tls – breakthrough or just another tool?tocico.net/2014_tocico webinar_v2-fox.pdf2 © 2014 tocico....

1© 2014 TOCICO. All rights reserved.

TOCICO 2014 Conference

TLS – BREAKTHROUGH OR JUST ANOTHER TOOL?

Presented By: ROBERT FOX [email protected]: JUNE 9, 2014



THE IMPACT OF BREAKTHROUGHS

HENRY FORD’S PRODUCTION SYSTEM- 36 Hour Lead Time- Amazing Cost Reduction- Personal Freedom- Climate Impact



THE IMPACT OF BREAKTHROUGHS

OTHER BREAKTHROUGHS- INTERSTATE HIGHWAY SYSTEM- TOYOTA PRODUCTION SYSTEM- MICRO CHIP- INTERNET- ETC



CHARACTERISTICS OF BREAKTHROUGHS

BREAKTHROUGHS DON’T JUST IMPROVE THINGS

THEY FUNDAMENTALLY CHANGE THE ENVIRONMENT

THEIR BENEFITS ARE NOT INCREMENTAL

THEY TOTALLY CHANGE OUR PERSPECTIVE OF WHAT ISPOSSIBLE

THEIR IMPACT CAN SELDOM BE PREDICTED IN ADVANCE



PURPOSE OF TLS

IMPROVE ORGANIZATIONS−TOC – BY FOCUSING IMPROVEMENT

ACTIVITIES−LEAN – BY REDUCING WASTE−SIX SIGMA – BY REDUCING VARIATION−TLS – BY COMBINING THE STRENGTHS OF

THE THREE APPROACHES



BREAKTHROUGH POSSIBLE?

GIVEN ALL THE HISTORICAL IMPROVEMENT EFFORTS…

IS A BREAKTHROUGH POSSIBLE?



TLS A BREAKTHROUGH?

PURE CHUTZPAH?OR

REMOTE POSSIBILITY?



LET’S FIRST DEFINE IMPROVEMENT

IN A “FOR PROFIT” ORGANIZATION IMPROVEMENT OCCURS WHEN WE

- INCREASE THROUGHPUT (T), OR

- REDUCE OPERATING EXPENSE (OE) , OR- REDUCE INVESTMENT (I), OR- SOME POSITIVE COMBINATION OF THE THREE



BREAKTHROUGH A POSSIBILITY?

I BELIEVE THE ANSWER IS YES…



BREAKTHROUGH A POSSIBILITY?

I BELIEVE THE ANSWER IS YES…

IF AN ORGANIZATION HAS A LARGE AMOUNT OF EXCESS CAPACITY



WHAT’S A NORMAL RANGE OF PROFIT MARGINS?

Industry Averages 2% to 10%



WHAT’S THE RANGE OF PROFIT MARGINS ON ADDITIONAL SALES?

Our Experience30% to 80%



BOTTOM LINE IMPACT

BEFORE ADDITIONAL SALES (RM 40% - T 60%)−SALES $100M, NP $5M

AFTER ADDITIONAL SALES OF 10%- Sales $110M, NP $11M (plus 120%)

AFTER ADDITIONAL SALES OF 20%- Sales $120M, then NP $17M (plus 240%)

AFTER ADDITIONAL SALES OF 30%- Sales $130M, then NP $23M (plus 360%)



THROUGHPUT IS KING

THE BENEFITS FROM INCREASINGTHROUGHPUT DWARF ALL OTHER

ACTIVITIES TO IMPROVE



1

IMPROVEMENT CHALLENGE

Every Improvement Requires Some Change

Is Every Change An Improvement?BUT…

“If you want different results, you must do things differently”- Dr. Demming

Change

IMPROVEMENT NO IMPROVEMENT30% 70%

So how do we insure(more of) our changes lead to improvement?



1

EXCELLENT SYSTEM LEVEL RESULTS

It’s Easy to Say We Want Excellent System Level Results, But is it Even Possible?

