systems Application from which all other application programs must be compatible. These government systems have never been up graded and are more than 50 years old. Most of these systems were coded before the present Systems Analysts were born. These systems are similar in function to Microsoft’s Windows 7 where all application programs must be compatible with it but it gets periodically up graded to Windows 8 etc. With cell phones becoming obsolete within a year, one can only begin to see the inefficiency of these obsolete systems. See Article 22. Why Government Screws-up Almost Everything it Touches.
I recommend avoiding obsolete IT systems by using Cloud technology and implement modern Relational Databases in a new facility using the SQL language and dump the obsolete systems.
Washington State is one of the few states who has come to grips with this IT problem. A few years ago while planning for the new IT facility at Olympia Washington. The then IT State Manager was planning on reinstalling their current obsolete application programs into the new facility. Fortunately a computer knowledgeable Congressman got wind of the scheme and persuaded the Governor to implement modern Relational Databases into the new facility using the SQL language. Unfortunately it was too late for failed systems installed in: Indiana, Virginia, Texas and others. The Indiana and Texas failures were catastrophic yet they were able to spend enough money to make the systems work. But the biggest failure was in Virginia where nearly a $billion was spent just for the develop a statewide email system which they could have had for next to nothing using Google's Gmail.
Saturday, August 9, 2014
Article 73. Fundamental Innovation at the VA
The main concern of the three Senators and the five Congressmen who voted against HR 3230, the latest appropriations bill funding the VA, is that the enthusiasm for solving VA problems might be the normal government action of simply throwing money at a national problem. We can also view the problem from Secretary McDonald’s point of view coming from the private sector. I think he would most likely view the funding as seed money for meeting the mission of the VA through innovation.
With all innovation there exists a fundamental component, having accurate cost data for making the key decisions about which innovative proposals and adventures are cost effective. Unlike many government leaders Secretary McDonald is well aware of this problem. Accurate cost data in most government operations including the VA simply does not exist. Yes; you will find cost data everywhere in government but not the kind of cost data I am referring to. What you will find is after-the-fact cost data what was actually spent on the operation not what should have been spent by employing Best Practices and innovation to get the highest efficiency with a balanced work load. The Development of a balanced work load in each medical area is the key to determining the minimum staffing needed to meet patient appointment schedules.
Meeting the VA’s Mission objectives
When we hear of mass hiring of VA personnel doctors and staff we must ask the fundamental question of how many staff members with what expertise and where should they be located? Innovation begins here, how do we develop the fundamental cost data so that the above question can be answered in the shortest possible time to dramatically solve the problem of meeting patient appointment schedules. Serving the current Veteran’s patient needs is an obvious first objective. In the following article I have addressed how the needed cost data can be generated and used to create a balanced work load. Article 72. Restoring Management Excellence at the VA.
Now that we have established a cost basis for the VA the VA can move on to examining what we normally think of as innovation:
1. Evaluating current VA Medical functions to determine the correct staffing using Right-Sizing.
2. Converting a Clinic’s first shift operation to a two operation.
3. Establishing Mobile Clinics for under served areas especially in our Western states.
4. Developing hardened prefabricated hospital units such as that used in prefabricating housing units.
5. Assembling the best medical minds in a high level advisory council.
6. Establish a Federal Program to certify skilled nurses as doctors. Be prepared for a flood of highly skill nurses from the public sector.
7. Establish a job training program for Vets undergoing extensive physical therapy to certify them as Physical Therapists for jobs in the private sector.
This list is far from being complete and misses the important innovations generated by VA employees through innovation and continuous improvement of their jobs resulting from the implementation of Enterprise Lean.
The main concern of the three Senators and the five Congressmen who voted against HR 3230, the latest appropriations bill funding the VA, is that the enthusiasm for solving VA problems might be the normal government action of simply throwing money at a national problem. We can also view the problem from Secretary McDonald’s point of view coming from the private sector. I think he would most likely view the funding as seed money for meeting the mission of the VA through innovation.
With all innovation there exists a fundamental component, having accurate cost data for making the key decisions about which innovative proposals and adventures are cost effective. Unlike many government leaders Secretary McDonald is well aware of this problem. Accurate cost data in most government operations including the VA simply does not exist. Yes; you will find cost data everywhere in government but not the kind of cost data I am referring to. What you will find is after-the-fact cost data what was actually spent on the operation not what should have been spent by employing Best Practices and innovation to get the highest efficiency with a balanced work load. The Development of a balanced work load in each medical area is the key to determining the minimum staffing needed to meet patient appointment schedules.
