If I were to define service as an efficient jugglery of to dos, with the right amount of resources and a great communication system, what would lean mean?
Lean is not mean. In fact, lean must mean an intended service, one with a well-defined service level to meet the expectations of any person, or for that matter, any process. A process is made to ensure the replication of a set of expected results. In fact, one can build up expectations for our brands and ensure that they are maintained by lean methods…
For example, when I board an Indigo flight, I expect it to fly on time largely. I also expect to board in a smooth, no nonsense way with a set precedent. Airlines maintain a close to zero idle time for aircrafts in between landings and take offs. Over the years, they have been able to retain this image largely. If you examine closely, a lot many lean principles are in play right from staffing to the precinct operational aspects – cleaning, check-in queues, boarding passengers, in cabin services, etc. Over the years, the efficacy of this ‘way of operations’ has been maintained… largely. And this has also most surely reflected in the financials and the business sturdiness of the company.
My most favourite burger junction remains McDonald’s and for me it is the epitome of speed through the driveway, pay and pick the grub, all within minutes, and since I am lucky, mostly with smiling servers. I have experienced this across many geographies. Their India experience aside, the business model has shown great promise across other countries.
Etched in my memory is my visit to the Bumrungrad International Hospital in Thailand way back in 2007. A walkthrough of the hospital’s services, process functioning and the attention to every detail from the patient’s perspective is something I still marvel about. In India we are still far from that level of precision in service. Since the time I have been tracking them, they have consistently been awarded for consistent sigma metric excellence. One of the most shining example of service excellence and lean principles going hand-in-hand.
Closer home, we were able to up the patient satisfaction index by 10 per cent, reduce daily interdepartmental complaints by 30 per cent, upped the per bed earnings by 9 per cent, and increased contribution by 5 per cent as a proportionate impact of service improvements amongst others by introducing some lean factors in a hospital. All of this by simply focussing on removing obstacles faced by staff and patients. All the processes were re-engineered with an eye to make things easy and quicker and one could see the perceptible difference when daily patient complaints started turning into appreciations for the team on ground. Slowly these appreciations turned to a perceptible difference in numbers as well. Since everything moved fuss free through system the patients went home earlier, the ALOS reduced, and the beds turned around faster, enabling a better throughput. And this has been a repeated experience. This was the effect when the treatment aspect wasn’t even touched — in fact, nor was the patient aspect. The target of the project was to make it an easier place to work and generate smiles amongst the staff.
The service stories compel one to wonder about the effects doctor schedules could have if they were to be made around patient scheduling. Most of the patient complaints are around the wait times – delayed appointments, delayed in-patient visits, delayed OTs, and of course delayed report results. Most of these delays are linked to doctors’ schedules. No one likes to wait, and definitely not when one is ill. What if the medical professionals followed their schedules as, in the legendary Dr. Eric Topol’s words ‘’the Patient will see you now”? In a hospital’s context, it is not that the doctors like to make their patients wait. On the contrary, the plethora of tasks that they manage calls for a lot of multi-tasking. If all these tasks were somehow to fit in like a big jigsaw puzzle, the remaining effect on a hospital’s patient satisfaction index as well as the balance sheet would be phenomenal.
Time management, protocolisation, communication and multi-tasking in multiple moving parts of any healthcare service calls for a lot of organisation. Ensuring that these work in tandem without dropping the ball reminds one of complex jugglery. And so, these also become a critical aspect of the required training. More so for the doctors. Despite the academic nature of the profession itself, very few doctors have exposure to various management tools. One will hear of a lot of training within a hospital but all of it is mostly on skill building. Of course, each of these skills are centred around the discipline of technique. But the softer aspects that would help them deal with many complex situations that entail resource management and even non-clinical aspects of patient management, more often that not, evades them.
Have you ever witnessed this? There are many team members assigned to do the same tasks. And, no one does them. Well, someone could have, but, no one did. Was it a lack of training, or protocol? Or was it a lack communication and understanding? Or even time management? Or is it a typical case of too many cooks spoil the broth, or in fact not making the broth at all! The answer lies in lean. The right resources for the job with the right tools gets the work well done. Very often I have seen that problems occur not when the staff is less but much rather when there is more staff as there is enough idle time to spoil the rhythm of work.
Lean involves negating overheads — be those of wasted resources, or unwanted costs. Lean could also mean listening to the voice of the customer (internal and external) as well as innovation of newer ways of doing things. Of course, in hospital realms, especially where variability can be high, one needs to draw lines around certain limits, lower as well as upper. In the ongoing pandemic situations, there are hospitals witnessing both ends of the spectrum. There are those that are too empty and there are those that are too full. And both are painful for the stakeholders.
Service promises are a great way to reach out to patients who are the service consumers for healthcare service providers, who in turn are the service consumers for device and drug manufacturers, HIT and so on through the value chain. Lean methodologies can help keep the value chain gated from the fallacies of unhealthy bulges, keeping the objective in mind as well as keeping the chain itself healthy. But all this is a continuous effort of monitoring and upgrading.