Let’s Use a Common Issue to See if it’s Remotely Possible, Even in Theory…

And Let’s Check to See if it’s Possible to Achieve Each of The 5 TOC Success Criteria for a Change



1

TOS SUCCESS CRITERIA FOR ANY CHANGE

• EXCELLENT Results for the System

• Win-Win-Win• Low-risk vs. the Benefits• Simpler, Not More

Complex• Structured Actions to

Deliver Fast Results and Feedback

“Any fool can make things… morecomplex... It takes a touch of genius - anda lot of courage to move in the oppositedirection…” e.g. E=mc2

In the Noise

Target

+ + =

Vs.

1.2.3.4.5.

Short time to Detect andCorrect



1

DO WE WASTE CAPACITY?

• You Have Three Projects to Complete• Each Customer Wants Their Project to be TOP-PRIORITY and

Delivered RELIABLY• Each Project has 20 Tasks• Each Task takes ½ sec. to do (e.g. ½ Day)

− 20 Tasks x ½ sec = 10 Seconds• Murphy Exists so You Give Yourself DOUBLE the Time

− 20 sec x 1 sec x 3 Projects = 60 Seconds

What is the Best Way to Get the Work Done?Option 1: multi-task giving each project the same priority.

(shift between the projects to advance each)Option 2: Don’t multi-task – do one project at a time



1

MULTI-TASKING

• Most Resources Have More Than One Task on Their Desk at Any Given Point in Time

• System Goals are Often Not Clear • If the Measure is Number of Tasks Completed, More Tasks Will be

Done• If the Measure is Efficiency, Then Efficiencies Will Be High• People Want to Do a Good Job, So They Make Considerable Efforts

to Comply With the Measurements

Multi-tasking is stopping work on a taskBefore it is completed to work on another task



20

OPTION 1- MULTI-TASKING

Task # Project X Project Y Project ZTask 1 1 ATask 2 2 BTask 3 3 CTask 4 4 DTask 5 5 ETask 6 6 FTask 7 7 GTask 8 8 HTask 9 9 ITask 10 10 J

Task 11 11 KTask 12 12 LTask 13 13 MTask 14 14 NTask 15 15 OTask 16 16 PTask 17 17 QTask 18 18 RTask 19 18 STask 20 20 TPLAN 20 sec 40 sec 60 sec

ACTUALGAP

Project XWrite all the

numbers 1-20Project Y

Write the letters A-T

Project ZWrite 20 shapes, in

the sequence, circle, square, triangle



21

OPTION 1- MULTI-TASKING

Task # Project X Project Y Project ZTask 1 1 ATask 2 2 BTask 3 3 CTask 4 4 DTask 5 5 ETask 6 6 FTask 7 7 GTask 8 8 HTask 9 9 ITask 10 10 J

Task 11 11 KTask 12 12 LTask 13 13 MTask 14 14 NTask 15 15 OTask 16 16 PTask 17 17 QTask 18 18 RTask 19 18 STask 20 20 TPLAN 20 sec 40 sec 60 sec

ACTUAL 90‐180 sec 90‐180 sec 90‐180 secGAP

Project XWrite all the

numbers 1-20Project Y

Write the letters A-T

Project ZWrite 20 shapes, in

the sequence, circle, square, triangle



22

OPTION 2- NO MULTI-TASKING

Task # Project X Project Y Project ZTask 1 1 ATask 2 2 BTask 3 3 CTask 4 4 DTask 5 5 ETask 6 6 FTask 7 7 GTask 8 8 HTask 9 9 ITask 10 10 JTask 11 11 KTask 12 12 LTask 13 13 MTask 14 14 NTask 15 15 OTask 16 16 PTask 17 17 QTask 18 18 RTask 19 18 STask 20 20 TPLAN 10‐20 sec 20‐40 sec 30‐60 sec

ACTUALGAP



23

OPTION 2- NO MULTI-TASKING

Task # Project X Project Y Project ZTask 1 1 ATask 2 2 BTask 3 3 CTask 4 4 DTask 5 5 ETask 6 6 FTask 7 7 GTask 8 8 HTask 9 9 ITask 10 10 JTask 11 11 KTask 12 12 LTask 13 13 MTask 14 14 NTask 15 15 OTask 16 16 PTask 17 17 QTask 18 18 RTask 19 18 STask 20 20 TPLAN 10‐20 sec 20‐40 sec 30‐60 sec

ACTUAL 20 sec 40 sec 60 secGAP



2

WHAT HAPPENED?

