Early Risers in Healthcare!


I always thought manufacturing people were early risers. In my last manufacturing job, the factory started production at 5 AM and I started most days at 6:30 AM (I was an internal lean consultant). I sometimes surprised the teams by showing up at 5 AM (much earlier than their supervisors, which is a whole different blog posting).

Tuesday, I'm starting a lean assessment with a hospital laboratory. They are a 24/7 operation by nature, but their first shift phlebotomists (people who draw blood from patients) start arriving at 3 AM and the peak is between 4 and 5 AM, hence I'll have to arrive at 4 AM to follow the “activity of the product.”

I'm going to ask tomorrow, as I always do, “Why is it necessary to wake up sick patients at 4 AM? Is this really best for them as patients?” I'll try to report back the answer tomorrow night if I'm not too tired after my early start. I know the typical answers and I'll let you speculate on those reasons here, if you like (click comments), but I'll report something back tomorrow.

At the least, this is the furthest thing from “level loading” the lab. At worst, it's poor “customer service” (and patient satisfaction studies generally show complaints from early blood draws). Many hospitals are attempting to level load the blood draws to benefit both the lab and the patient.

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. Looking ofrward to your next post. I’m making this same transition myself just now. Watch for couriers and batching from satellite hospitals / physician practices!

  2. You may find the reason is that Doctors want the information when THEY come to work. My observation is that the health care system is optimized around doctor time, not patient well being or patient time. Patients are inventory. Patients wait for doctors, doctors don’t wait for patients. Be interested if you find that this is true or not.

  3. Yes, the most common reason given is the MD’s. MD’s want their test results by morning rounds, usually by 7 AM or 8 AM, so they can check on patients and get out (the MD’s) of the hospital ASAP to go back to their private practice office. Hospitals are not just competing for patients, they are competing for doc’s. Hospital admin will claim “if we don’t provide the test results by 7 AM, they’ll go and take their business to a hospital who will.”

    The challenge is to reduce Turnaround Times (Cycle Time) to do the tests as late as possible to maybe wake patients later. But, it still doesn’t address the lack of level loading unless you wake patients all night long and spread out the tests. Then, there’s an issue of whether or not the docs/patients need “fresh” test results or if the lab needs “fresh” samples for testing.

    A complex system, but one worth fixing.

  4. Mark: I think you hit it. Cycle time. Is the best technology being used? (Most rapid analysis methods and machines?) Could it be done at the patient’s bedside or in the hall (minimum transport, which is waste)? Radical: Could it be done WHILE THE DOC is seeing the patient, real time feedback? Could it (the blood draw system) be permanently hooked up and the draw taken while the patient is asleep, thus enabling all night long level loading?

    “Prudens quaestio dimidium scientiae” (to ask the proper question is half of knowing.)


    • Paul –

      A few thoughts on what you suggested or asked:

      1) There are “point of care” lab tests that can be done for some types of test at the bedside… they are more expensive and the quality is sometimes considered to be less accurate. But, a full analysis would look at “total cost” not just the cost of the test itself (if a faster test gets a patient discharged more promptly, that might be worth the higher test cost).

      2) Hard to get “real time” feedback for many tests a doctor would need.

      3) The “permanently hooked up” is called a “line draw” where the blood is draw from an IV line, not a separate needle stick. However, this must be done by a nurse, not a phlebotomist (increasing cost and time constraints on the nurse) and this might not be appropriate for patients who don’t already need an IV.

      I’d, of course, really want to ask these questions at the gemba with healthcare professionals… but what I typed above is my recollection of these discussions I’ve had in the past.


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