What in the name of God is Lean six sigma anyway?

Leo Fatkar · 23-03-2019 1:22am #1

I mean I've an idea what it means, but what's all the fuss about? Who the hell tells HR to list this on every job spec? Why is it always a requirement if no one has experience in it? I presume people who have common sense don't need to have experience in it anyway.

Should I do a course in this stuff now or something to pretend I'm passionate about it.

Rikand · 23-03-2019 1:52am

Never heard of it, so I just googled it. Sure ya learn something new every day

anawfulway · 23-03-2019 2:03am

To save some tediousness in actually looking this up online: Outdated Japanese/American pseudo business theory dressed up as engineering with plenty of buzzwords to make dullards feel clever and superior. "Lean Practioner" 6 Sigma Blackbelt" etc.

Its espoused by the type of skeezes better suited to marketing but who did engineering degrees cos thats where the money was and swallowed whole by gullible idiots who dont truly understand what the skeezes are saying but like to fit in and feel smart too.

BuboBubo · 23-03-2019 2:11am

Lean 6 sigma, and "5S"... oh Lord! It was all the rage in big manufacturing companies about a decade ago, the idea was to cut down on unnecessary processing (muda - Japanese for waste) and moving stuff/layouts to increase productivity. There's different levels of training too; green belt, black belt etc - not joking! I did a bit of in-house training in my previous job in Lean Manufacturing.

Waterford IT still run courses on it afaik, it's a good thing to have under your (ahem!) belt

if you're interested in managerial jobs in manufacturing.

Leo Fatkar · 23-03-2019 10:58am

anawfulway wrote: »

To save some tediousness in actually looking this up online: Outdated Japanese/American pseudo business theory dressed up as engineering with plenty of buzzwords to make dullards feel clever and superior. "Lean Practioner" 6 Sigma Blackbelt" etc.

Its espoused by the type of skeezes better suited to marketing but who did engineering degrees cos thats where the money was and swallowed whole by gullible idiots who dont truly understand what the skeezes are saying but like to fit in and feel smart too.

Good God, you're more cynical that myself.

Mr E · 23-03-2019 11:02am

I was a green belt in this 20 years ago.

Load of sh*te.

Money making racket for trainers.

Leo Fatkar · 23-03-2019 11:17am

anawfulway wrote: »

To save some tediousness in actually looking this up online: Outdated Japanese/American pseudo business theory dressed up as engineering with plenty of buzzwords to make dullards feel clever and superior. "Lean Practioner" 6 Sigma Blackbelt" etc.

Its espoused by the type of skeezes better suited to marketing but who did engineering degrees cos thats where the money was and swallowed whole by gullible idiots who dont truly understand what the skeezes are saying but like to fit in and feel smart too.

I'm going to have to become good lying in interviews

anawfulway · 23-03-2019 11:25am

Leo Fatkar wrote: »

I'm going to have to become good lying in interviews

Isnt that the whole point of interviews anyway. Wrap yourself up in a bunch of happy-go-luck self motivational horse****. Real go getter, goes the extra mile. Basically portray yourself as some kind of corporate slut/ souless robot and the job is yours.

Disclaimer: I'm not good at it. Advice may be misleading.

Wanderer78 · 23-03-2019 11:30am

What scam is manufacturing running these days, I no longer keep up with it, there was lean, just in time... some people truly get off on this stuff, it's fcuking disturbing

jackboy · 23-03-2019 11:39am

Leo Fatkar wrote: »

I mean I've an idea what it means, but what's all the fuss about? Who the hell tells HR to list this on every job spec? Why is it always a requirement if no one has experience in it? I presume people who have common sense don't need to have experience in it anyway.

Should I do a course in this stuff now or something to pretend I'm passionate about it.

Every modern manufacturing site is saturated with this now. Some if it is good but it has to be seen through. You might as well do the course.

BobMc · 23-03-2019 11:49am

My missus is a BlackBelt

dudara · 23-03-2019 7:49pm

The fundamental idea of Six Sigma is fine. It’s just attained some kind of cult status as far as some employers are concerned. Probably because it was highly valued by Jack Welch and GE.

The Bishop Basher · 23-03-2019 7:53pm

I was trained and used the tools and methodology for a few projects to “tick a box”.

