Health care, I’m often told, is different. This usually means, ‘different from industry’, and certainly different from car making.
This is true, of course. In health care it is often the interaction of staff and patient that carries the greatest value. Generating the time and space for this to happen, and making sure that the right equipment and supplies are available when needed is, however, the result of a series of processes. If these processes don’t work, staff find that they don’t have the time they need, and patients feel rushed or are kept waiting – or both.
In understanding what needs to happen to let a service function effectively to let staff do their job, takt time is a useful tool. ‘Takt’ is a German word, used in music, which means the ‘time’ or ‘beat’. In lean work it means the rate at which the service has to work to meet customer demand. You calculate this by taking the time available to do the work, and dividing it by the demand. So, for example, if there are seven working hours available after breaks and 40 patients to be seen, then the equation would be 420 minutes divided by 40, making a takt time of 10 minutes 30 seconds.
This does not mean that only 10 and a half minutes are spent on each patient: rather, it means that, on average, one patient has to be ready to leave the department over ten minutes, or about six patients an hour. The time required to work with that patient may be substantially longer. So, for example, if the intervention takes one staff member 21 minutes, then at least two staff members are needed, and so on, in order to keep up.
Attaching a number is often very useful. A colleague and I worked with staff in a surgical speciality who wanted to look at their out-patient activity. They had over 30,000 appointments a year. The calculations were complicated, as some appointments were for the same people having multiple interventions on the same visit. Taking it at face value for a minute, however, this would mean that around 130 appointments have to be delivered on the average working day, assuming five-day a week working, 50 weeks a year. Knowing this made it easier to understand why waiting lists lengthened: there were few days in which the minimum required number of appointments were offered. A modest shortfall of ten appointments a day becomes 50 a week, 650 in thirteen weeks, or over 2,500 in a year – which is around a month’s capacity for this service.
In this case, there was no requirement to keep to the exact number each day – the clinic type and intervention complexity varied by condition – but if around 650 appointments were not available each week, then the waiting list would inevitably lengthen. Knowing this, the service established a flow team, who take responsibility for ensuring there is enough capacity to keep up with current demand.
A common objection to takt time in health care is that demand varies. Again, this is true, but there is considerable flexibility in how to apply takt time. So, for example, the takt time may vary by day of the week and time of the day. The key here is in matching capacity to demand (sometimes demand itself can be reduced or levelled – I’ll cover that in another post).
There is an interesting discussion of the use of takt time in a forum exchange. One responder points out that takt time can vary at different times of the day in an accident and emergency department. Departments do often vary staffing to reflect demand, but another post notes that, in one service, when they looked at takt time the service discovered that they altered staffing two hours after the demand began to increase, resulting in a failure to meet takt time, and an inevitable increase in waits for patients. In this case, the delays became noticeable some time after demand began to exceed capacity, and without looking at takt time, the department could have spent time focusing on a later time period.
Are there ways in which you can make use of takt time in your services?
Image courtesy of luigi diamanti at freedigitalphotos.net