Waiting – The Hardest Part

“The waiting is the hardest part
Every day you see one more card
You take it on faith, you take it to the heart
The waiting is the hardest part” – Tom Petty

I won’t make you wait.  Today is the W in Tim Woods. Waiting.  Everyone knows what waiting is.  Something is not ready – a person, a part, a computer program, anything.  And unlike some other types of waste, this one is easy to spot.

I worked in IT for many years.  I know all about waiting.  And I know about the other end, hoping that IT can improve computers and programs to make them run faster.  Because it is more than just annoying.  Even a 1 second delay in a screen refresh is enough time for your mind to wander into another line of thinking.  For example, imagine you are a doctor or nurse and you want to look up information on a patient.  If it takes 10 seconds to pull up the record, that does not seem long.  But it is more than enough time for the care provider to start thinking about their other patients, to mentally start listing other tasks they have to perform, to wonder what is for lunch.  Then, getting back to the patient takes more than the 10 seconds.  Research has shown that it can take up to a minute to mentally switch between tasks.  If you don’t believe that, think about the last time you were deep into a task and then took a phone call on a completely different topic.  It took a little while to figure out where you were when the phone call was done.

This applies to any environment.  Keeping customers waiting on the phone while looking up their information is not fun for you or them.  Not being able to send a customer home with a part they really need because you cannot get it right away makes customers visit other stores.

Some things to consider when you have identified waiting:

  • Do you have all of the information and material you need?
  • Is there confusion on the part of staff on how to handle certain situations?
  • Do you have approval requirements that can be mitigated some other way?
  • Is your technology and equipment up to date?
  • Are roles and responsibilities clearly understood?

It will be easy to identify waste due to waiting.  It will be harder to remediate it.  Just like the other wastes, look at your processes as a whole.

And don’t wait.  Spending 3 hours to save someone even 5 minutes a day will pay for itself in about 7 weeks.  And they will thank you for it.

Motion – Good For Health, Bad For Productivity

Today is the day of the M from Tim Woods, standing for Motion and the process waste caused by too much of it.

I do some things in my life that add extra motion, like parking far from entrances and walking around town if I have several errands to run.  But in a work environment, when I am trying to be as productive as possible, I want to eliminate motion as much as possible.  Waste is created when people or tools are moved beyond what is required.   For instance, in a hospital environment, if the lab and radiology departments were far from the emergency room, the time spent moving patients or specimens only delays treatment.  Trips to a printer, even extra clicks on the computer searching to find files or information, constitute movement waste and time lost.  Additionally, there can be staff frustration because they cannot find what they are looking for.

As with most kinds of wastes, this one can be hard to find.  Most hospitals have their labs and radiology departments centrally located for quick access.  To find motion wasted inside of the departments, it is usually required to follow someone right through the process and even map it out on a piece of paper.

  • Determine your most common tasks and make sure that all of the tools to do them are convenient.
  • On the computer, use bookmarks and aggregate commonly accessed files and forms in a few, well-organized, pages of links.
  • Try to determine if there are any steps that are being done sequentially that could be done at the same time by different people or resources.
  • Use technology to automate processes, like transferring files or entering routine information.  Even pre-filling default fields on electronic forms can help with that.
  • Collaborate with your customers and suppliers, internally and externally, to make sure work is being done at the correct step.  Many times, especially with technology changes, moving a task to a different person or work area creates huge efficiencies.

Take the time to walk though your processes (commonly referred to as Gemba) and identify wasted motion.  Make sure to do this as a team and in a positive way.  Include the person doing the work to give them ownership.  And if work is being moved from one person or group to another, be clear about why that is happening.

It will be time well spent.

For more information on Gemba, follow this link to Wikipedia.

Inventory – Always Time For Spring Cleaning

Today, we are covering the I in Tim Woods, Inventory.  The classic picture of inventory is a bunch of unsold products waiting for a buyer.  Every item in the supermarket is inventory.  Every unsold car at a dealership is inventory.  But this can apply things that are only used internally or to environments where there is no physical inventory.