Some of it was really effective and I still use it to this day.

Some of it was pure ****e.

ressem · 23-03-2019 8:45pm

Leo Fatkar wrote: »

Why is it always a requirement if no one has experience in it?

There are people with experience with it?

I presume people who have common sense don't need to have experience in it anyway.

The LEAN part is about teaching people how expensive waste and defects can be on an assembly line; the knock-on effects on the business and other employees of even small defect rates.

e.g. oops there were 2 defective units in this 1000 unit batch run. Person on the floor running the line shrugs their shoulders, 2 units x €5, ah well not worth investigating.
That's common sense without training,

but
Customer policy refuses to accept incomplete batches from suppliers. €5000 direct cost. Cannot meet orders demanded on time, customer lost. A whole load of replacement materials with long lead times and minimum order quantities required. €thousands more. Delivery canceled and has to be redone at a later date. trucks, ferries/flights, container rental.
->
replacement or backup materials have to be ordered and stored. There might be lead times of 3 months for materials to arrive. Materials might have short expiry dates, or require valuable heater / fridge space for material stability. The incoming material or backup complicates quality and microbiological re-checks because of the need to stop the the excessive "just-in-case" materials from building up.

The business has to price higher to manage all of this, and closes because it isn't competitively priced.

Some of the 6 sigma practices are training in keeping the work environment in good order. Keeping tools and components to avoid contamination, loss, time wasted in searching. Common sense just involves putting the tools in a toolcase with a "property of" label.

6 Sigma practitioners might do one better. Putting commonly needed tools on a board with a taped outline, so everyone passing can see that that the tool is not where it's supposed to be, and a logbook to id the last holder.

Small things that can reduce the "for want of a nail the country was lost" effect.
The maths and achieving 3.4 defects per million are not really achievable to small to medium enterprises. Other than that, it's worth learning, even if that's 20 quid of udemy videos for the basic ideas.

pleas advice · 23-03-2019 8:53pm

Hence the 'bakers dozen' ...

UsBus · 23-03-2019 8:59pm

If Toyota were jumping off cliffs, some manufacturing companies in Ireland would be at it. I could never fathom why medical device companies here would treat a car manufacturer as the Bible in good manufacturing practice..

Wanderer78 · 23-03-2019 9:05pm

UsBus wrote:

If Toyota were jumping off cliffs, some manufacturing companies in Ireland would be at it. I could never fathom why medical device companies here would treat a car manufacturer as the Bible in good manufacturing practice..

To be fair, Toyota were obviously doing exceptional things in organising the efficency of their operations, so no wonder their ideas carried across the world into other industries, but some people turn this stuff into a 'philosophy' that sells well

Fr Tod Umptious · 23-03-2019 9:09pm

Is it any relation of Kanban ?

ressem · 23-03-2019 9:12pm

UsBus wrote: »

If Toyota were jumping off cliffs, some manufacturing companies in Ireland would be at it. I could never fathom why medical device companies here would treat a car manufacturer as the Bible in good manufacturing practice..

They have to have a process, and the kaizen approach which involves stopping the production line when a defect is found, and improving is seen as suitable.

The cost of defects in medical device products is enormously destructive? Medical device companies have audit after audit from customers and regulators, even paperwork defects can cause full recalls; or block all the company's products from being allowed into the US.

They have to have a process to spot problems as soon as possible, and a practiced, documented & trained reaction to the problem.

_Brian · 23-03-2019 9:13pm

I worked on a large maintenance dept as a supervisor when we were implementing lean six sigma stuff.

Labelled lots of tool chests for dumping and brought them home and have a nice set up on my garage now.

It’s great for companies who like meetings and buzzwords, and lads roaming about with clipboards.

the_pen_turner · 24-03-2019 12:40am

at its core lean is brilliant and can really be usefull to a company but it has loads of limitations in reality.
it only works on paper if everybody is super efficient (delivers everything on time , just in time etc but supliers here rarely deliver on time)
everybody does every job side of it is good if it actually happens but managment and bosses rarely back it up. they dont clean the toilets or sweep up a mess like lean teachs
only really works in a profit sharing company where the workers get to see the benifit of all the extra work they are doing.
the inventry side of it is great if you have someone with ocd over it that meticalisly orders when its needed

dreamers75 · 24-03-2019 12:44am

Its technically called "common sense" in most parts of the world.

