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.

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.