Waiting on Cookies ‘n Cream: My Experience with Level Loading in Healthcare

Posted on Posted in Featured Article, Medical Practice

If you’re from the southern region of the United States, then I’m sure you’ve heard the story of Blue Bell ice cream and the reasons why it had to halt production earlier this year. Blue Bell carries quite the following, and several friends of mine eagerly awaited the return of this Texas treasure.

My favorite has always been Cookies ‘n Cream.

Cookies ‘n Cream was hard to come by when Blue Bell FINALLY got back into stores a couple of months ago. The reason being that the company had limited resources and capacity available as it got plants back on line, and as such, their production started with the classics of chocolate and vanilla. As a customer of Blue Bell who had weathered several months without my favorite flavor, I was willing to wait a little longer for Blue Bell to get Cookies ‘n Cream back on the shelves. I did this while enjoying the Cookies ‘n Cream version from a competitor. I know — blasphemous!

So, from a process perspective and with only the knowledge of what I’ve been able to observe as a consumer of Blue Bell, the company has had to bring it’s full complement of flavors online slowly and in phases. It has had to limit access to certain flavors, because of a need to produce, what I can only perceive as, the classics first – doing this to ensure they get a good inventory level into its distribution channels. In essence, Blue Bell was following the principle of level loading its production resources to meet the needs of its customers.

ThroughPut Solution’s lean glossary defines level loading as: (a.k.a. Heijunka, Balancing) A Technique used to balance production throughput according to the needs of customers (Demand).

As an industry, Healthcare routinely deals with the concept of assigning limited resources to a specific task or function, therefore, limiting that resource from fulfilling needs of other tasks or functions. Over the next few posts, I will provide you with expanded examples of the experiences I’ve had with several healthcare organizations related to finding the right mix of deploying limited available resources. Below, I have briefly described the challenge presented in each situation.


Physician Office Appointment Availability

One large specialty physician practice I worked with had a next available appointment date of 15 days out making it hard to accommodate referrals that required follow-up on a shorter timeline.

In a very busy physician office, the challenge that is presented is balancing the need to have new patients coming into the practice with being able to keep up with the existing patient population the physician serves. The easy answer is to throw more resources at it by bringing more physicians into the practice to help alleviate some of the pressure on the physicians who already have an established presence within the medical practice. This could prove to be an expensive proposition for a small practice and if there is limited exam room space, a facility upgrade may be on the table as well – adding more cost. Another option to consider is to reevaluate the template used for appointment scheduling and reviewing the processes integral to the patient flow through a patient visit.

The goal with this team was to increase new patient volume while maintaining (or improving) the amount of follow-up appointments accommodated by the physician’s current schedule template.

Infusion Suite Capacity

Infusion Suites encounter a wide mix of treatment duration’s throughout the course of one day. For example, one patient may undergo a 6 hour, 8 hour or longer treatment while others will require 2 hours or less to complete their visit for the day. In my work with several infusion suites, the situation the team I worked with found was one where the schedule was front-loaded showing a very busy clinical space in the first half of the day. The nurses on the team were at capacity an hour in to the schedule and patient wait times were impacted as the team got each patient started on their infusion. This resulted in a very busy first half of the day, but by 2pm (sometimes as early as 1pm) the infusion suite would be empty and their would be unused capacity.
The challenge presented in this situation was to find a way to utilize the existing clinical resources to increase the volume seen in the facility through a revamp of the infusion suites schedule, level loading the staff schedule to increase overall capacity and placing a focus on reducing non-value added work.

Hospital Admission & Discharges

What happens when 11 admissions come in to the hospital through the emergency department and there are 11 discharges planned, but several of them don’t have a discharge order. An analysis I conducted of two separate and very different community hospitals’ admission and discharges revealed the same pattern. The pattern showed admissions would start trending up in the ED around 10am showing a peak around 1pm and 4pm while discharges would begin increasing around noon and peaking around 8pm.
The task at hand in this situation was to find a way to have anticipated discharge orders available, have the necessary resources available to turn the bed over and meet the demand of incoming inpatient admissions all the while making it as seamless as possible to the patient.

I will be covering how the teams involved impacted each of the situations described above over the next few weeks.

How would you approach one or all of these situations?

Follow me on Twitter: @JamesCHearn

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