Basically list all the **** a department does in a day then someone goes over all the things they do and makes you do less of them because they are wasting your time.

Because they dont work there they can ask the really fcuking stupid questions.

Its great.......... but also not great as it highlights how fcuking retarded the management are in departments.

One glorious example was finding out an IT worker needed 3 PCs to upload to an FTP, this guy had Computer Science from UCD and I have to quickly explain what he was doing:

The business scans documents and uploads them to a customers FTP, the scanning person would scan a document to a PDF file located on the C drive of PC1 (pc was not networked) the IT guy would put the PDF on a USB (Pc1 had USB blocked for normal users). Then put the PDF on PC2 and put it in an encrypted sophos folder(only PC2 had this software) then use the USB to move it to PC3 to upload it. People with IT degrees knew of this and during our lean session I was literally pissing my self laughing when this came up.

Jimbob1977 · 24-03-2019 12:56am

It goes back to Motorola in the 1980s.

For every million widgets on the manufacturing line, you will find that 3.4 are defective. That equates to Six Sigma..... I have no idea why.... I'm not a mathematician.

The idea is that everyone should improve their processes to achieve minimal error and maximum efficiency.

It was a hot topic in the 90s and 00s.... along with JIT and Kaizen. There were black belts, green belts, etc. People banged on and on about it.

I reckon it's a bit dated now. Still, you should probably be aware of it for an interview in a related field.

the_pen_turner · 24-03-2019 12:59am

i dont see how it could ever be dated. its a basic idea that everyone does their best to improve the company and to do their job as best as they can. its all about making improvements to achieve that.

BuboBubo · 24-03-2019 2:47am

Fr Tod Umptious wrote: »

Is it any relation of Kanban ?

Yes!

Its all about reducing storage. There shouldn't be any with lean, because its all about continuous flow. Having stuff sitting on shelves is considered a waste. It's not making money sitting there. No value is being added to the product in storage - it's costing money.

GalwayGrrrrrl · 24-03-2019 7:24pm

There’s a fair amount of interest in applying lean and kaizen to healthcare at the moment- eg in large hospitals.

Tacklebox · 24-03-2019 7:33pm

So instead of using common sense and logic, some genius decided to make a mountain out of a molehill.

I remember someone telling me they were a senior quality assurance engineer...

Sounds really interesting and professional.

But a first year student in secondary school could do it after a few weeks training.

Kinda akin to a tulip picker saying they're now a horticulturist.

I suppose if you complicate simplicity it's easy to manipulate and control people.....

ressem · 26-03-2019 11:45pm

Tacklebox wrote: »

So instead of using common sense and logic, some genius decided to make a mountain out of a molehill.

I remember someone telling me they were a senior quality assurance engineer...

...

But a first year student in secondary school could do it after a few weeks training.

...

Quality engineer. That's a very different job, not really on this thread topic.

Plenty of jobs offered at 60-70K for senior quality engineers, if it were that easy.
Over the course of a year, a bright person can be trained in a lot of the required actions to maintain a working system, visibly sticking to good manufacturing practice / good automated manufacturing practice, and dealing very clearly with corrective actions.
https://www.fda.gov/iceci/inspections/inspectionguides/ucm170612.htm

Setting up a system and holding a company to that standard is tricky,
and being stuck in a room being grilled by 3 FDA auditors for a week looking for deviations from that standard, and satisfactory explanations; failure that can break the company. Not fun at all.

Irishder · 28-03-2019 5:41pm

I have a Masters in Lean, Green belt and am a Certified lean expert.

Reading the posts on this is indicative of how organisations and consultants ram lean tools down employees throats.

What usually happens is someone thinks we better do this lean stuff, hire someone or a consultant in to implement it. There are short term wins everyone high fives each other then when the consultant walks away it all falls to ****.

It needs to be embedded into the way of working. A bit like how safety is perceived now, its just how companies operate. It should be a long slow process that focuses on change management and employee buy in.