For instance, think of your clothes closet at home.  You probably have multiple articles of clothing in there.  When you get something to wear, you have to pick through them.  This is not a problem unless the closet begins to get too full, making it hard to find what you are looking for.  This is an inventory problem.

The same can be true on a network.  If a file is being stored in multiple locations, it vastly increases the likelihood that you will soon have out of date files on your network and that people will be using the wrong version.  If you are getting so many emails that you are not reading and processing them all, the chance of missing something important goes up exponentially.  If you have a bunch of pre-printed forms, you have the potential of them being obsolete and having to search through many to find the one that you want.

To identify if you have an Inventory problem, look for places where things pile up.  That can be forms, old computers, folders on your network, office supplies, emails, phone messages, etc.  Find the areas where things are hard to find.  For example, on your network, you can link to a file from a hundred locations to make it easy to find, but make sure there is a single, version controlled, copy of that document.  Try to make pre-printed forms easily available on demand.  If you have work backlogs, dig deeper into the process to remediate them.  That may involve changing your workflow.  See how different employees handle the same task.  There is a good chance someone has already found a better way.

Inventory cannot be completely eliminated, but inventory waste can be managed.  Let go of those old dresses and shirts you no longer wear and make things easier for yourself and your customer!

Transportation – Don’t Drop It!

Today, I am going to start a series of more detailed reviews of each of the eight kinds of process waste, following our acronym, Tim Woods.  Today is T for Transportation.

Transportation can include both physical and electronic forms of hand offs.  For instance, delivering parts to a work station is one type of transportation.  An email is another.  Storing files in a network folder can be another.  Even commuting can be considered.  In each case, there is the potential for things to go wrong.  Too many, too few, or the wrong parts can be delivered.  They can be too early or too late.  The email could go into a spam folder.  It could just be unread in the deluge of other emails.  It could go to the wrong person.  The file could be stored to the wrong location.  It might be accessed and modified by two people at the same time, losing some of the work.  Traffic, weather, and accidents can all affect a commute.  We cannot avoid these situations, but we can minimize them.

Transportation is often not viewed as a waste because there is often a physical structure that is in place.  Even in an office, if everyone is not in the same small room, this is something that has to be dealt with.  It is often caused by new processes being overlaid onto existing infrastructure without taking into account the changes that can be made for new processes and technology.  Staff turnover can affect this dramatically, too, as new people either have good ideas and implement changes or they do not understand the process and add complexity.  Even things as simple as having to get approval from a supervisor cause additional transportation.

And easy way to delve into this potential waste and find it is to count the number of time work moves from station to station.  These are hand offs.  A station is anywhere that work is performed.  This can be physical work or electronic files.  Look for delays and potential problems at each of those hand offs.  Make sure to include the movement of people as well, both commuting and having to move from station to station to complete work.   Draw a map of how the work moves from station to station.

Don’t overlook Transportation waste, because if you can minimize it, you will find that your work processes flow much faster and with reduced defects.

For a great handout on the types of waste and what to look for, check out this PDF at the State of Minnesota’s Continuous Improvement site.

Waste Not, Want Not – Where To Look For Process Efficiencies

When you are working with a team to streamline processes, it is helpful to give them some places to look.  Here is a great tool that will work across any process in service or manufacturing.  I sometimes post these on the wall of the room of a project team.

Enter Tim Woods, a rather innocuous sounding name, but one that is guaranteed to help you out.  But his name is an acronym for the 8 types of waste to look for.  I am going to focus on the service industry today.

Transportation – each handoff in a process increases the risk of something going wrong, like the request being forgotten, or a specimen being lost.  For more on this, see my previous post about handoffs.

Inventory – any material that is not currently being used is inventory.  Some is necessary to have on hand, but the more you have, the greater the risk of it spoiling, becoming obsolete, and generally getting in the way of the things you really need.

