“If the patient dies, it is the doctor who has killed him, and if he gets well, it is the saints who have cured him “.
Dr. Acula had read this forwarded message for the umpteenth time – on Whatsapp, Facebook tags, tweets and a thank you greeting card from one of his patients. What frustrated him the most about this message was, it was also sent by a relative who had taken his consultation a week back and did not have the decency to pay him. Dwelling on how the day began, he got into his car amidst wishes from his driver and the security guard. They set off to the hospital which was a good hour and a half from his home: an ideal time to read the newspaper.
After going through a couple of pages of politics, corruption, crimes and celebrity endorsements, he finally reached the page which was dedicated to World Cancer Day.
Articles such as “Childhood cancer is a growing problem”, “More than half of new cancer patients in India are women”. “Tobacco ban can avert 40% cancer”: he thought to himself ‘Wish they would increase the no of hours in a day to 48 so that I can see more patients’!
Currently, he was seeing around 50 patients at OPD and another 15 in Chemotherapy, every day. Although the official appointment slots were only five minutes per patient, the consultation took a lot longer than that.
“Probably suggested by someone with an MBA or an Engineering degree. I don’t know what role they have in a healthcare environment other than civil and mechanical engineers.” thought Dr. Acula as they pulled into the parking lot of the hospital. “Oh yeah, Electrical engineers too” thought the doctor as he got into the lift with a flickering light.
As the doctor approached the OPD, he saw his assistant scurrying around some of the patients waiting to collect their files and instructing them to wait or calming them down by saying “Doctor had an emergency procedure- so he is late”. With a sense of dread looking at the number of patients already waiting- he proceeded towards his chamber. He saw with slight anger that the nameplate on the door still read “Dr. Richard Stiff- Orthopedic surgeon” and not “Dr. Acula Hematologist- Oncologist”. He signaled to the assistant and tapped on the nameplate and went inside. He put on his coat, washed his hand and took a seat to find the day’s patient list on the table. He browsed through the list:55 patients for the day:2 patients who he already met him yesterday, 10 troublesome patients and 1 patient who is nearing the end.
With a sigh what he remembered was the forwarded message he received in the morning.
After the end of a long day- asking patients to reorder the documents, asking them to perform particular tests (explaining it is necessary and he was not trying to rip them off), dealing with a couple of patients who were late to their appointment and picking fights with other patients, attending a seminar on how to improve the patient flow with the Administration head, the doctor started to pack feeling glad that he is not going to see any patients for the next 3 days as he was visiting a conference in Singapore. Feeling slightly guilty for feeling happy, he waved a goodbye to his assistants and left for the day.
Dr. Acula rushed to the airport the next day to find his flight delayed by an hour. The waiting area was already packed with waiting passengers. He found a seat next to a fat guy who was working on his laptop. He browsed through his phone and caught up with his messages and returned calls. Dr. Acula’s eyes then fell on his neighbor’s laptop and noticed that he was making a presentation. “Existing vs Proposed Productivity Improvement” read the slide heading and he had displayed a graph which showed how he had improved production with the same manpower. Feeling skeptic, the doctor started a conversation:
Dr. Acula: Sorry to intrude, can I ask you a question?
Fat Guy: Sure.
Dr. Acula: How is that you could increase the production with the same manpower?
Fat Guy: Productivity improvement.
Dr. Acula: And?
Fat Guy: Some more stuff for which I must go in depth so that you can understand.
Dr. Acula: (Indicating the display board which showed the delayed time) I have time!
Fat Guy: Okay, so work can be categorized into Value Added and Non-Value Added i.e. Work which customers pay for and work which the customer doesn’t pay for.
Dr. Acula: Aah!
Fat Guy: So, what we do is identify the Non-Value Added activities and find a way to eliminate it so that they can accommodate more work in the same time.
Dr. Acula: So, what did you do in this company that increased production by 75%?
Fat Guy: 100% to be precise. The operators in this company moved materials manually which added 20 minutes per part. We added a simple Gravity conveyor which cut short this time which in turn could be used for working on the next part.
Dr. Acula: That’s impressive! Travel time cut short plus less money spent on fuel or electricity.
Fat Guy: Exactly.
Dr. Acula: But this will work well in a set organization where everything is already well defined?
Fat Guy: Not necessarily. We have designed an entire plant from scratch and had given requirements of resources even before the factory started.
Dr. Acula: That can be calculated. What about service industries where things are not standard. Say for an example-a call center?
Fat Guy: We have simulated an entire call center where now the system is streamlined and have reduced the call waiting times by 15%.
At this point, the crew member had arrived and people immediately started to form a queue in front of the counter. He got up to join the queue when the Fat Guy spoke up.
Fat Guy: It will take another 35 minutes for the first person to enter the flight. Sir, so I suggest you take a seat rather than standing in the queue.
The doctor checked his watch and it read 9:00. So now the doctor was slightly irritated and sat down next to him.
Dr. Acula: What about doctors? I mean clinic, OPDs and hospitals? Have you worked with them?
Fat Guy: No.
Dr. Acula: How would you work there? You will not be able to set anything there- the entire thing is very subjective.
Fat Guy: Sir, like I said- any activities can be broken down into Value Added or Non-Value Added. All we have to do is identify the Non Value added ones and see the scope of reducing or eliminating it.
Dr. Acula: But whatever the Doctor does will always be Value Added. The patient might talk to him for 2 minutes or 20, how can you define this as a standard?
Fat Guy: But are those the only activities which the doctor does during a consultation?
Dr. Acula: Well, no. He goes through the documents, physical checkups, scans, reports, writes prescriptions.
Fat Guy: So I think I can classify that as Pre-Consultation, Consultation and Post Consultation activities?
Dr. Acula: That would be fair.
Fat Guy: And the consultation is the main part where the actual value is added to the entire patient visit.
Dr. Acula: Yes!
Fat Guy: So, if there was a way in which I can concentrate on Pre-Consultation and Post-Consultation activities, see if I can find a way to reduce those somehow so that the doctor gets more quality time with the patients, wouldn’t you say that is a productivity improvement?
Dr. Acula pondered over this. He had spent many of his times fuming on his assistants and patients whenever things were not in order and always thought of ways to change the system. Now after this conversation, the doctor was felt there are improvements possible everywhere.
The Fat Guy packed the laptop into his bag. Dr. Acula asked him “So, you are an engineer?”
The Fat guy replied, “An Industrial Engineer to be precise”. “What’s the difference?” asked the doctor.
“Engineers make things” said the Fat guy tapping his watch which read 9:35, “Industrial Engineers make things better,” he said pointing to the gate where the crew member started allowing the passengers on the plane.
The Guy is Girish R Kini, Senior Consultant at SNic. He recently presented a paper at Best of ASCO, Hyderabad on Industrial Engineering practices in Healthcare.