Productivity 3: Productivity is more than a process

This the the third in a series of Productivity notes by Sarah Fraser. Productivity is more than a process.

New and improved policies can impact the design and implementation of efficiencies. For example, new recruitment, pension, appraisal and similar policy changes can impact processes not only in the short term but also long term. I do think that policy improvements are a necessary condition for many other efficiencies to be put into place.

Clinical productivity is often conceived as as "how hard are we sweating out clinical assets". Another way of looking at this is to see clinical productivity as the most up to date and best practice clinical methods being used. For example, continuing to carry our surgical procedures that are no longer proven to be effective is not productive.

Process productivity is the most familiar aspect of efficiency chasing in healthcare. Largely based on the principles of Lean (or reduced and less focused use of Lean) it is helpful but not enough to meet the healthcare challenges for the next 2 - 5 years.

Productivity 2: Reduced variation is not enough

This is the second in a series of productivity notes. Reducing variation is only part of the productivity process.

Reorganising processes so they are precise and prediction is helpful but not enough. In the diagram, the red dots are hitting the target in a predictable way. However, while they may be precise, they are not accurate. The green dots, with less precision, are more accurately placed around the bulls eye.

What I learn from this is the need to

• know the definition and position of the bullseye (what is the purpose of the process being improved)
• measure for accuracy as well as measuring variation
• fix accuracy first, then go for reduced variation

Productivity 1: Operational Efficiencies are not enough

This is a the first in a series of Productivity notes from Sarah Fraser.  Are your productivity projects innovative enough?

Organisations, like the NHS, will need to do more than streamline some processes as part of their cost saving initiatives. Many projects underway are badged as productivity improvement yet mostly they are about basic good management. For example, reducing DNAs (Did Not Attends), improving the Discharge Process, holding less meetings, carrying less stock etc. These are important and help to provide a good base form which to develop more innovative approaches, however, I am concerned few organisations considering gains in productivity through redesign and reconception of processes.

Many managers may feel like they are standing in the equivalent of the Victorian cotton mill with a clipboard in one hand and a stop watch in the other. Yes, it is possible to gain more efficiency from a process. I argue, however, that the leaps in efficiency come from reconceptualising what is being delivered. For example, in many countries for at least a decade, group appointments are available for patients with long term conditions. This is one small example of how rethinking a process can create both an efficiency and an improved patient experience.

Measuring large scale change

Many complex programs are designed to deliver large scale change. A key concept is knowing when a change is being made, and whether it is in the right direction.  Large system change is different to process change in that it seldom has a clear beginning and end, has multiple causal factors (some of which we will never know), and the result is often separated from the action in time and space.

Differentiating the types of measures from each other helps, as well as estimating and checking connecting between them.  The following categories may be useful to you in deciding how to measure what.

Inputs: a bit like a baseline measure though perhaps a bit more active. It could be the number of patients not attending their appointments or the % of staff committed to a new organisational vision.

Activities: this counts how much is done of something designed to engender change. IN the case of large scale change there may be a variety of activities underway at the same time. This could be the % increase in number of people attending a workshop, the number of patients

Outputs: the results of the specific activities. So if the number of employees attending a patient experience workshop increased, and the workshop had an aim of improving staff satisfaction, then an output would be the amount of increase in staff satisfaction (and perhaps compared to areas where employees had not attended the workshop.

The above three measures often look alike. What is key is to understand what large scale change is being measured and to think through, and perhaps map, the links between the identified measures.

Outcomes: this differs from outputs in that it moves up a higher level - more long term, bigger impact. For example, if patient satisfaction increases then an outcome may be more patients returning, more income etc.

Impacts: this is the final level of measure. Perhaps the organisation reaches a new public grading, patients in the local area experience better health as a result of the improved services etc. Reduced health inequalities is another example.

Identifying the measures is only half of the learning from measuring for large scale change.A key step is to find a way to map out the linkages between the measures. To do this at the start of a program is helpful as learning from the actual measures can be replotted. This will help identify whether movement to the large scale change is underway as a result of the current activities - or not.

Keeping track of progress; learning from DHL

It's a long story, but the short version ends with my handbag needing to be sent from Stockholm to Buckinghamshire in England. This experience has left me wondering why it is we find it so difficult to keep track of patients within a hospital, let alone across systems.

From time of pick-up to signature at home I could watch the 24-hour journey unfold (one click on a weblink, no data entry). I could see what action was being taken at each stage. If you're interested you can see the detailed information below (it's not the greenest of journeys...). It took only 2 minutes from the time of signature for the information to appear on the system.

Yes, patients are not parcels. Patient information also requires a certain degree of confidentiality management. However, I wonder what it would be like if within hospitals (let's start somewhere simple) we were able to keep track of the inpatient, figure out in which corridor they are now, how long they have been waiting for their scan, whether they have had their meal etc. This information will provide insight into the systems and the patient's experience. Maybe we could start by monitoring blood samples in this way as they are already bar coded. Maybe we could start with a system to help keep track of patients in the hospital for who speaking is difficult, such as those with dementia, stroke or some other disabling condition.

I wonder what else we can learn from DHL about how to monitor and improve pathways using technology?


585907200 - Detailed Report
Date Time Location Service Area Checkpoint Details
Oktober 18, 2009
11:59

Arlanda - Sweden Försändelse hämtad
Oktober 19, 2009
18:04

Arlanda - Sweden Processed at Arlanda - Sweden
Oktober 19, 2009
18:28

Arlanda - Sweden Skickad från Arlanda - Sweden
Oktober 19, 2009
18:49

Arlanda - Sweden Anlänt till DHL i Arlanda - Sweden
Oktober 19, 2009
19:48

Arlanda - Sweden Lämnat avsändare
Oktober 19, 2009
19:55

Arlanda - Sweden Processed at Arlanda - Sweden
Oktober 19, 2009
22:16

Arlanda - Sweden Skickad från Arlanda - Sweden
Oktober 20, 2009
00:15

Leipzig - Germany Anlänt till DHL i Leipzig - Germany
Oktober 20, 2009
00:46

Leipzig - Germany Processed at Leipzig - Germany
Oktober 20, 2009
03:27

Leipzig - Germany Skickad från Leipzig - Germany
Oktober 20, 2009
05:28

London-Heathrow - UK Skickad via London-Heathrow - UK
Oktober 20, 2009
05:37

London-Heathrow - UK Skickad från London-Heathrow - UK
Oktober 20, 2009
05:51

London-Heathrow - UK Anlänt till DHL i London-Heathrow - UK
Oktober 20, 2009
06:18

London-Heathrow - UK Processed at London-Heathrow - UK
Oktober 20, 2009
06:41

London-Heathrow - UK Skickad från London-Heathrow - UK
Oktober 20, 2009
07:33

Gatwick - UK Anlänt till DHL
Oktober 20, 2009
09:12

Gatwick - UK Ute för leverans med kurir
Oktober 20, 2009
10:39

Gatwick - UK Signatur