This weekend I got a ground wasp sting in my hand / arm. The arm is swollen and need antibiotics. This I know from experience because I have been bitten before. Antibiotics were then the only thing that bit as opposed to allergy medication. Monday morning began the project to get antibiotics. This is by law the only doctor that can print, so I had to get a doctor's appointment.

In retrospect, it was actually pretty smooth. After being called to my clinic with a busy tone for nine attempts, I came up with a rose for the tenth. This went on with his voice, "thanks for your patience, we will do our best to answer your call as soon as possible" (in Västmanland). After 20 minutes I gave up. I went downstairs from the office and walked to the clinic. There was that one person in the waiting room and quite dead. I was received and managed to get an appointment with a nurse who then examined me and took a doctorate. He gave me the final forensic medicine. The entire process took about a minute effective time. The total time in waiting rooms, etc. amounted to about 40 minutes, which means an efficiency of 2.5%. This I am definitely happy with, it felt like it went pretty quickly.

A social problem

The medical care is ineffective is a social problem. Although the State has a health care guarantee, so it happens that people actually have to wait over 90 days in processing. It has such a long wait! On www.vantetider.se it is possible to download material on the improvement work carried out on the subject. It uses a continuous process that is copied from the Japanese model for improvement, lean production. This is great. But where's the big deal?

Doctor, the bottleneck in health care

The problem underlying an overly long waiting time is too slow stream. The average flow through a process limited by the bottle neck. The flow in and out of the process can not exceed the average flow from the bottle neck, but the line is growing to infinity. If the assumption is made that the queue length is long, but stable, are:

The flow through the bottleneck = flow into the process = flow out of the process, where the flow rate = number of patients / unit of time.

In medical care, doctors are bottlenecks, or at least theoretical bottlenecks. Anyone who is sick must visit a doctor, the doctor is the resource that is most valuable in the flow and therefore, she should also be the most rare and maximized. Should nurses be bottlenecks they would have had more than wages and were lowest in number.

Eliminate bottlenecks / increase the flow

In order to obtain a shorter waiting time, the flow increase. This is because the number of people in the queue (in need of care) is unchanged and that (Little's Law):

Queuing time = Number of queue / stream

To increase the flow by minimizing the effect of doctor bottleneck, there are two options. Either hiring more doctors (onödigt!) or you can start the doctors work smarter. Can the doctors handle more patients per unit time as the flow increases.

How can doctors take more patients per unit of time?

The doctor's effectiveness depends on how much of his time is spent to serve patients. According to my observations and concerns involved Doctor more time on documentation than for example, to talk to patients. If the doctor would put all their time on serving patients, the system could be twice as effective, with the assumption that the doctor today put half of their time on documentation. If someone makes documentation work for the doctor the doctor may take twice as many patients and documenting the doctor need not cost as much as an additional doctor in salary. Moreover, a specialist in that document to document much faster than what the doctor made in parallel with the doctor treating the patient, saving all the time that the doctor today put on documenting.

With the extra work

Flow Dr = Number of persons / (physician time + dokumentationstid) ≈ Number of persons / 2 * medical journal

Put the doctor at the center

Flow Dr = Number of persons / (physician time + 0) ≈ Number of persons / physician time

Other things that affect the queuing time in health care: Variation

A model that would be very effective in health care is to put the doctor at the center and get her to put 100% of their time in determining the type of medication and perform treatment. The doctor is still the bottleneck so that sufficient capacity exists in the system to divert people to her, but for example there will be queues in front of the registration. Despite this, there will always be a queue anyway. Variety is another factor affecting. The flow can not be constant but varies over time. Different patients can take some time. In addition, patients arrive at different intervals. More patients will, for example, probably around lunch. This causes the cue will be built when the inflow is greater than the average flow and graze during the opposite. This is never possible to get away without excess capacity at the doctor. The doctor must have the capacity to handle more patients per unit time on average than they actually are. The concept of capacity is the same as the maximum flow that can go through the doctor, or the number of patients per unit time that we discussed earlier. By increasing capacity, reducing the effects of variation.

Variation can occur in a different manner, patients may have different diseases that require different doctors. It may be a shortage of doctors for a specific type of disease (a bottleneck) and sufficient capacity for doctors of another disease. This deal, through specialist departments that handle all the cases are of rare diseases that have few doctors. This evens out the effects of variation. To have specialist departments are queuing theory well and it should proceed with care.

Improvements in health care for real

Health care is much in the news these days because it just is so inefficient that I describe. A hospital is a process that has been ill as input, and healthy people as output, so you can actually see it and must see it to create a competitive society. There is nothing inhumane in such a sight. Inhumane, it instead when patients have to wait and suffer because of an inefficient process.

Input output model can be applied to patients, the disease transformed to the healthy

To create an effective care, in addition to the theory of diseases is also able to design efficient processes. After my visit to the doctor today, I see that there is much left to do because more than 90% of my day consisted of waiting despite our getting in the waiting room.

The result of my brief analysis is all about getting the doctor to work more efficiently. Not faster but more efficiently. The doctor must spend all their time on value adding activities and leave all other work to other staff there is better access.

In our writing my thesis in operations management, business development. I am looking for exciting processes to streamline. Health care is one such option, but also the office environment is interesting. Then I can dig deeper into a problem than the 20 minutes I put on this post.