Suffering with hospitals

There is a growing trend in implementing Lean tools and concepts in non-manufacturing environments. I have already worked in a Customer Service area, Engineering Product Development, Export and Import. What  they do have in common is: lots of waste and opportunities!

Waste is a non-value-added activity, which the customer is willing to pay for. At Toyota, the seven wastes were classified in:

• Overproduction, the worst one;
• Waiting;
• Material transportation;
• Unnecessary process;
• Inventory
• Movements;
• Defects;

Going to an hospital is far from being a joyful activity, especially for the kids. It is suffering from the beginning to the end and I understand that part of that suffering could be much less. Well, this week I went to a doctor with my son and I faced a lot of waste in this process. I do not know if people realize how simpler it could be.

At least here in Brazil, scheduling is the easiest part. The problem begins when you arrive at the hospital or clinic. When we arrived, we parked the car and we were supposed to go to the infirmary. Question: do you think there was any identification showing where it would be? You are right, there was not. We went to the main reception and, after 10 minutes waiting, we were informed where to go.

In our case, we arrived 15 minutes before the scheduled time and then we went to the reception, where we got to pick a password number to be attended. Why is it all about? Simply for the lady at reception desk confirm that we really had all the docs required to go to the other reception (????). Yes, there was another reception desk and another kind lady who started to generate (finally) the medical protocols. Despite the disorganization in her desk, we realized that we had non-schedule patients already waiting, but ahead of us. I just argued the reason of scheduling with her and I had no response.

After 10 minutes waiting in line, some more minutes waiting the lady to look for the protocols in the middle of work in process papers on the desk (finished protocols, waiting approvals, on going protocols), we were finally attended and guess what? We had to answer the same questions already made in the first reception desk, and we had also to confirm the things that were already written in the medical protocol such as, "which exam are you going to do?". A complete waste of time!

After overcome this step, we were sent to the WAITING room (one of the seven wastes). 10 more minutes waiting until finally see the doctor for the exam. 5 minutes with the doctor and we could go back home.

Let's us make an analysis. We took almost 1 hour to see the doctor. Let's take a look in a graphical way:

Applying some LEAN concepts, this time could have been much less:

1 - improve visual displays and signals, especially in the hospital entry. That would make people spend less time looking for where to go (5S);
2 - the main reception is an unnecessary step for the scheduled people . It should be a standard and clear that it is only required for emergencies and non-schedulled patients (Standardized Work);
3 - There is no priority in the exams, neither a way of time schedule management to allow doctors to attend non-scheduled patients. A Visual Management board would be very useful here;
4 - There is an opportunity for leveling. Non-scheduled patients should only be attended in low load periods of the day (Heijunka);

As to me, the biggest waste was my time, but concerning the hospital, there is clearly a waste of money. If cases like mine were faster, it would allow the hospital to perform  more exams and, as consequence, more earnings to the hospital. And I am not mentioning the motiviation for the employees for being more productives. I hope to have initiatives like in USA in the future, where Lean Hospitals are spread (at least a bit).

Vueling: lack of customer value understanding

The greatest LEAN thinkers have defined it in 5 principles, as follows below:

1. Specify what creates value from the customers perspective
2. Identify all the steps along the process chain
3. Make those processes flow
4. Make only what is pulled by the customer
5. Strive for perfection by continually removing wastes

Last year I went several times to Europe to work in a project. In one of my visits to Spain, I came to know one interesting fact by its lack of Lean, specifically the first principle (value).

In Spain, there is an airline company called Vueling, a low cost airline company for domestic flights mainly. The positioning of the company is well-defined: transport passangers with low operational cost, offering low cost tickets. That's it! I have flown once with them and comfort definitely is not part of the strategy.

That is not an issue. That is the company's strategy and it is bringing good results for them.

The problem is... In the lust of bringing more customers, the company launched a flight from Barcelona to  Lerida. You might be asking what is the problem with that? Simple! Do you know what is the distance between Barcelona and Lerida? 160 Km. Take a look at the map below.

Travelling by car would take us 2 hours to complete the journey. By train (there is a high speed one), it would take us 30 minutes, but we have got to include the transit time to the station plus check-in time... let's say 1h15 minutes approximately.

What does it mean? Who will buy an airplane ticket to travel the same distance that can be done faster and easier by either car or train? The answer to that question is: 2 people! They could only sell 2 tickets! Take a look at the press release:

According to the company, it was a marketing strategy mistake. In my opinion, they did not understand that a customer would never pay more to spend more time. Furthermore, the operational cost of Vueling is higher compared to the benefit generated. It was clearly a lack of customer value understanding. Actually, it was a lack of LEAN!

Welcome to the blog "Lean for all"

The idea of this blog is sharing the daily routine situations that could be easier, faster and with higher quality, I mean, much more LEAN.

Daily we are in contact with situations like this and I will share it with the readers for discussions. We will have the opportunity to discuss how it could be improved and how our world could be better.

Let's make the world more LEAN!