• Which Rule Gave Better Results?

• Which Met the Five TOS Success Criteria?

• Some Surprising Conclusions:• There is Considerable EXTRA Capacity, Even Though it

Appears Almost Totally Hidden

• It is Possible to Make Large Improvements with Small Changes



“SYSTEM LEVEL” IMPROVEMENT

T I OE

What happens when we focus on OE?

Which measure should be the main focus of organizations? Which measure is the one that organizations focus on most?

Functional view of organization

Physical view of organization

Efforts to reduceOE everywhere,Saving in one place Often hurts others

Dept A

Dept DDept C

Dept B

problem

problem

problem

problem

Fix problems everywhere

Improvement takes a long time—many things have to changeImprovements in one area create problems elsewhere



2

FOCUSING ON THROUGHPUT

T I OEThroughput is the Reason Any Organization Exists,It Must be the Organization’s Focus

but…

Throughput

We only get Throughput atThe end of the process, when every link in the chain has done its job

Dividing the organization into parts and managing them as if they are separate entities won’t help us, we need a way to synchronize all the parts to work together effectively

and efficiently


TOCICO 2014 ConferenceMANAGING SYSTEMS

Organizations Are Like Chains.

What Determines the Strength of a Chain?

What Must Be the First Step in Improving Any Organization (Chain)?

AInput Output(T)B C D E

20 16 10 14 18units/ Hour



ISN’T IT DIFFICULT TO EXPOSE HIDDEN CAPACITY?

We have a bottleneckEstimate the“Blue Light”

TimeBlue Light45% Estimate Major

Causes of non Blue Light

Setups14%

No Tools7%

Attack the largest/easiestfirst

We Call it anInterferenceDiagram



2

CHANGE ISSUES

Doing things that should not be done

Not doing things that should be done

• The most dangerous things we face are the many SMALL opportunities to improve• How many opportunities for improvement can you think of?• The scarcest resource we have is MANAGEMENT ATTENTION• It is just as essential to STOP the “less important,” as it is to start the “more important”

• In any organization there are very few CONSTRAINTS which dictate the performance of the system•Do we know where our CONSTRAINTS are?• Increasing our focus on the most important opportunities will produce bigger results faster



TOC’S FIVE FOCUSING STEPS

1. Identify the Constraint(s)2. Decide How to Squeeze the Most Out of the

Constraint(s)3. Subordinate Everything Else to the Above Decisions4. Elevate the Constraint5. Go back to Step 1

DO NOT ALLOW INERTIATO BECOME THE

CONSTRAINT OF THE SYSTEM



3

A FLAW IN THE FIVE STEPS

Every Time We Break a Constraint, We Force the Organization to Change Its Focus and Realign Itself.

It Means Constant Change—And Change is Not Easy For Organizations.

Is There a Way to Gain the Benefits of The Five Steps Without Demanding Constant Changing?

Since Every Chain Always Has a Weakest Link…Why Won’t We DECIDE Where We Want It to Be

Then We Can Take Steps to Keep The Constraint Where We Want It To Be



A MORE STRATEGIC PROCESS

1. IDENTIFY the constraint



A MORE STRATEGIC PROCESS

1. SELECT the Control Point2. Decide How to EXPLOIT The Control Point3. Ensure That Everything Else Can Always SUBORDINATE

to The Control Point

WORRY LESSABOUT INERTIA



DEVELOPING A THROUGHPUT OPERATING STRATEGY (TOS)

Map the Overall Flow of the System/Organization–From 20,000 FeetDecide How to Best Measure Performance (3-4 Measures) Strategically Select the Control PointDescribe WHAT GOOD LOOKS LIKE at:

- At the Control Point- For the Feeding Operations- For the Following Operations



DEVELOPING A THROUGHPUTOPERATING STRATEGY (TOS)

Step 1Inputs

Step 2 Step 3 Step 4Outputs

Map the Overall Flow of the System




• Decide the Goals and Key Metrics of the System

Step 1Inputs


MEASUREMENTST, LT, Q




• Strategically Select the Control Point

Step 1Inputs






• WHAT GOOD LOOKS LIKE – Describe How Things Should Operate For Every Link of The Chain

