Here is a short blog piece on the American Society for Quality website, written by a doctor. It's positive about lean, which makes me cringe at the ole' “Lean and Mean” title. I presume that people think it's cute rhyme and use it without thinking sometimes.
He makes a point about changeover:
We used to schedule all the left eye cataracts in the AM, right eyes in the PM to minimize time in moving the microscope. Same for knee arthroscopy.
I've seen this too at a hospital — large batches in order to minimize the amount of Operation Room setup and changeover. It's classic non-lean sequencing: AAAAAABBBBBB (or LLLLLLRRRRRR). They assume the changeover time HAS to be long, it's not standardized or made efficient (by analyzing external vs internal setup). Using “SMED” principles, you could do the procedures in a “mixed model” sequence:
Am I missing something? Or is there a risk that some hospitals are adoping a lean method without thinking about what waste is caused by LLLLLRRRRR? Do surgeons get sloppy if they're doing too many of the same side? Or is there actually a surgical quality advantage to doing the same thing many times in a row?
What would you say?
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