It really is a game changer when implemented correctly. If you think of the current crisis in our health system. I am 100% convinced Lean thinking and application would go a long way in solving the mess that is our hospitals...

whiskeyman · 28-03-2019 11:00pm

The concepts are sound and it's pretty useful.

Adoption of it into some organisations is hilarious to watch though. Still lots of money being thrown at it.

Post above me sums it up!
Cheers Irishder.

Nelbert · 19-06-2019 8:17pm

Did an intro to it today (white belt).... it certainly has a lot of potential in the right hands in Irish healthcare.... but like many things it’s actually just a specific focused subset of good management practices.

listermint · 19-06-2019 8:23pm

The key with these things are that they are a framework not an anchor.

If its used to redtape and governance then it fails.

banie01 · 19-06-2019 8:27pm

Anyone with any lean or Six Sigma training could make serious efficiency inroads into HSE practice.

Take an outpatients appt as an example, the number of physical moves for the patients paper file/notes alone is a complete waste.

There is much duplication and unnecessary repeat or redundant steps in an OPD appointment that can and should be streamlined.

Adoption of lean practices can go a long way towards this by giving appropriate tools to those most directly involved in the process to make changes.

A big problem with Irish Organisations and their implementation of lean/six sigma is that all too often it is rolled out to management 1st and pushed as a top down change.

Invariably this fails to gain traction, it really needs to be an organisational change led from the bottom up.
Getting staff buy in as early as possible on the transformation process makes it a staff led programme, but staff productivity and genuine involvement make those changes much more involved and resilient.

The goal of 6 sigma really can and does align quite well with Healthcare and the mantra of right 1st time can and does prevent patient injury in organisations that do use 6 sigma.

knipex · 19-06-2019 8:53pm

Lean is a catchall term for what was initially a manufacturing system known as TPS or Toyota Production system. A set of tools that allows for the highest quality paert to be built in the shortest possible lead time and the lowest possible cost by eliminating waste.

Defective parts are one type of waste.

6 sigma is a QUALITY program that aims to develop processes that deliver under 3.4 defects per million. ie to develop consistent, reliable processes.

6 sigma is one of many tools used to build a lean process.

Another is 5S (or 7S as its becoming now)

Kanban is technically a card, or a trigger that an upstream process uses to call for something it needs from a down stream process or a supplier and is a tool within a "Just in Time" manufacturing process.

Over time its evolved to come to mean a parts bin or similar (it tends to develop different meanings in different facilities.)

All these are just tools.

6-sigma
5S
Kaizen
Quality Circles
SMED

All tools that work together or individually to eliminate waste and improve quality.

The problem is you get "specialists", who "specialise" in one element or one tool or indeed in Lean but have no or limited understanding or care for the otehr impacts they may be having.

In an organization where lean tools are used and implemented as part of an overall improvement strategy they can transform organizations (Dell is in PC manufacturing peak was the poster child for lean and Just in Time, Toyota post WW2 developed many of these tools out of necessity, they had limited raw materials, limited finance and limited labour pool.) Japanese manufacturing was built on lean.

In organizations where tools are cherry picked and used in isolation they cause problems. Lots and lots of problems and invariably fail which gives lean a bad name.

Hoboo · 19-06-2019 8:58pm

knipex wrote: »

Lean is a catchall term for what was initially a manufacturing system known as TPS or Toyota Production system. A set of tools that allows for the highest quality paert to be built in the shortest possible lead time and the lowest possible cost by eliminating waste.

Defective parts are one type of waste.

6 sigma is a QUALITY program that aims to develop processes that deliver under 3.4 defects per million. ie to develop consistent, reliable processes.

6 sigma is one of many tools used to build a lean process.

Another is 5S (or 7S as its becoming now)

Kanban is technically a card, or a trigger that an upstream process uses to call for something it needs from a down stream process or a supplier and is a tool within a "Just in Time" manufacturing process.

Over time its evolved to come to mean a parts bin or similar (it tends to develop different meanings in different facilities.)

All these are just tools.

6-sigma
5S
Kaizen
Quality Circles
SMED

All tools that work together or individually to eliminate waste and improve quality.

The problem is you get "specialists", who "specialise" in one element or one tool or indeed in Lean but have no or limited understanding or care for the otehr impacts they may be having.

