Anne Daley, a senior consultant at Chi Solutions Inc, Ann Arbor, Michigan, offers a few examples of easy-to-implement lean activities that can lead to important process changes for radiology (while acclimating both leaders and staff to the new methods). “When you first start doing lean services, in my opinion, if you want to gain the biggest value, you should either have a leader formally trained or bring in an experienced lean facilitator. To facilitate a group of people through a complex project like improving turnaround time, you need someone who’s done this before,” she says.
Figure. To ensure optimal adjacencies in the design of a new facility, Seattle Children’s Hospital in Washington used a conceptual tool to reflect the seven flows of medicine: patients, families, caregivers, supplies, equipment, medication, and information. For radiology, in particular, Daley has found an activity called five S to be useful. The five basic components of five S are sorting, straightening, shining, standardizing, and sustaining. “It’s a systematic way to organize a workplace,” she says. Her guide to using the five S steps begins with sorting. “It’s amazing how many items are useless in a workplace,” Daley notes. “A fun exercise is to use colored dots to determine what you’re really using: green dots are for daily items, yellow dots are for items that are used weekly or are critical when needed, and red dots are things that don’t need to be in the work area at all. I often see radiology departments keeping a one-year supply of things in a work area, and then there’s no more room. A one-week supply is more practical when space is at a premium.” Straightening: Daley recommends arranging items in such a way that those most commonly needed are at hand, while those needed less often can be placed on a high shelf or in another out-of-the-way storage area. “It sounds like common sense, but common sense is not always common practice,” she says. “That’s what lean services are all about: making common sense a common practice.” Shining: This step is focused on keeping the items in a workspace clean and accessible for all potential users. “A lot of technical people don’t look at cleaning as their job, but housekeeping people can be afraid to touch anything in a technical area, so this is something that, many times, is overlooked in radiology,” Daley explains. Standardizing: Daley says, “Many radiologists have personal preferences on how to set up a procedure room, which can also lead to wasted time and movement. You can’t always standardize room setup 100%, but if you can get consensus on 80%, you will improve efficiency.” Sustaining: This step consists of continually maintaining the changes enacted in the first four steps. “The end of a shift is a common time for a technologist to do a quick check to make sure everything has been put in order for the next person,” Daley notes. Another useful exercise for radiology is spaghetti diagramming—visualizing the flow of people, materials, or information through a process. It can be easily accomplished using a blueprint of the workspace and colored pens that trace the flow within that workspace. This was a key component of Seattle Children’s Hospital’s design process for its Bellevue Clinic and Surgery Center, and it’s an activity that is often illuminating, Daley reports. For example, in one hospital department, “Spaghetti diagramming revealed that during the day, a patient would come into the waiting room, sit down, go to registration in another area, sit down again, then go back to the front desk for paperwork, then sit down again—and then, finally, go in for imaging,” she recalls. “Consider a person in a wheelchair or on crutches doing all that. It’s not good. In this case, the department decided reception and registration staff should be cross-trained so patients could avoid all the unnecessary extra steps.” At Seattle Children’s Hospital, spaghetti diagramming (see figure) helped create the adjacencies and colocations that enabled the design team to minimize the Bellevue Clinic and Surgery Center’s size and cost while maximizing its capacity. Lisa Brandenburg, CAO, recalls, “We drew the seven flows of medicine (patients, families, caregivers, supplies, equipment, medication, and information). We traced what the average radiologic technologist did in a day and counted the number of steps involved, then tried to reduce them as much as we could. Traveling more than necessary is waste.” Kaizen is the Japanese word for improvement. To keep lean principles alive in the workplace, Daley recommends holding periodic quick-and-easy kaizen (QEK) sessions, with rapid process improvement focused on specific applications within radiology. For example, the goal might be to reduce clutter on a busy work counter. Daley says, “Organizing binders on a counter isn’t a project in itself; it’s a QEK.” The most important thing to remember when implementing lean services is the emphasis on taking recommendations from the staff members who actually perform the processes to be improved. “A lot of these tools can be used à la carte, or when you have a more complex issue to take on, like patient throughput, you can use a number of them together, through a facilitated, team-based approach,” Daley says. “The key is to focus on the people side of the change, not just to go through the motions of using the tools. Unless you change your culture, the improvements you make are probably not going to be sustained over time.”