Let me tell you two short stories of two Swedish women in their thirties.
We will follow them both through their interaction with the Swedish healthcare system.
We will start with Maria.
It is Monday morning and as Maria gets dressed she discovers a lump in her left breast.
She is concerned, and with just cause.
Breast cancer is the most common cancer among women in Sweden.
She contacts here local healthcare center and gets an appointment the next day with her family doctor.
She meets with the family doctor.
He makes the examination but can’t rule out that the lump is cancer.
He refers her for a consultation to the breast clinic at the local hospital.
Maria is told she will receive the time for the consultation in the mail.
Maria is worried and what to get the examination over with. She checks her mail every day for the appointment.
After ten days she has still not received her appointment letter. She calls to try to find out status.
After some searching the nurse on the phone finds her referral and promise it will be processed later today.
Four days later she receives the appointment letter.
The appointment is scheduled for the next week.
Today it’s time for the mammography and ultra sound.
Maria arrives a little bit early. She sits down in the waiting room.
15 minutes after the scheduled time her name is called
The mammogram and ultra sound just takes few minutes.
She is once again sent home as the referral to the breast surgeon is sent.
Ten days later she is due back at the breast surgeon at the local hospital.
The breast surgeon has analyzed the images but unfortunately he can’t rule out cancer. He need to refer her to a cytologist so they can take a tissue sample.
Maria is sent home and she is now out of herself of worry and can’t remember a thing the surgeon told her.
Would she be sent a new appointment or should she schedule one her self?
The next day she calls back to the hospital, but can’t get by the automatic machine. She leaves a message.
Later that same day she is called back by a nurse. She explains that a referral has been sent to the cytologist.
She is told that she has an appointment in two weeks.
Two weeks of constant worries Maria meets the cytologist. He takes a tissue sample.
He explains that the sample now needs to be analyzed and the result will be sent to the breast surgeon she meet earlier. The doctor don’t know exactly how long the analysis will take as the lab is usually very busy.
She will receive an appointment in the mail.
After six long weeks Maria is back at the breast surgeon for the diagnose.
Now let us meet Anna.
It is a gray Tuesday morning and when in the morning shower Anna discovered a lump in her breast.
At lunch she shares her worry about the lump with her best friend.
She tells Anna about the “On stop breast clinic” at the local hospital. Anna decides to check it out as soon as the lunch is over.
Back at her computer Anna finds the information on the “One-stop breast clinic”.
Next time it is open is in two days. She decides to go.
It is now Thursday afternoon and she walks into the clinic.
She immediately gets examined by a nurse. The lump definitely needs to be examined.
Anna is sent to the waiting room and will be called as soon as the doctor is available.
Only 15 minutes later a breast surgeon calls her name. He examines her breast. He can’t rule anything out.
He want to take a ultrasound and a mammogram.
Anna is one again sent back to the waiting room. You will be called as soon the nurse is available, she is told. She prepares herself for a long wait.
But just after a few minutes her name is called and a specially trained nurse take the mammogram and then a doctor performs the ultrasound. They confirm the lump in the breast. But a tissue sample is needed.
The nurse follows Anna to a cytologist who takes a tissue sample.
He apologues as he asks Anna to take seat in the waiting room again as the sample is sends off for analysis.
Anna is one again back in the waiting room. She buys a soft drink in the vending machine and starts reading a magazine.
A few minutes later, to her surprise, she is back to the breast surgeon and he gives her the diagnose.
Both Maria and Anna went through the same diagnose process steps but with two totally different experiences.
For Maria it took over 1000 hours to get her diagnose but it took less than 60 hours for Anna. How come they had such different experiences? Maria’s process time line is full of red LEGO bricks. Anna’s not so much. Why?
The two different process has been optimized based on two different business strategies.
|Maria’s process is optimized from the different healthcare units perspectives. It has been optimized for resource efficiency. This means that the process is optimized to keep the doctors, nurses and machines as busy as possible. This is supposed to drive down the cost per activity. The result is most often a process full of red and yellow bricks.||On the other hand, Anna’s process is optimized for flow efficiency. The process is also optimized on her as the customer. This means that the process is optimized to have Anna go through the process as fast as possible with as little wait time as possible, not so many red bricks. How busy the doctors, nurses and machines are is a secondary concern.|
You may think that the process Anna went through is much more expensive than the process Maria went through. But in fact the “One-stop shop” concept that focus on flow efficiency costs the same or less. This is often due to the fact that most yellow bricks, required waste, can be removed from the process.
If you would build a LEGO time line of your processes, would they be mostly red and yellow? Or would they be mostly green?
This story is my free translation and adaptation of a similar story in the great book This is Lean: Resolving the Efficiency Paradox by Niklas Modig and Pär Åhlström
I highly recommend this book too anyone who wants to learn more about Lean.
For more info: http://www.vadarlean.se
The images in this post is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License.