Motion – this is movement of employees to get from one place to another.  Things like staff that are constantly going back and forth from different units, or having to travel to pick up and receive work.

Waiting – this is any time in a process where nothing productive is happening.  If you have ever sat in an ER waiting room, you know what this is.  This includes customers/patients and staff.  Waiting for lab or back office work to be completed affects everyone.

Over-processing – is when the work done is not valued by the customer or doing it sooner than then need.  A generic example is extra diagnostic tests.  Another is trying to interest a customer in a product before they have a need for it.

Over-production – when more work than necessary is done, this adds cost to the process. Things like features on checking accounts you never use, lab draws that are unnecessary, or even mailing letters to people in addition to email.

Defects – these are mistakes.  These lead to rework, meaning fixing accounts, new lab draws, corrective procedures.  These are worse than whatever a simple defect was because the mean people have to go outside of the efficient process to fix them, leading to any and all of the other forms of waste.

Staff – this is not a tradition form of waste, but one that is incorporated into many systems now.  Simple put, these are people who are underutilized, either mentally or physically.  In my experience, it is mostly the former.  Usually, they have just stopped sharing their ideas on how to do things better.  This can be the hardest to recognize, but the most rewarding to address, for both the staff and the organization.

Train your teams to look for these and you will make progress in Hour 1!

For more information on these topics, you can go to Wikipedia to research “Muda”, a Japanese word meaning “futility; uselessness; wastefulness”

I also got useful examples from 8 Types of Waste in Healthcare.

Don’t Push When You Can Pull

If you have ever tried to move something that was too heavy to pick up, you know that it is usually easier to pull the object then try to push it.  The same is true with most processes.

In any kind of process, there are two ways to organize work at a given step.  One is called a push method and the other is called the pull method.  They push method when you get work that you cannot schedule, like a phone call, a customer walking into your store, anything that you do not have control over.  The work just happens when it happens.  The pull method, on the other hand, means you organize your own work.  Going to your inbox in your e-mail, voice mail, any kind of work queue that you have set up.

For most processes the pull method is going to be much more efficient than a push.  For example in an emergency room, customer show up.  Patients arrive in no particular order as they need assistance.  This is a pure push model.  But, the triage nurse sorts through all the patients and their issues, just like you do with your e-mail.  She sets the order that patients that now can be taken by the emergency room staff.  Staff can then use a pull method to insure that they take the most critical cases first in order to optimize care for everybody.  There will be exceptions, because a patient in critical condition can arrive at any time, but the more efficiently they can deal with other patients, the more capacity they have for those extreme emergency cases.

The same is true for most other roles.  If an employee or department is allowed to organize their work and only move on to the next task when the current task is complete, they will be far more efficient than if they are constantly having to interrupt tasks they are working on and have multiple open tasks.  Research has shown that once a person abandons a task and returns to its it takes up to a minute just to figure out where they were in that task and re-engage their mind.  This is true of switching attention between two different patients, working on two different documents at the same time, or solving advance physics problems.

When you are looking to increase performance in an area that has multiple demands on it, look for a person or equipment that is being forced to constantly switch between tasks.  Look to see if there are ways that the workflow at that location, can be modified to optimize it for that person.  Sometimes you cannot.  If you in direct customer service, the job is mostly push.  You have to get more creative there.  And be wary of people will often claim they can multitask well.  The human brain cannot think about two different things at the same time.  People often take pride in how many things they can work on simultaneously, but usually either quality or quantity of the product suffers.  Part of your job might be convincing them that there is a better way.

Feel free to exercise the pull methods and read other entries in my blog!

Expert + Expert = Magic

Everyone is an expert at something. In any kind of process, people are experts at their part of the process, but usually not the whole process. Those people become managers and begin to lose all perspective.*  As I discussed  in a previous post, teamwork is finally important to creating the best outcome. So if you are looking to improve or create a process, get those experts together and charge them with making things better.