Meeting the VA’s Mission objectives
When we hear of mass hiring of VA personnel doctors and staff we must ask the fundamental question of how many staff members with what expertise and where should they be located? Innovation begins here, how do we develop the fundamental cost data so that the above question can be answered in the shortest possible time to dramatically solve the problem of meeting patient appointment schedules. Serving the current Veteran’s patient needs is an obvious first objective. In the following article I have addressed how the needed cost data can be generated and used to create a balanced work load. Article 72. Restoring Management Excellence at the VA.
Now that we have established a cost basis for the VA the VA can move on to examining what we normally think of as innovation:
1. Evaluating current VA Medical functions to determine the correct staffing using Right-Sizing.
2. Converting a Clinic’s first shift operation to a two operation.
3. Establishing Mobile Clinics for under served areas especially in our Western states.
4. Developing hardened prefabricated hospital units such as that used in prefabricating housing units.
5. Assembling the best medical minds in a high level advisory council.
6. Establish a Federal Program to certify skilled nurses as doctors. Be prepared for a flood of highly skill nurses from the public sector.
7. Establish a job training program for Vets undergoing extensive physical therapy to certify them as Physical Therapists for jobs in the private sector.
This list is far from being complete and misses the important innovations generated by VA employees through innovation and continuous improvement of their jobs resulting from the implementation of Enterprise Lean.
Monday, August 4, 2014
Article 72. Restoring Management Excellence at the VA
The VA Health Care system has a clear obligation to improve its management capability through Best Practices both in the medical services it provides to Vets and in the management practices it uses to manage the Health Care system. The OIG provides audit capability for lost and misspent funding. This is an after the fact activity which largely misses what is really is needed in managing the VA Health Care System. The Audit capability manages waste in funding dollars it does not manage labor expenditures or machine and facility utilization. The VA does not have a labor management system based on the actual cost of health care processes nor does it have an adequate equipment and facility utilization system based on Resource Accounting. But Resource Accounting can be very expensive to implement and manage I recommend that that resource management of machine and Facility utilization be tied directly to the Best Practices in health care. Once the Best practices have been established for a medical area such as Cardiology they will determine the needed imaging equipment and the floor space for a balanced patient load.
The VA does have Quality management Services
The Quality Management Service focuses on the Veteran and organizational functions that promote positive patient outcomes by standardizing processes. These standardized processes can be used as a starting point for the development of the cost in labor and expense for all functions of the VA. Without this basic data VA management can not adequately determine which functions are operating with relative efficiency and which are not. Private industry keeps tabs on the cost of parts and labor processes using time study but due to the cost of time studying they only time study manufacturing production areas. The following approach avoids the cost and the disagreeableness of time studying health care personnel.
Enterprise Lean avoids the problems of time study by empowering the employees themselves to find the most effective way including testing of current Standardized practices to arrive at a Best Practice for doing their jobs followed by determining how this can be done with the most efficiency. In the process of doing this you will be employing the knowledge of the employees who are actually doing the work in most cases the real experts. Facilitators Guide the Functional Lean Team through the Lean process and document the results in a Best Practices spreadsheet. Besides the identification of the Best Practices for health care and management the lean process will also provide: the labor hours expended, the machines utilized and a basic sample of the floor space involved in the function. When all of the functions have been documented you will have a functional budget and the critical data needed to manage VA operations. But most importantly the data can be used to develop a balanced work load to minimize Wait Time. Employees waiting on other employees is the single biggest source of inefficiency. This is addressed in the development of a Throughput Staffing Schedule which balances employee work assignments for different levels of patient appointment schedules.
The second part completes the implementation of the modified Enterprise Lean in all remaining areas of the development VA Facility.
This approach works in all areas where the number of Doctors is the key driving force but where Psychologists and Physical Therapists are involved an entirely different approach is needed based on the diagnosis of each individual patient and the patient's plan of recovery. I suggest the following approach:
1. Establish a high level Doctors Lean Team to develop or adapt Best Practices for patient Recovery Plans.
2. Standardize Recovery Plans.
3. Determine the cost for each recovery Plan.
4. Determine the number of patients assigned to each Recovery Plan for an annual budget.
Overall Plan based on number of Doctors:
First two months
Each VA Medical Facility will identify all maximum patient loads in each medical area to meet required patient appointment schedules (not a part of the Consulting Agreement). This data will be needed to staff Throughput Schedules being developed at the development VA Facility.
