Improvement Insights Blog
Punishing the Masses for the Sins of the Few
Gut feel often leads to wasteful solutions to almost everything. Here’s why:
“Hi, I’m Jay Arthur author of “Lean Six Sigma for Hospitals” and the QI Macros [software].
“When I was working at U.S. West in the phone company we had a little problem in Iowa. We were doing about 12,000 repair appointments a month; that’s where they would come out and fix your landline phone. (I know you don’t have those any more but we used to have landline problems.) Anyway, customers were complaining because we would tell them we would fix their phone four days from now, so on Monday we’d tell them Thursday and so on. We’d make an appointment for a repair technician to come out.
“Now guess what? People would take time off from work to stay home to greet the poor repair guy, but the repair guy would not show up and their phone would start working again. That was annoying them quite a bit and so I got called in to do a little data analysis.
“Very quickly we discovered as we were looking at these: there’s something called a loop test. In a phone company we could test from the central office where all the switching occurs all the way out to your phone and then all the way back. If that loop was okay then the problem had to be inside of our switching area. Probably 75% or 80% of the [customers] that we were getting appointments for did not need an appointment because it was in our switch. We figured this out on a Monday and on Tuesday they changed how we handled all that so if we had a successful loop test out to the house we just said, “Your phone will get fixed on Thursday; you do not need to stay home.”
“I’m telling you, the old plant guys… these are the guys who took care of repairing, maintaining and connecting all the phones out there in the world and in Iowa and 14 states total. I’m sure they were not happy about this, but a month later we discovered that we hadn’t had any problems and we still had about 3,000 repairs where they had to go out to the customer premises and fix stuff, but about 9,000 those went away. We didn’t have to redo appointments to come out and work with them.
“Now I can tell you what happened: somewhere along the way, some old plant guys said, “Hey, my guys went out there and the people weren’t home. I need you to make a repair appointment with everybody.” Guess what? That was not a good choice, right? That was based on gut feel, not on anything.
“This is what I call “punishing the masses for the sins of the few.” We punish all these other people for the sins of a few people who weren’t home or some gut-feel trial-and-error thing that came out of somebody’s imagination somewhere. That’s one example of this.
“I just saw a presentation on blood tubes and waste and in hospitals, and the essence of it is about every patient that gets blood [drawn] they take extra vials. Why would they do that? Well, just in case… just in case. Just in case we need to do another test. Well, wait; let’s find out how many times you have to do that.
“It turns out 93% of the time you didn’t need to take an extra vial, so we were punishing 93% of patients with an extra vial. Now I assure you if you look at the presenting symptoms of that patient you can guess whether you might need an extra vial and you could do that.
“So what they did was they cancelled all this extra vial stuff. They put in some new protocols and said, “When do we think we’d really need that? Let’s go look at the 7% that need an extra vial and let’s find out what the characteristics of those patients are, and let’s make sure that we set up the protocols so if we’re collecting blood for these kinds of patients we know that we should get a little extra blood.”
“If you’re getting too much blood, guess what? If you have somebody who’s anemic you keep taking extra vials of blood they become more and more anemic. That’s not good, it causes patient harm. And then it costs a whole bunch of money to take that that blood tube and get it recycled because it’s hazardous waste and it can’t be disposed of in the usual fashion. That costs money, all right? Just the tubes alone were $12,000 a year, and I’m betting the disposal was [around] 24 to 36 thousand. (I don’t know what it was, but it was more than the tube, obviously.)
“This is another case where we’re punishing the masses for the sins of a few. I don’t know about you, but I see this way too often… way too often.
“I’m Jay Arthur. That’s my Improvement Insight for this week. Watch out for punishing the masses for the sins of the few because you were too lazy to get a little data. to figure out exactly what you need to work on and leave everybody else alone. Leave them all alone, all right? It’s hard on them, it’s hard on the economy, it’s hard on everyone else. Let’s just get a little smarter and use a little data. Let’s go out and improve something this week.”