By expert, I don’t necessarily mean someone who has PhD from MIT or Stanford.  I mean the person who does a specific task every day, is good at it, and therefore familiar with many of the intricacies. I compare each of these people to a runner on a good relay team. Individually, each is very fast.  You don’t have to work on the running part.  The key place to look is for the handoffs.  And where most of the efficiency will be gained or lost.

The issue can be as little as differing expectations between two people in the process.  Does the first runner place the baton in the hand of the second runner or does the second runner take the baton?  Someone on your customer service staff requests account maintenance from a coworker in operations.  The first person expects the work to be done within 2 hours, but the second person has direction to get it done by the end of the next business day.  That is going to lead to conflict and poor customer service.  Even if those times were reversed, which is a better outcome, the customer’s understanding of your capabilities is below what you can provide.

In this scenario, it makes sense to have what a discussion between the between those two people to equalize those expectations, and just as importantly, find out WHY they have those expectations.  In my experience, this is the conversation leads to a process that will now take an hour to complete.  And it will be replicable to additional people and processes.   That cannot be done if the two parties are not having an open discussion on that specific process. This same holds true for more complicated process is where there are more parties involved. The more steps, the more people included (up to a point), the more opportunity you have to make improvements.  Make sure your group has knowledge of all steps, though,  otherwise it will make it hard to create that positive outcome that you want.

So get those people together, let them talk and watch for the magic to happen.  Your job is to keep the open dialogue going.

*I am kidding about manager abilities.  Most managers I have worked with have been great contributors and have a high level view that is important when working towards solutions.

Accuracy – Deliver What You Aim For

Hit your customer’s expectations, he will love you.  Miss them, and you have a LOT of work to do to make that up.

Let’s say you go to the emergency room. Let’s figure out how accurate the staff needs to be in the top that in order for you to feel like they have done a good job. Let’s use a baseline of 90%.  90% is great for a lot of things. If you shoot if you make free throws added 90% rate that is phenomenal. If you have your kids ready for the bus in plenty of time on 90% of school days, there is not a word that enough to describe that. If you get 890 percent on a test, that is generally an A.

A 90% rate of getting the diagnosis and treatment correct is an arbitrary number and probably lower than any emergency room out there.  I have worked with these people and they are good at what they do. And the other 10% just means something went wrong, not anything major.

Let’s look at the steps of the visit to the emergency room. First you register and describe your problem. Then you talk to the triage nurse, who gets more detail on the issue. Then you are assigned to a bed or room. Another nurse comes in and gives you a more detailed examination. Then a doctor examines you.  You might have blood drawn or have an x-ray taken.  Your problem is diagnosed and treated. At the end, you get some instructions, either written or verbal, and you get discharged. At some point in the future you get a bill, but we won’t focus on that today.

Now, we have posited that the 90% success rate for your emergency room visits is good. How about 90% success rate in each of the steps?

  • Let’s say the registrar gets some piece of information wrong,. No big deal, you can always fix it later.
  • The triage nurse evaluates you and puts you in the wrong place in the queue to be treated. Again, usually not a big deal.
  • The bed that your to be assigned to is not ready.
  • The nurse does not adequately prepare you to talk to the doctor.
  • The Dr. misdiagnoses your issue.
  • There is some kind of printer error or problem with the discharge instructions.

But as long as any of these mistakes happen only 10% of the time, that is still OK, right?  This is where the math comes in. If there are six steps in this process and the probability of success at each step is 90%, then the probability that you will get through this visit and everything goes right is only 53% (.9 x. .9 x. 9 x .9 x .9 x .9).  That is the magic, or the curse, of compounding.  Increase the success rate of each step to  95% or 19 out of 20. The odds of you having a completely good experience in emergency room are still only 74%.  To get to 90% each person who you deal with has to be right almost 99% percent of the time.

This is a very simple example and it shows how insidious small numbers of errors in multiple steps in a process can add up to make a very inefficient process. In real life, there is usually one step that is the worst offender  or causes the worst problems.  Finding and fixing that step will get you a long way to a more efficient process.