This Consulting Agreement develops a Throughput Schedule plan for each area where medical services are needed to meet increased VA patient loads. An OIG Analyst will be assigned to each medical area to Facilitate Hospital Employee Lean Teams in applying Best Practices to each of their Functions. The Lean Data will be captured in a spreadsheet and used in the higher level Doctor’s Lean Team to develop the Throughput document which will be captured in a staffing spreadsheet. The Throughput staffing spreadsheet will contain a large number of repeated reiterations of the original Best Practices balanced schedule design. The Throughput Document will contain enough reiterations to meet any VA facility’s patient appointment schedule requirements.
Third month
The staffing spreadsheet for each medical area will be test implemented at the development VA Medical Facility. With the success of the test implementation each spreadsheet medical area will be stored on a thumb drive.
Fourth Fifth and sixth months
Each OIG Analyst will depart The development VA Facility for another VA Medical Facility with the medical Thumb drives containing a spreadsheet Throughput Schedule for each medical area. Spreadsheets have a unique capability for selecting what gets printed. In this case the number of patients needed to meet a VA Facilities appointment Schedule can be selected from the staffing spreadsheet before printing the Throughput Schedule for a specific VA Facility.
Part two should be implemented at all VA facilities this will take some time but trained OIG Analysts should be able to make these implementations in a few years. As new VA medical facilities are built any over-staffing identified by the full implementation of the General Reform Model in existing VA Facilities can be transferred to the new VA Facilities.
Organizational Reform:
To address the problem of the toxic bureaucratic culture of the VA I recommend replacing the Bureaucracy with Team Management. The Principal Consultant will begin the process of organizational reform by replacing the Bureaucratic organization with a Team Management organization with top management managing the Agency’s activities through Group Teams with each managing several Functional Teams. The Lean Teams at the Functional level will become self managed Functional Teams with each of their elected leaders reporting directly to a Group Managed team. Group Managed Teams will assume their management role from the pre-organized high level Lean Teams. There is some flexibility in how this process actually occurs but it is necessary in order to eliminate the problems caused by the Bureaucratic organization. The important advantage in changing from a Bureaucratic organization to a Team Managed organization is to prevent the return to a toxic bureaucracy. The Team Management process eliminates the need for low level supervisors saving $billions.
I suggest that VA Should Look into the expansion needs of those VA hospitals that are operating on one shift. A two shift operation doubles the capacity and solves machine and facility requirements almost instantly.
The VA Health Care system has a clear obligation to improve its management capability through Best Practices both in the medical services it provides to Vets and in the management practices it uses to manage the Health Care system. The OIG provides audit capability for lost and misspent funding. This is an after the fact activity which largely misses what is really is needed in managing the VA Health Care System. The Audit capability manages waste in funding dollars it does not manage labor expenditures or machine and facility utilization. The VA does not have a labor management system based on the actual cost of health care processes nor does it have an adequate equipment and facility utilization system based on Resource Accounting. But Resource Accounting can be very expensive to implement and manage I recommend that that resource management of machine and Facility utilization be tied directly to the Best Practices in health care. Once the Best practices have been established for a medical area such as Cardiology they will determine the needed imaging equipment and the floor space for a balanced patient load.
The VA does have Quality management Services
The Quality Management Service focuses on the Veteran and organizational functions that promote positive patient outcomes by standardizing processes. These standardized processes can be used as a starting point for the development of the cost in labor and expense for all functions of the VA. Without this basic data VA management can not adequately determine which functions are operating with relative efficiency and which are not. Private industry keeps tabs on the cost of parts and labor processes using time study but due to the cost of time studying they only time study manufacturing production areas. The following approach avoids the cost and the disagreeableness of time studying health care personnel.
Enterprise Lean avoids the problems of time study by empowering the employees themselves to find the most effective way including testing of current Standardized practices to arrive at a Best Practice for doing their jobs followed by determining how this can be done with the most efficiency. In the process of doing this you will be employing the knowledge of the employees who are actually doing the work in most cases the real experts. Facilitators Guide the Functional Lean Team through the Lean process and document the results in a Best Practices spreadsheet. Besides the identification of the Best Practices for health care and management the lean process will also provide: the labor hours expended, the machines utilized and a basic sample of the floor space involved in the function. When all of the functions have been documented you will have a functional budget and the critical data needed to manage VA operations. But most importantly the data can be used to develop a balanced work load to minimize Wait Time. Employees waiting on other employees is the single biggest source of inefficiency. This is addressed in the development of a Throughput Staffing Schedule which balances employee work assignments for different levels of patient appointment schedules.
