The new UK Government has announced plans to attack the “Waste of Rework” in the NHS, provider of the public UK hospital system. BBC News – Hospital Face Fines
The Waste of Rework is the waste of resources (time, people, materials, equipment etc) when a process isn’t completed to the required standard. Consequently more of the resources have to be spent putting the work right – which also has a knock on effect on the subsequent work planned.
It doesn’t matter whether we are talking about metal forming, handling insurance forms, answering customer calls, or attending to patients, doing a job right first time, will use up less resources, than having to re-visit the job. So this waste, from a Lean point of view, is pretty universal.
The change proposed is that if a customer (okay they do still call them patients, they haven’t admitted these people are customers who have paid for the service, through taxes!) is re-admitted within 30 days of being discharged then the hospital will not be paid for the second stay, if it is related.
Hence I’ve viewed this as the hospitals will no longer be paid for the Waste of Rework, so the incentive is to get treatment right first time!
Within many of the reports on this new ideal came the complaint that this change will lead to longer times in hospital and increase the length of waiting lists. The people making these claims have never seen any lean thinking or queuing demonstrations on the effect re-work has on the capacity of a system. Re-work lowers the capacity of any system and often by more than the measured rework figure.
So a 10.5% rework rate will reduce capacity by more than 10.5% because of the effects it has on planning, we use a calculation known as OEE (Overall Equipment Efficiency) to demonstrate this, don’t be put off by the manufacturing bias to the name of this, you can use it for any process.
Now I don’t have all the figures to understand this but the % of re-admissions as proportion of all discharges, in the NHS, went up from 8.8% in 1998/9 to 10.5% in 2007/8. There is no indication whether this
- is a statistically significant rise,
- is a consistent rise from 1998/9, or just 2007/8 was a high year
- is a function of re-admissions within the new 30 day limit,
- is due to a focus on treatment at home, which might carry more risks
- or just a function of an ageing population.
Whether it will actually work or drive the correct behaviours we don’t know because is the problem of rework being caused by people being sent home to early, or by something else….
Now if the Government used the 5Whys to determine this waste, then we’d have a better idea…..
P.S. Do you know what the rework level is in your organisation?