Lean Tools: Utilizing Swim Lanes to Optimize Productivity

Introduction

Quit frequently healthcare organizations face financial dilemmas where demand for a service exceeds capacity and it appears additional resources are needed to add capacity.  However, the productivity and margins for that service are not meeting expectations.  Adding additional providers and/or facility size may increase capacity but the service will continue to operate below productivity and financial expectations. Prior to making the investment in additional resources the prudent manager may apply a lean tool called swim lanes to determine if there is an opportunity to add capacity without adding resources.  The following steps will show you how to apply a Swim Lane approach toward optimizing productivity.

Step 1: First measure your current production levels, list the resources utilized to achieve those levels and identify your financial status.  The following example identifies the production level and resources utilized in the operation of one suite in an ambulatory procedure center. In this example we have the following key resources and results.

Step 2: Next, use the swim lane tool to identify how those resources are being utilized to achieve the current productivity level.  This assessment involves a detailed, time based, review of the patients’ flow through the center, the sequence of activities deployed to serve the patient and the resources utilized to delivery those services.  As you can see in Exhibit (1)* the swim lane approach involves listing resources and the services they provide in rows (lanes) by their sequence of occurrence.  Meanwhile the columns provide a timeline allowing for the assignment of completion time to each activity.    This step will provide you with a clear understanding of why your current resources generate the current capacity.  Please see Exhibit (1)* which illustrates the flow of patients though the procedure center.  As you can see in this example the initial procedure center capacity is just 3.4 procedures in the first hour.  The following table provides a summary of the utilization of manpower and key facility resources.  This data reflects high utilization of the physician’s time but very low utilization of the other resources.  The procedure volume capacity under the current process averages 3.7 cases per hour over a 4-hour period. The actual workload achieved of 3.1 cases per hour represents 84% of capacity. 

         Procedure Center – Initial Capacity

Step 3: In the next step utilize the swim lane illustration to analyze the current resource assignments and determine if there is any opportunity for improvement in the process.  Key areas of consideration in identifying improvement opportunities are:

1. Are all the activities necessary?
   1.  Does each activity in the process bring value to the service?
2. Are we being completely efficient or are their opportunities to reduce the time required in the completion of each activity?
3. Are we optimizing the use of each resource?
   1. Are the roles for each position appropriate for their skill level and costs?
   2. Have we minimized inactive time for each resource? 
   3. What percentage of the time is a space or item of equipment being utilized for its intended purpose?
4. Is out process feasible
   1. Are we assigning resources to multiple activities at the same time?

In the Procedure Center example, the primary area of opportunity involves the assignment of duties to the physician.  In this case the physician is the highest utilized resource and also the most expensive resource for the procedure center service.  While we generally want the highest price resource to be the process limiting factor in order to optimize productive efficiency, we don’t want the physician to be the limiting factor because he/she is performing duties someone at a lower skill and compensation level could perform. Obtaining the patient’s consent is a potential activity for reassignment.   There are also, multiple periods of staff and equipment inactivity in this example.  This resource inactivity must also be addressed in order to optimize the process productivity.

Step 4:  Next, take advantage of the opportunities identified in step 3 to reorganize the service and improve productivity.  The swim lane approach puts you in a position of understanding which significantly increases the probability of successful process changes.    In this example the first step for improvement will be to relieve the physician of the consent activity and assign this role to a nursing assistant.  Next, we will use the freed time for the physician to accelerate the completion of procedures which will serve to increase the productivity of all resources.  Please see Exhibit (2)* for a swim lane containing the results of this improvement.   The following table summarizes the productivity capacity for each of the key resources after applying the process improvements.   Reassigning activities to the appropriate resources allowed for accelerated procedure activity and a significant increase in productivity.   The procedure volume capacity under the improved process averages 5.75 cases per hour over a 4-hour period

Step 5:  In the final step is to project new production levels, the resources utilized t, and the new financial status.  At 84% of the new capacity the production level jumps to 4.83 cases per hour while using the same resources.  As a result, the margin jumps from 8% to 36%.

Conclusion
In this example we were able to use the lean, swim-lane tool to add an additional 55% to system capacity without adding resources but by simply reorganizing the work process. As a result, we experience a significant jump in both manpower and facility productivity eliminating the need to invest in additional expensive resources in order to meet demand.  Producing more volume with the same resources also drives improved financial results and eliminates the low margin dilemma discussed in the introduction.  One important lesson from this analysis involves the ripple effect of reduced physician productivity on overall system efficiency.   In our pursuit of a meaningfully useful electronic medical record we must remember this lesson as we assign new documentation requirements to health system resources. 

*Exhibits are located at https://www.valuehealth1.com under Business Tools

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Reprinted with permission from MGMA, 104 Inverness Terrace, East, Englewood, Colorado 80112.