Obtaining the Critical Management data Needed by the VA
I recommend that my General Reform Model be implemented in two parts. The first part addresses the immediate need to develop the data for determining staffing and facilities expansion for all VA facilities. This done by providing a Throughput balanced work load for each medical area with expanded steps which can match the patient requirements for any VA facility. This will be done in the areas where increased patient services are required.The second part completes the implementation of the modified Enterprise Lean in all remaining areas of the development VA Facility.
Part One:
The following approach addresses the immediate need to develop the data for determining staffing and facilities expansion for all VA facilities. This is done by providing a Throughput balanced work load for each medical area with expanded steps which can match the patient requirements for any VA facility. This will be done first in the areas where increased patient medical services are required. Think of each step as being a balanced set of Best Practices functions that eliminates wait times with the right combination of staff that can service a specified number of patients. With each step a doctor and support and nurses are added and the functions are rebalanced servicing a larger number of patients.This approach works in all areas where the number of Doctors is the key driving force but where Psychologists and Physical Therapists are involved an entirely different approach is needed based on the diagnosis of each individual patient and the patient's plan of recovery. I suggest the following approach:
1. Establish a high level Doctors Lean Team to develop or adapt Best Practices for patient Recovery Plans.
2. Standardize Recovery Plans.
3. Determine the cost for each recovery Plan.
4. Determine the number of patients assigned to each Recovery Plan for an annual budget.
Overall Plan based on number of Doctors:
First two months
Each VA Medical Facility will identify all maximum patient loads in each medical area to meet required patient appointment schedules (not a part of the Consulting Agreement). This data will be needed to staff Throughput Schedules being developed at the development VA Facility.
This Consulting Agreement develops a Throughput Schedule plan for each area where medical services are needed to meet increased VA patient loads. An OIG Analyst will be assigned to each medical area to Facilitate Hospital Employee Lean Teams in applying Best Practices to each of their Functions. The Lean Data will be captured in a spreadsheet and used in the higher level Doctor’s Lean Team to develop the Throughput document which will be captured in a staffing spreadsheet. The Throughput staffing spreadsheet will contain a large number of repeated reiterations of the original Best Practices balanced schedule design. The Throughput Document will contain enough reiterations to meet any VA facility’s patient appointment schedule requirements.
Third month
The staffing spreadsheet for each medical area will be test implemented at the development VA Medical Facility. With the success of the test implementation each spreadsheet medical area will be stored on a thumb drive.
Fourth Fifth and sixth months
Each OIG Analyst will depart The development VA Facility for another VA Medical Facility with the medical Thumb drives containing a spreadsheet Throughput Schedule for each medical area. Spreadsheets have a unique capability for selecting what gets printed. In this case the number of patients needed to meet a VA Facilities appointment Schedule can be selected from the staffing spreadsheet before printing the Throughput Schedule for a specific VA Facility.
Part Two:
The second part begins in the third month and completes the implementation of the modified Enterprise Lean in all remaining areas of the development VA Facility. The reasons for doing this is to determine where over-staffing is occurring so employees can be retrained to fill the needs in under staffed critical medical areas and to develop a functional Budget for the development VA Facility. This will provide the data needed for management budget decisions as well as machine and floor space utilization for the entire development VA facility.Part two should be implemented at all VA facilities this will take some time but trained OIG Analysts should be able to make these implementations in a few years. As new VA medical facilities are built any over-staffing identified by the full implementation of the General Reform Model in existing VA Facilities can be transferred to the new VA Facilities.
Organizational Reform:
To address the problem of the toxic bureaucratic culture of the VA I recommend replacing the Bureaucracy with Team Management. The Principal Consultant will begin the process of organizational reform by replacing the Bureaucratic organization with a Team Management organization with top management managing the Agency’s activities through Group Teams with each managing several Functional Teams. The Lean Teams at the Functional level will become self managed Functional Teams with each of their elected leaders reporting directly to a Group Managed team. Group Managed Teams will assume their management role from the pre-organized high level Lean Teams. There is some flexibility in how this process actually occurs but it is necessary in order to eliminate the problems caused by the Bureaucratic organization. The important advantage in changing from a Bureaucratic organization to a Team Managed organization is to prevent the return to a toxic bureaucracy. The Team Management process eliminates the need for low level supervisors saving $billions.
I suggest that VA Should Look into the expansion needs of those VA hospitals that are operating on one shift. A two shift operation doubles the capacity and solves machine and facility requirements almost instantly.
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