Step 1Inputs Step 2 Step 3 Step 4Outputs


Keep the CP busy, off load non critical activities

Move work quickly to CP. Build a buffer of work. Break any bottlenecks

Move work quickly Assure high quality



DEVELOPING A THROUGHPUT OPERATING STRATEGY (TOS)

• Use This Picture to Drive the Most Important Changes First – Tiger Teams

Step 1Inputs









• Use This Picture to Continually Drive Local Improvements –Throughput Rounds

Step 1Inputs








AN EXERCISE

You Are in Charge of Increasing the Throughput of a Doctor’s office

Use the 3 Strategic Steps of TOC− Where Should the Control Point Be?− Describe What it Means to EXPLOIT the Control Point− Describe How Should the Rest of the Office Subordinate to the

Control Point

How Would You Go About Identifying Ways to Improve the Throughput?

4



CREATING IMPROVEMENT

Patient Check in

Diagnose and Treat

Pull file

Patient Prep

Treatment plan and

check-out

Testing

TreatedPatient

IncomingPatient




Patient Check in

Diagnose and Treat

Pull file

Patient Prep

Treatment plan and

check-out

Testing

TreatedPatient

IncomingPatient

MEASUREMENTS –NUMBER OF TREATED PATIENTS?




Patient Check in

Diagnose and Treat

Pull file

Patient Prep

Treatment plan and

check-out

Testing

TreatedPatient

IncomingPatient

The Doctors are spending higher Percentage of their time Diagnosing and treating patients. Doctor is able to treat more and more patients effectively

MEASUREMENTS –NUMBER OF TREATED PATIENTS




Patient Check in

Diagnose and Treat

Pull file

Patient Prep

Treatment Plan and

Check-out

Testing

TreatedPatient

IncomingPatient

The Doctors are spending higher Percentage of their time Diagnosing and treating patients. Doctor is able to treat more and more patients effectively

The Doctors always have ready patients And everything they need to Treat them.

Patients move quickly from treatment to release, there is very little waiting

MEASUREMENTS –NUMBER OF PATIENTS TREATED



A MEDICAL PRODUCTS COMPANY

Main Assembly

Chassis

QIP

QC,Final,

PackageSub

assembly

Control Point = Main Line

Main Line & QIP has a high blue light time. (Blue light is “physically working on a chassis”).

The output of the Main Line is increasing

Sets of sub-assemblies available to main line at all times.

RM always available to support sub-assembly needs.

Increasing speed and flexibility of building sub-assemblies

Work should move quickly, no back-ups



MEDICAL PRODUCTS TOS

Sub Assembly

Sub Assembly

Sub Assembly

Main Assembly & QIP

FINAL QCPACKAGING

CUSTOMER

Work should move quickly. No backups

Main line & QIP have high blue light time. The output is always increasing

RM always available to support sub assembly

Sub Assemblies alwaysAvailable for Main Line.Sub Assembly increasingflexibility



.

RESULTS

Within 8 Months of Starting…

5.8 units/ dayAverage Output

Zero Inventory & Backorders

Overtime Above24%

Labor Staff of 29

13.1 units/ dayAverage Output

Zero Backorders3 Weeks Inventory

Overtime Below5%

Labor Staff of 21



.

RESULTS – A COST SAVINGS PERSPECTIVE

SAVINGS WITHIN 12 MONTHS OF STARTING…

Overtime Down From24% to 5%

Labor Staff 29 to 21 $266,688

$ 38,219

Total OE Savings $304,907



RESULTS – A THROUGHPUT PERSPECTIVE

PROFIT WITHIN 12 MONTHS OF STARTING…

Total Cost Savings

Throughput Increase5.5 Units to 13.1/day

Total Net Profit Impact

$304,907

$876,000

$1,180,907



UTAH WORKFORCE SERVICES

• Economic Crisis Created Workloads 3X Previous Levels—58k to 178k Annual Public Assistance Cases

• Declining Tax Revenues Led to Budget Cuts of More Than 15%• Very Public Erosion in Service Levels:

− 15 Days to Make Food Stamp Determination− 23 Minute Average Wait Time on Phones for Applicants− An Issue at the Legislature and in Governor’s Office

• Threat of Out-Sourcing the Entire Department• Needed to Reduce $9.2 Million More From Annual Expenses by

June 2012 AND Improve Service

5



ClientApplication

ClientChange

Re-Certification

Collect information and Request Verification

ProvideVerification Image Enter

EvidenceAuthorize/

Deny Benefits

Determination

Control Point

• Staff are working on actions that lead to correct decisions today.

