Article 119. Simple two Part Reform can Achieve Massive Improvement in the VA

Simple two Part reform can Achieve Massive Improvement in the Veterans Administration.  The two part reform can be implemented almost entirely by existing VA personnel. The reform increases Management control, solves most of the VA's personnel problems and adds efficiency in Part Two saving $billions. I am available to answer any questions you may have about the reform call: LawrenceRosierConsulting (573) 426 2997.

Part 1. Continuous Improvement Teams

A simple two part reform can achieve a massive improvement in the Veterans Administration.  The first part is the implementation of Continuous Improvement Teams (CI Teams) throughout the VA in its hospitals and its offices.

History: CI Teams originally known as Lean Teams (aka Enterprise Lean) were first implemented by Toyota and adopted by nearly all Automotive MFG companies.  Now it has been implemented in Washington State, Minnesota and Iowa state Governments. It has also been implemented at the Cleveland Clinic.

Reason: The Veterans Administration is a large bureaucracy that is not easily managed by the Secretary of the VA especially for appointments from outside the VA by Presidents.  By implementing CI Teams throughout the VA the Mission for Continuous Improvement is given priority and a physical presence within the organization. Each team has a direct connection to VA's DC office where difficult problems can be solved.  Each Team is comprised of a working group both in hospital procedures and in VA offices. Team Leaders are elected by secret ballot and meet once a week or once a month to review and implement improvements to their work processes.

Part 2. The Daily Plan

The Second part of the reform implements what I call a Daily Plan by each CI Team whose basic processes do not change and are the same from day to day.  The CI Team with the help of a trained consultant creates a standard Daily Plan which can be duplicated in all VA areas where the same process is being done.

Development: Nearly all hospital Procedures undergo Planning and identification of which individual is going to do what job during the procedure.  The Daily Plan Standardizes this process and organizes it such a way that balances out each job such that jobs begin and end at the same time.  Thus no employee has to wait on another employee to finish his job. To achieve this the employee who has too much work will give some of his work to another employee that has less work and balance the operation.  The result is a very highly efficient operation that when operated continuously with a higher volume of patients in a hospital environment can increase the average efficiency by 60%.

Summary: This simple implementation throughout the VA will attain maximum efficiency.

Suggestions for implementing Reforms in the VA

 

Overview of Approach to Reforming Veterans Affairs.

The standard Government and Industry approach which I have developed can be used for implementing Reforms in the VA.  This approach first implements Continuous Improvement Teams (Enterprise Lean) facilitated by OIG Analysts.  As a part of Enterprise Lean's basic function of continuous improvement, Daily Plans are produced by the CI Teams doing repeated processes..  This activity is aided by OIG Analysts acting as Facilitators.

Reorganizing for the Implementation of Reforms

This approach taps into special expertise of the VA OIG organization retraining OIG Analysts to be the primary implementers of the VA reform process.  Using Government Personnel (OIG Analysts) instead of Outside Consultants, enhances the expertise of the OIG organization and will save $millions.  This approach will leave an ongoing OIG organization to maintain government management efficiency. Ref: Article 88. Lawrence Rosier Consulting Blog.

Pilot implementation 
Veterans Affairs Hospitals were selected as a likely pilot for starting the implementations of reforms. This will give a boost in helping Veterans needing healthcare and speedup Patient care through implementation of special patient throughput techniques.  Ref: Article 100. Lawrence Rosier Consulting Blog.

I suggest that the reforms be implemented first at the Hospital Facilities of the Washington DC Veterans Affairs Medical Center 50 Irving St NW, Washington, DC 20422

The Phases of the Reform Process

Implementation of Continuous Improvement Teams
The first phase is the implementation of Continuous improvement Teams. I suggest that OIG Analysts be trained as facilitators to guide each CI Team through the election of a leader process.

Implementation of the Daily Plan

OIG analysts will work with the CI Teams to get the highest efficiency and effectiveness possible in the Daily Plan.  OIG Analysts can use the data developed from the Daily Plans to develop bottoms-up budgets which identify the actual costs of all needed systems.  This is also the data needed to manage the organization’s work load and in the determination of staffing needed. Ref: Article 96. Lawrence Rosier Consulting Blog

A suggested simple approach is orient OIG Analysts as facilitators and immediately implement the selected VA hospital into CI Teams. The facilitators will then lead each team into building its Daily Plan.

Review of Lean Team Results and Collection of Lean Data

After a period of about two months most Functional Lean Teams, those that were organized and trained by OIG Analysts acting as Facilitators, should have their Daily Plans completed.  I suggest that some Functional Lean Teams with significant savings present their improved method to upper management.   The OIG Analyst will study the new method to document savings

Activities of the Reform Consultant

The Consultant will play a key role in being sure that the employee CI Teams are properly trained.  The Consultant will insure that the activities of OIG Analysts will be able to facilitate the implementation of CI Teams and will also aid in the development of daily plans.


Attaining a Balanced Work Flow

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

The Maximum Patient Throughput Method

The first activity is to determine the actual backlog of patients waiting for each specific hospital Procedure and select the most critical needed.

Individual employee Lean Teams (including Nurses) meet to determine the most effective way to do their Procedure in a Daily Plan.  The objective is to find the most effective and efficient way of doing the Procedure in a balanced work load environment. The Daily Plan is built around the Doctor or surgeon’s time in doing the Procedure for each patient.  This time determines how many patients can be done in a day.  The design of the Daily Plan may be repeated with another Doctor or surgeon to bring down the backlog.  

The Daily Plan arranges the processes in the order that they may be completed some in parallel with the Doctor’s time as key to obtaining the Maximum patient throughput Schedule.

The method also determines the equipment utilization of the process.  Besides determining the maximum throughput of patients the process also establishes a cost for labor and equipment depreciation and a budget for each Function.  The data can also be used to determine the exact increase in staffing and equipment needed to meet a desired patient appointment and processing schedule.  Support operations personnel are used to fill in when Team members are on vacation or absent.

Accurate Cost Data

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.  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 practices and innovation to get the highest efficiency with a balanced work load. The Development of a balanced work load in each medical procedure area is the key to determining the minimum staffing needed to meet patient appointment schedules.

Three levels of Throughput- Current, Capable and Required 

When we examine Patient Throughput we find that there are 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 bring down high Patient backlog levels.  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 can 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.

If the original Capable 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.

Before new computer VA Reporting 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 two months but the computer systems will take as much as a year to develop time that the VA does not have. Ref: Articles 54 & 55 Lawrence Rosier Consulting Blog.

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