In an organization where lean tools are used and implemented as part of an overall improvement strategy they can transform organizations (Dell is in PC manufacturing peak was the poster child for lean and Just in Time, Toyota post WW2 developed many of these tools out of necessity, they had limited raw materials, limited finance and limited labour pool.) Japanese manufacturing was built on lean.

In organizations where tools are cherry picked and used in isolation they cause problems. Lots and lots of problems and invariably fail which gives lean a bad name.

Another major cause of failure is a poor or no change management strategy, organisations expect to implement all these great ideas without even buy in at the top nevermind the other necessary steps. Usually in companies with a weak or undervalued HR team with no seat at the table.

knipex · 19-06-2019 8:59pm

UsBus wrote: »

If Toyota were jumping off cliffs, some manufacturing companies in Ireland would be at it. I could never fathom why medical device companies here would treat a car manufacturer as the Bible in good manufacturing practice..

The TPS and lean moved out of car manufacturing and into other industries in the 80's. It prevailed initially across high volume manufacturing initially starting in heavy engineering type industries but quickly moved in electronics manufacturing industry, PC manufacturing and across the entire manufacturing sector.

Lean has been used in medical device since the 90's in the US, Korea, Japan, even India and China. Ireland is far from unique and in many cases well behind the curve.

For teh last decade or more Lean has made serious inroads in the service industry.

knipex · 19-06-2019 9:02pm

Hoboo wrote: »

Another major cause of failure is a poor or no change management strategy, organisations expect to implement all these great ideas without even buy in at the top nevermind the other necessary steps. Usually in companies with a weak or undervalued HR team with no seat at the table.

No argument on that

If senior management don't embrace and drive it then it will fail. TPS or lean also pushes hard the team approach with huge focus on internal stakeholders and their input and training. Its a collaborative approach and without collaboration it fails. Also huge focus on training and bringing along workers, making them feel involved, getting them to take ownership but many companies balk at this and skimp on the training and involvement so it fails..

Gimme A Pound · 19-06-2019 9:03pm

Did the first part - just basic cop-on. But I know it gets more interesting. I really like the idea - I love streamlining and I hate clutter - but it seems to be a difficult one to package. And it's not suitable for every workplace yet companies seem to think it's "one size fits all".

Stovepipe · 19-06-2019 9:06pm

Lean works very well in some manufacturing settings but it's a pain in the arse when your management tries to force it into an airline, which is not a manufacturer, in case anyone missed it. It's good for tool control, keeping things tidy and so on, but for running an airline, it's a waste of time.

screamer · 19-06-2019 9:07pm

The basic principle of all of it is to reduce waste, thereby increasing efficiency and ultimately profits. Think- do more with the same or from employers POV do more with less. It’s a real racket with training companies raking it in.

banie01 · 19-06-2019 9:13pm

knipex wrote: »

For teh last decade or more Lean has made serious inroads in the service industry.

The toolsets for lean/six sigma are moving into a much wider array of industries.

I was introduced to Six Sigma in 2000's in Dell, I've since worked in multiple roles in other industries that are playing catch up in terms of international competitors and Irish too. I would say however no other company I've worked for has ever approached Dell for the level of integration and commitment it put into those tools.

The urge to embrace these tools always comes from the top, but TBH as you have already said...
The lack of HR and entry level engagement is a serious impediment to any change management programme.

The rush in my experience is always towards ensuring middle/high management getting green/black belt certified.
Which is IMO the wrong way to implement those changes.
I would be evangelical about pushing these changes from the bottom up.

White/yellow belts and kaizen or A3 projects initially,at the point closest to the customer and working back the production stream.
Introduce the Green/Black belt portions of the training to managers of those undertaking the initial projects to allow an amalgamation of those projects and ensuring any potential economies of scale are pushed to all areas.

The Motorola/TPS/lean/6 sigma whatever name you use, is great in so far as it offers a standardised approach to problem recognition, solving and metrics that is transferable across all lines of business and industry.
It is however only ever as good as its actual implementation and control.

knipex · 19-06-2019 9:21pm

Stovepipe wrote: »

It's good for tool control, keeping things tidy and so on, but for running an airline, it's a waste of time.

thats 5S. which is one tool in lean. Just one fo many.

