Work Flow - An Example

Please refer to the Process Map of the anticoagulant blood testing clinic.

If value had been properly identified here, by asking the patients what is important to them, there would more than likely be a requirement to provide the service in the shortest possible time, with no interruptions or delays. As can be seen from the map, the current process would hardly meet this requirement.

In an ideal world the patients’ blood would, quite simply, keep flowing! From the patients’ point of view, in an ideal world, they would come into the clinic and a blood sample would be taken straight away. The blood would be tested straight away and the result would be given straight away. Their next appointment would be arranged straight away and they would go home, in an ideal world . . .

The ideal world is the picture of perfection that is the constant aim of continual improvement. How close can your process come to it?

If achieving perfection seems an impossible task, that is no problem – what’s important is that you are continually moving in that direction, always looking for better ways of creating value for patients.

An excellent way of getting a process to deliver a service as quickly as possible, with no interruptions or delays, and with the minimum waiting time, is to look at the process map and identify parts of the process where the work is not flowing. The idea being to remove all delays, hold-ups, bottlenecks and queues.

The major area where things are not flowing smoothly in the anticoagulant blood testing process is when the patient’s sample gets sent off to the central blood testing laboratory (there are other areas). Now – you may be thinking that there are some good reasons why INR testing is carried out in a central laboratory. The anticoagulant clinic is only one of several departments in the hospital that require INR blood tests to be carried out. It may therefore have been decided that it is ‘more efficient’ to have one central, fast, high-volume INR testing machine rather than having a smaller, slower machine in each of these departments.

But is this necessarily true? Maybe the cost calculation needs to be revisited. Organisations usually assume that a central, high-volume machine is more efficient than many decentralised, slower machines. They are often wrong.

This issue of ‘flow’ is counter-intuitive. On the surface, it doesn’t seem to make sense. But when you redo the figures you often find that the large central machine is less efficient than smaller, decentralised machines. You may find, for example, that the large machine is idle for a lot of its life, while it waits for big enough, ‘efficient’ batches of blood samples to accumulate. You may find that the purchase cost of a large machine is equivalent to that of very many smaller, slower machines. You may find that the maintenance cost of a complex machine is more than the maintenance costs of many smaller machines.

Most importantly of all, from the patient’s point of view you may find that a smaller, much less expensive, slower machine – located at the point of contact with the patient – provides a vastly superior service. The buzz-word people use when they redo the efficiency calculation and replace high-volume machines is ‘right-sizing’, i.e. having the right size, speed, and cost of machine, in the right place.

If you want to make your process flow it is useful to pretend to be the ‘piece of work’ (in this case the blood sample) and see what happens to you as you progress through the process. As the piece of work, what you will want to do is keep moving. Your whole aim in life is to get from the start to the end of the process, and into the hands of the patient in the smoothest, quickest, and most direct way.

In the anticoagulant example this could be achieved by having a small INR testing machine in the clinic. When a patient’s sample is taken it could be put straight into this machine, tested, and the result could be given to the patient in a couple of minutes rather than the couple of hours it takes in the present system.

When you have mapped your process, look for areas where work is being batched and queued and try to find ways of keeping it moving. Make the work flow. The patients will be delighted – and it may be more cost effective!