Breakthroughs and Bottlenecks
Finding and fixing bottlenecks creates breakthroughs in business, in services, in healthcare.
Everyone has experienced bottlenecks in traffic. A stalled car blocks a lane, and two lanes merge into one. Or traffic ahead slows for no apparent reason. Or a bottleneck emerges as too much traffic tries to exit, blocking the cars behind.
Bottlenecks exist in business and government services too. Service breakthroughs come from identifying and fixing these bottlenecks.
Take Delayed Transfers of Care from hospital. The hospital certifies that inpatients have been appropriately treated and are now medically fit to be discharged. But the patient needs extra care for rehabilitation and it is not available. The patient lingers in hospital, tying up scarce resources and beds. The key is to look at each step in the process and discover ways to speed up the process.
In one case we brought all the stakeholders together, about 35 people representing 60 organisations. Several day long workshops defined the patient pathways and the organisations involved at the front end and back end of the hospital.
A small group of us met separately afterwards to identify the process from the hospital perspective. We found that the hospital on weekends was not certifying patients to be ready for discharge, causing a backlog of patients to be evaluated on Monday. Assigning a middle manager over the weekend resolved this bottleneck.
A different example is Diabetes care. Day long workshops of 24 stakeholders identified a hub and spoke model to improve patient care in the community. Still we knew there were too many diabetic foot amputations but we didn’t know why. Desk research, executive interviewing, and small group meetings led to changes for GPs and for podiatry care.
Workshop Syllabus
1. Identify bottleneck and system participants
2. Define workshop goals and procedures
3. Introductions
4. Participants provide their perspective on bottleneck
5. Lecture – root cause analysis and the five whys
6. Create small groups of mixed teams
7. Each team develops own solutions
8. Present solutions to overall group
9. Rank solutions by:
a. Priority
b. Timeline
10. Reassemble small groups
11. Assign solution to each group to make operational
Root cause analysis is one description of the technique of finding bottlenecks. In other words, what is the root cause of the problem? We see the bottleneck here. Look backwards. Where is the first instance of this problem? What caused this? That is the root cause.
The Five Whys is another technique for finding bottlenecks. You see a problem. Ask why. Find that answer and ask why that happens. Find that answer and ask why that happens. Three more times ask why and you have probably found the root cause.
We work with you to solve your intractable problems.
Bottlenecks:
Start: there is a process that needs improvement
Options:
1. It is known exactly where the bottleneck is.
2. The outcome is sub-optimal but it is not known exactly where the bottleneck is.
Process:
1. Where the exact bottleneck is known, the process is to review all the inputs to this point.
2. Where the point of bottleneck is not known but the outcome is sub-optimal, the entire process needs to be evaluated.