I have heard (not seen but heard) of it being implemented very successfully in a solicitors office and have seen it implemented in a call center, again very successfully.

In both cases it was implemented as part of a larger lean program

Nelbert · 19-06-2019 9:32pm

banie01 wrote: »

Anyone with any lean or Six Sigma training could make serious efficiency inroads into HSE practice.

Take an outpatients appt as an example, the number of physical moves for the patients paper file/notes alone is a complete waste.

There is much duplication and unnecessary repeat or redundant steps in an OPD appointment that can and should be streamlined.

Adoption of lean practices can go a long way towards this by giving appropriate tools to those most directly involved in the process to make changes.

A big problem with Irish Organisations and their implementation of lean/six sigma is that all too often it is rolled out to management 1st and pushed as a top down change.

Invariably this fails to gain traction, it really needs to be an organisational change led from the bottom up.
Getting staff buy in as early as possible on the transformation process makes it a staff led programme, but staff productivity and genuine involvement make those changes much more involved and resilient.

The goal of 6 sigma really can and does align quite well with Healthcare and the mantra of right 1st time can and does prevent patient injury in organisations that do use 6 sigma.

Agree with your point but it disregards the context.... if hospitals were flush for cash they’d have each spent the few million quid for electronic patient records.....
Big deal made about that European fund loaning Ireland money last year or the year before for EPR..... no sign of it filtering down....
Given a finite budget and political pressures choices are made...... would Waterford prefer an EPR or a second cath lab an expert review says wasn’t required?

_Brian · 19-06-2019 9:37pm

Company I worked in 10 years ago had a real hard on for it, mostly because of the cool buzz words and endless meetings.

We trained and has Kysans out the ying-yang. Loads of useful equipment was deemed surplus which we divided up and brought home - that was the best outcome.

It has some good points but if a company is prone to getting tied up on small stuff in meetings this thing is like opening a suitcase with a black hole in it, people just get sucked into the small stuff and never make any real progress.

banie01 · 19-06-2019 9:38pm

Nelbert wrote: »

Agree with your point but it disregards the context.... if hospitals were flush for cash they’d have each spent the few million quid for electronic patient records.....
Big deal made about that European fund loaning Ireland money last year or the year before for EPR..... no sign of it filtering down....
Given a finite budget and political pressures choices are made...... would Waterford prefer an EPR or a second cath lab an expert review says wasn’t required?

The money actually saved by improving the procedures and handling of OPD alone could easily allow either a higher volume of patients to be treated or for the capital saved to be diverted to capital acquisition projects such as the Waterford Cath lab.

There is a reason the use of these toolsets is becoming endemic in the private sector.
The funds saved as a result of these tools are at the end of the day, financially validated and affect the bottom line.

Introducing new work practices into state bodies is notoriously difficult and it is a lot harder to overcome vested interests supported by "custom and practice" and the sword of Damocles that the unions hold when it comes to working practices.

The assumption is always made that it's just change for the sake of change, each efficiency gained has a cost associated.
Those saved costs can then be redirected.

Nelbert · 19-06-2019 9:42pm

banie01 wrote: »

The money actually saved by improving the procedures and handling of OPD alone could easily allow either a higher volume of patients to be treated or for the capital saved to be diverted to capital acquisition projects such as the Waterford Cath lab.

There is a reason the use of these toolsets is becoming endemic in the private sector.
The funds saved as a result of these tools are at the end of the day, financially validated and affect the bottom line.

Introducing new work practices into state bodies is notoriously difficult and it is a lot harder to overcome vested interests supported by "custom and practice" and the sword of Damocles that the unions hold when it comes to working practices.

The assumption is always made that it's just change for the sake of change, each efficiency gained has a cost associated.
Those saved costs can then be redirected.

Yes but your example is one which requires a significant upfront investment which can’t be ignored. Such capital being spent in one area deprives another until those savings (or additional activity based funding) are actually realised.

_Brian · 19-06-2019 9:43pm

It’s the unions that are ultimately holding back the health services.

No changes in work practice without increases on pay, no flexibility without pay increases, no accountability even with pay increases.

