Sunday, September 13, 2009

Introducing variability, flow and processes in a funny video to anyone

I'm leading on two variability & flow management projects at the hospital right now, and the terms "variability" and "flow" are certainly not something the medics hear much about. I needed a quick way of explaining what the projects are about, what these terms mean, and what kind of problems we are trying to resolve. A colleague suggested this video from the ever popular "I Love Lucy" TV series, episode "Chocolate Factory". It does a wonderful job of making people laugh, as well as acting out some strong parallels to a process, and the variability and flow within the process. Take a look at the video (it's a funny one!) and read on for the parallels to the operation of a hospital. The doctors, nurses and patients on my team all found the video not only hilarious but also made it clear to them what we are trying to do in the variability & flow management project.

The parallels:
  • Process: the chocolates can be patients coming into the hospital 'conveyor belt'. Lucy and her friend Ethel can be the nurses, for example, (or the various clerks, doctors, pharmacists, radiographers, etc.) handling the patients, 'dressing' them up or giving them care to make them better so they can go on to the next hospital professionals, i.e. the pharmacists to receive medications in the next room down the conveyor belt. The patient traveling through the conveyor belt is a process. Similarly, Lucy and Ethel picking up the chocolate from the conveyor belt, taking the wrapping paper, wrapping up the chocolate nicely, placing the wrapped chocolate back onto the conveyor belt, and returning to the position to be ready for the next chocolate, is a process. Lucy and Ethel are the 'servers' within the process. The things they do to the chocolate are 'steps' within the process. The girls feeding the chocolate onto the conveyor belt for Lucy & Ethel in the previous room are the servers of the upstream process to Lucy & Ethel's wrapping process. Similarly, the girls boxing the chocolates in the next room, perhaps, are the servers of the downstream process.
  • Flow: The chocolates going through the Lucy & Ethel's wrapping process is a flow.
  • Variability: The speed the chocolates are placed onto the conveyor belt is a source of variability, because the speed changes, and so is the speed that Lucy & Ethel wraps the chocolate, as they have very different styles of wrapping. This results in the variable speed of the wrapped chocolates flowing out of the Lucy & Ethel wrapping process.
  • Queuing & waits - When Lucy & Ethel were running behind and when they started to collect the chocolates in front of them and in their hats, so that they can wrap them later, that's queuing the chocolates, and those chocolates are experiencing 'waits'.
  • Mis-communication: When the supervisor meanie lady shouted to the upstream girls to "let it roll" and nothing happened so she had to go to the previous room to sort it out, that's mis-communication or signal failure. :)
The video also shows some classic examples of problems around processes:
  • Isolated processes and working in silos – what is going on 'upstream' and 'downstream' is absolutely unknown to Lucy & Ethel.
  • Lack of issue escalation procedure - when the chocolates are coming too fast for Lucy & Ethel to handle, they had no way of letting the upstream or the manager know (but of course, the meanie supervisor lady didn't allow them to leave one chocolate behind).
  • Performance management - the meanie supervisor lady did not have realistic expectations on Lucy & Ethel's performance, or maybe she simply didn't have any clue about the variability of the sometimes very high demand placed on Lucy & Ethel from the upstream.
  • Reactionary management - When the supervisor lady came into the room and saw that Lucy & Ethel had no chocolates on the belt and therefore ordered the upstream to feed faster is very reactionary. She simply made the decision based on one observation / data point, and did not ask any questions about why it is that way.
Hope you find the video useful in your work as well. I'm sure you can draw parallels to other industries aside from health care. Please feel free to share it with me. Things are often best explained by humour.


Peter Kolar said...

Nice article.

AK said...

Very nice! :)

firma ekle said...

Thank you, good article