You’re Doing it Wrong Part 7: Workflow and Organic Processes

“This is the way it has always been done” is a sure way to sink a business

Introduction

We are taking a step back from healthcare and health insurance to bring you a new series: You’re Doing it Wrong.  In this 15-part series we will discuss all the things that business people, et al., do that are counterproductive and raise the cost of their own products and services and consequently the cost to you, dear reader, the consumer.  This seventh installment is an indictment of the entire workflow mentality: Assigning a worker to the work instead of managing processes.  

We are taking a break from healthcare because there is no new real news.  The AI hype is just getting worse and will never pan out; the EMR vendors haven't realized that you can't document encounters with text or language; insurance companies rip off everyone, so we are stepping back and looking at the bigger picture.  If you need your weekly dose of healthcare, read our article Saving Healthcare: How to Make Rural Healthcare Viable

The Situation

Jonah runs a manufacturing plant.  Before you say “this doesn't apply to me; I’m not in manufacturing,” it does apply to you.  Jonah wants to be successful and produce as many widgets as possible with the fewest resources.  Jonah walks through the plant one day and notices blank widgets piling up in front of the widget lathe.  Jonah has a bottleneck at the widget lathe.  The widget lathe operator is frantically trying to keep up, and the widget lathe itself is running at capacity.  The upstream workers are standing at their machines, bored, knowing that working at capacity will only make the bottleneck worse.  

This is the situation at hundreds of millions of workplaces worldwide.  Someone, or tens of someones or hundreds or thousands of someones are waiting on one employee to get done with his or her work.

The Logical Conclusion 

Jonah has competition.  There are maybe hundreds of Jonahs around the world competing with our Jonah and they are ready, willing and able to find a way to put him out of business.  With our bottleneck above, it shouldn't be hard either.  

Jonah faces an existential crisis: not solving this bottleneck could close the plant and take not only his job, but hundreds of others at the plant and the plant itself with him.  

The Short Answer

Eliminate the bottlenecks.  Buy more widget lathes and hire more people to run them.  Find the next bottleneck.  Lather, rinse repeat until you are making enough widgets that the price has to go down due to supply and demand.

The Slightly Longer Answer

The previous Short Answer is certainly one way to solve the problem, but it is very brute force and not artful at all.  If we employ a little finesse, we may be able to do a little training and just do more with less.

If you are wondering why I picked the name Jonah, he is the main character in Eli Goldratt’s The Goal, where he discusses the Theory of Constraints.  We follow Jonah through the entire learning process to an elegant and satisfying conclusion.  

Jonah learns to look at the entire process holistically, not as individual processes.  He learns that throughput is his contribution to the company and the goal of the company is to make money.  Specifically, he learns

1. Identify
   Find the constraint and examine why it slows down production
2. Exploit
   Squeeze as much capacity as possible out of the bottleneck in an effort to remove it.
3. Subordinate
   Subordinate all other process steps in terms of time and resource allocation
4. Elevate
   Invest time, money and equipment to ease the constraint.
5. Release
   Move on from the removed constraint by changing focus to the next constraint and following the same five steps

That is all well and good, but what does it mean exactly?  How do you do that?

Let’s look at another example in our usual subject: healthcare.  

Normally, a hospital will assign one nurse to four or five rooms depending on the department.  Let’s assume four.  In a twenty room department you therefore have five nurses.  At any point during the day/week/month/year, one nurse will be completely awash with work that s/he cannot possibly get done.  It is just too much.  A second nurse will be just right and getting things accomplished without tasks getting missed and “falling through the cracks.”  The other three will be standing around gossiping or “charting” or otherwise just waiting for new tasks or doing busy work.

That sounds a lot like Jonah’s problem with his widget lathe operator, doesn’t it?  

In Jonah’s case, he could cross train the foundry or powder coating staff to help out the lathe operator.  He could buy a new lathe to absorb capacity at peak production and run it with the finishing or foundry people as necessary, or he could just hire an additional lathe operator to go with his new lathe.  

In the hospital case, we don’t even need to cross train our staff; they are all doing the same job, with the same equipment.  What we need is a way to spread the load over the entire staff and right size it.  What administration needs is a work queueing system.  A queue is established for each room in the department and each qualified nurse.  All the nurses subscribe to all the room’s queues.  The normal things, like “check on the patient every two hours” and “give medication” are all automated, while ad hoc things like “the patient in 302 just rang the nurses station with a bathroom request” are added as necessary.  The oldest/most urgent task in the queue is assigned to the longest idle nurse.  This way we get all the work done, nothing falls through the cracks and everyone does the same amount.  Further, we have time for long running processes that would otherwise take days to get accomplished in lieu of all the other things that need to be done.  Finally, a performance review becomes more than a popularity contest.  For the first time we can see what tasks and what kinds of tasks each employee got done and what takes the longest and maybe come up with a solution (like a research assistant at half the cost of a nurse) to solve problems creatively.    

For example, my mother was in the hospital after Thanksgiving.  The doctor wanted to do an MRI.  Mom has a bladder control implant.  They can’t do the MRI without completely tuning off the implant.  The nurse needed a couple/few hours to find the manufacturer and get the instructions to turn off the implant.  That two-hour process took eight days.  That is a huge waste of time and energy.  

The queueing system would also work in Jonah’s case too, though asking machine operators to carry a device and check it may be a little much.  Instead, we can watch the throughput of each machine and post it on a monitor for everyone to see and react to.  When the widget lathe operator gets snowed under, send the employee with the most excess capacity and therefore the least backlog to help clear the lathe backlog

Conclusions

Linear workflow thinking and their inherent, organic processes grow up over time.  It is easy to say “this is the way it has always been done.”  If Goldratt’s Jonah had said that, he and all his workmates would be out of jobs.  

We have shown a way to eliminate workflow thinking and replace organically grown processes with a queueing system that will streamline and automate processes and process steps.  In reality, there is no process.  A task may have dependencies, the widget lathe operator doesn’t have anything to machine without having raw materials from the foundry, but this is not a workflow. This is a dependency.  The foundry should build up a backlog for the machining and then go help with the machining.  It is just as easy in a business, medical or any other setting.  The employees get cross trained to do each other’s jobs and then go do them on demand.    

As an aside, I have been admonished not to use the term bizdiot, it is off putting, so we won’t.  If, however, this term offends you, maybe you should look at and modify your own actions instead of being offended and expecting me to change mine.  

I calls ‘em like I sees ‘em.

Remember, this is part seven of a fifteen-part series about how businesses are being run incorrectly by business people who probably haven’t been trained in the Theory of Constraints.  We are demonstrating not only the problems of modern business, but real, viable solutions.

 I will be putting out one or maybe two articles per week.  If you liked what you read or want to relate your personal experiences, contact us here, on our site, SentiaHealth.com, our parent company SentiaSystems.com, or send us an email to info@sentiasystems.com or info@sentiahealth.com.  By here I mean comment and tell me that I am a cotton headed ninny muggins or whatever else you need to say.