Look at the likes of the SSC in santry where I can make an appt for mri late in the evening or early in the morning thus minimising the idle time and improving throughput for the same capital spend.

I’ve been in a company that got bogged down with Lean stuff.
Imagine the management meetings in the HSE, the endless consultancy fees, the union resistance to making swift immediate changes in practice. It’s a pipe dream that it could ever happen.

banie01 · 19-06-2019 9:53pm

Nelbert wrote: »

Yes but your example is one which requires a significant upfront investment which can’t be ignored. Such capital being spent in one area deprived another until those savings (or additional activity based funding) are actually realised.

No, it really isn't.
Steps are already in train to move to fully EPS compliant systems already.
Acceralation of that particular capital spend is reallocation of a budget line item to bring forward an already approved spend.

That can be fairly quickly offset in practice by elimination of the portering of records from Central Records in a hospital to the clinic secretary, the files subsequent steps from her desk to each of the triage nurse, Clinical nurse specialist and Specialist along with the move back to reception and from there back to central records again.

Eliminate the 2 porter journeys, and the non treatment time of 3 clinicians in walking a file and you have a significant saving on labour cost along with a fair portion of extra actual clinical time available for treatment.

This is just a spitball review of the file walking aspect of an OPD visit.
The term favoured in 6 sigma for things like the file walk is "non value add".
In this instance I don't agree with that particular label.
It is a simple example of a needed step, it is nigh on impossible to treat a patient without a file

But it is a series of actions that bleed cash, staff resources and time from an already heavily strained system.

Now I'm not saying my example is an immediately needed change or even the right one to implement.
Without actually reviewing the system, it would be very arrogant of me to say I'm right do it!
But it as an example of how the flow of a simple interaction for needed information can add layers of touch and work that are unnecessary and easily redirected.

Nelbert · 19-06-2019 10:27pm

I’m not disputing the impact.

I’ve worked on some large scale projects moving towards EPR and some of the financial incentives in terms of realisable cost savings are extremely appealing. I’ve done full cost benefit analysis (with cost savings intentionally underestimated) and despite the scale of investment it does payback.

It requires significant upfront cost however and navigating a lot of vested interests.
My personal view is centralised funding from the HSE / DOH which is ringfenced will make EPR happen anything short of this will leave us in status quo.

Full disclosure; I work in a public hospital, I WISH we had an EPR (doing an MSc in Data Analytics so the opportunities it would open up for improvement and analysis is quite something!). But from previous jobs I can understand the mixture of political intervention, vested interests and unions preventing such a large investment. Ironically I think it will be a political intervention that ultimately leads to the ring fenced money that’s required to make it happen.

The efficiencies and analytical opportunities it would create would I feel have one of the most significant positive impacts on patient care in both acute and community care if done properly.

Basically the clinical secretary in OPD example having time wasted with physical charts is indeed a symptom of a significant systematic waste but it’s not something that could be solved within the confines of a lean project within the OPD in isolation..... it’s a massive transformational project for the entire organisation.

AndrewJRenko · 20-06-2019 12:14am

Nelbert wrote: »

Agree with your point but it disregards the context.... if hospitals were flush for cash they’d have each spent the few million quid for electronic patient records.....
Big deal made about that European fund loaning Ireland money last year or the year before for EPR..... no sign of it filtering down....
Given a finite budget and political pressures choices are made...... would Waterford prefer an EPR or a second cath lab an expert review says wasn’t required?

No sign of it filtering down? How hard did you look?
https://m.facebook.com/story.php?story_fbid=2398623066826880&id=455157191173487&comment_id=2399195470102973&notif_t=feed_comment&notif_id=1560960697992577&ref=m_notif

Nelbert · 20-06-2019 7:34am

AndrewJRenko wrote: »

No sign of it filtering down? How hard did you look?
https://m.facebook.com/story.php?story_fbid=2398623066826880&id=455157191173487&comment_id=2399195470102973&notif_t=feed_comment&notif_id=1560960697992577&ref=m_notif

Not on Facebook for start and if you think that will have the sort of major impact required you’re kidding yourself. It’s a start but you’re talking 10+ million for each of the major acute hospitals

What in the name of God is Lean six sigma anyway?

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