Even Earlier!


Lean Blog: Early Risers in Healthcare! (My belly aching from March)

OK, a new early “low” of sorts. Currently visiting a hospital, patient blood draws start at 3 AM. Even with having to be there that early to observe the process, I still love working in healthcare. Good night!

All for the convenience of the doctors and their schedules….. this creates an inordinate and costly demand spike on the laboratory, having all of that blood come in so early in the morning. Lack of level loading, to say the least.

I'm reminded of the Toyota quote, “Heijunka: You won't be HAPPY Without It.” This is a tough one to crack in healthcare. Some aspects of “demand” (specimens arriving at the lab), you can control (courier routes from community health centers, etc.), but not the doctors.

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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. Hi Mark,

    Are 3am blood draws really for the “convenience” of the doctor? Health care consumers, who are not in the hospital, expect office based physicians to be available at our convenience, daylight and early evening. This leaves the morning (sometimes early morning) or late night as the only times those physicains can see patients in the hospital.
    I believe the early morning blood draws are only one example of the inability to control scheduling in health care delivery. Other examples include trying to figure out how many trauma patients will present themselves to an ER tonight and will the flu bug hit today or next week.

  2. Chuck — You’re right, one reason the doc’s need to be done at the hospital so early is so that they can get to their office for appointments. But, it’s also a lab cycle time issue. If you need all of the labs done by 7 AM, you need a certain amount of lead time for blood draws, transport to the lab, and testing. You can cut that cycle time through lean methods (less batching, etc.) and not have to draw SO early.

    I’d still place SOME blame on the doc’s for 1) not realizing the impact of their scheduling on support services and 2) not being more creative in “leveling out” their rounding hours. I’m sure some docs would prefer to round later in the morning.

    The ER/trauma stuff is surprisingly predictable, according to some studies I’ve seen. “Scheduled” surgeries created more variability in OR and support schedules than ER/trauma surgeries did. People tend to get stabbed or get into wrecks at predictable times (not including “special cause” events).

  3. I thought about this some more. If the morning draws and rounding issue is a systemic problem, I’m not right to blame the doctors. Who is responsible for the system? Management. We should look to administration to help everyone see the big picture. Administration needs to help people understand how they can act in a non-suboptimizing way, perhaps.


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