You Don't Need More People!
You Need Less Waste and Rework
Companies immersed in crisis management often think the solution is to get more people. But you don't need more people; you need less waste and rework that is causing the crisis.
Virginia Mason Medical Eliminates the Need for More Nurses
In every hospital I've ever worked with, the nurses think there aren't enough nurses to handle the patient volume. But as Virginia Mason found out through various improvement projects, it's possible to increase nurse time with patients from a typical 35% to over 90%. Hospitals don't need more nurses, they need to redesign the work flow so that nurses can spend more time with patients. At Virginia Mason:
- Nurses now only travel 0.6 miles per day instead of the 5 miles they used to walk every day which easily translates to 1-2 hours of time wasted searching for supplies. Virginia Mason identified the top seven supplies nurses need and ensured that those supplies were easily available and constantly restocked in every patient room.
- Nurses used to stay late updating medical records. Now computers on wheels or computers in the room allow nurses to keep patient medical records up to date in the patient's room. This is just-in-time (JIT) at it's best.
- Nurses can call a Patient Safety Alert (PSA) anytime they think a patient might be endangered by a medical procedure. This saves lives and reduces length of stay.
- Nursing and patient satisfaction has soared with the implementation of many of these kinds of improvements.
You don't need more nurses; you need less waste (travel) and rework (patient complications).
When I worked at US WEST, one of the Baby Bells, it took four days to get a phone repaired—four days of backlog followed by an hour or less of repair. This, of course, was unacceptable to business or residence customers. The "Plant" leadership thought they needed more people and tried to use quality improvement to prove it. They even scheduled a trial in Salt Lake City to test out same day appointments and brought in repair personnel from all over to make it happen.
The very first day on the project, I called our VP of Quality Improvement and explained to her that we didn't need more people, we needed less repair. Unfortunately, the train was already on the track to disaster. After two months and millions of dollars, the project ended in failure.
Some of the staff in Iowa, however, noticed that they had 12,000 repair appointments a month, but many didn't need a repair technician because the problem wasn't at the customer's home. I did some analysis and we quickly discovered that repair service representatives did a "loop test" to determine if the problem existed between the central switching office and the customer's home. If not, the problem was in the switching office. Customers were annoyed that they made time to stay home, but often a repair technician never came to their house. Their phone just suddenly started working.
Two-thirds of the repairs could be handled in the switching office. Only one-third needed home appointments. We figured this out on Friday and implemented a procedural change on Monday. Service reps no longer made an appointment for every repair call, only for the ones with a failed loop test. The "Plant" people were furious because it could ruin their performance numbers, but the service reps stuck with their new improved process.
One month later, scheduled appointments had dropped from 12,000 to 4,000 without any change in "repeat repairs" (the need to repeat a repair). Mean time to repair had changed to same day service for central switching office repairs and the time to repair a loop problem dropped as well because technicians were focused on solving problems outside of the switching office. Customer satisfaction soared.
As the Iowa Plant people found out, you don't need more people; you need less waste (scheduling outside repair technicians unnecessarily and making customers stay home to meet a tech.)
There is an old saying from Frederick Brooks, author of the Mythical Man Month: "Adding people to a late software project only makes it later." Having worked on many software projects in my day (my wife worked on many more), I can tell you that this is always true. When management got anxious and brought in more programmers, it took skilled people time to bring them up to speed which slowed the overall process.
Writing the same code over and over again with slight tweaks is a form of waste and overproduction. I worked on one project at Bell Labs and we knew we couldn't possibly meet the schedule with traditional development, so I recommended that we maximize our use of reusable code. With that in mind, every aspect of the project varied between 75% and 90% reuse. We met our target dates without adding programmers.
You don't need more programmers; you need more reuse.
Any time you find yourself fighting fires and managing crises with too much overtime, stop before you hire more people to fight the fires; ask yourself: "Do we really need more people or just less waste and rework?" It often takes far less time to find and fix the causes of waste and rework than it does to hire and train more people.
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