• Decisions are increasing

Feeding the Control Point

Complete information flows to authorization. We are

reducing the time/ effort to get complete information

Measures• Decisions/ FTE• Backlog• Time to Decision• Quality/ errors

Feeding the Control Point

The backlog of pending decisions is going down

UTAH ELGIBILITY SERVICES



UTAH WORKFORCE RESULTSDECEMBER 2011

• Call Wait Times Typically Below 9 Minutes• Time to Process Food Stamps Less Than 8 Days• More Than $14 Million in Annual Expense Reduction—

8 Months Ahead of Commitment to the Legislature• Savings Achieved Without Layoffs: Staff Attrition • Positive Impact on Employees…• What Got the Results?

− Measures− Full kit

5



Everybody Wins

Utah Department of Workforce Services

“The number of cases handledby the department’s Eligibility

Services Division has nearly tripled.”-The Deseret News

“At the same time the Departmenthas saved more than $18 million

in administrative costs while reducing the time [to process applications].”

-The Deseret News

“This is not just about cost reductions. This isabout cost reduction and improved services.”

-Kristen Cox, DWS Executive Director

Governor Appoints Cox to Run Budget Office

“Now it’s time to do the same thing across the enterprise. It’s about service. It’s about results.”

-Gov. Gary Herbert



5

MailReturnsPayments

Receive, open, sort

Check Deposit

Image/ KFI(data entry)

Document Preparation

Upload Temp Storage

$

Shred

TOS – PAPER TAX PROCESSING

Other Departments

electronic

paper20-25%

Control Point: Image/ KFIImaging is always scanning (blue light). More and more documents

are going through Image/ KFI

Feeding the Control Point: Image/ KFI always has clean documents to process, the work flowing to Imaging/

KFI enables them to work faster and faster.

We are reducing the time needed to get work to Image/ KFI

After the Control Point: Work should flow quickly after imaging,

and not slow down imaging.We are reducing the time to

complete work after imaging.

MeasuresTime to processBacklogControlled Prod release date?Quality?



Department of TaxationBefore

“For at least 5 years the Legislature has been concerned with processes and processing of Tax income. The state government takes 45-60 days to deposit tax payments.”

- Sen. David Ige

“The Committee is overwhelmed by the phenomenal change within the department. The statistics were phenomenal, more than 100,000 [more] checks being deposited within 2 weeks is a remarkable difference in a short period of time”

- Sen. David Ige

< 7days 21+ days

2012

2012

2009-11Avg.

2009-11Avg.

110%Increase

In processingUnder 7 days

80%Decrease

In processing over 21 days

After

In less than 3 months:

Results Now



5

PaperApplication

WOTC TOS

DeterminationIssued

ElectronicApplication

Mail processing

Data entry

Eligibility matching

StaffReview

QRCertification determination

Needs determination

Denial determination Document

Storage

Re-determinations

Measures• Turn around time on decisions• Determinations/ day (week)• Quality rate (accuracy)• Value of certifications

Control point• Analysts are spending their time processing

applications •More and more “correct” determinations are being

made

Feeding• We always have applications ready for review

•We are getting the correct data entered into the system faster and faster

Following the control point•Determinations made are issued quickly (no back

log)•Determinations are issued faster and faster



WORKFORCE COMMISSION

199

102

Jan OctJun

38

AverageDays to Process

Thank you! We are very excited and supremely proud of the team!

-Laurie BiscoeWOTC Director

Eliminate Backlog



5

TOS SUCCESS CRITERIA FOR ANY CHANGE

• EXCELLENT Results for the System

• Win-Win-Win• Low-risk vs. the Benefits• Simpler, Not More

Complex• Structured Actions to

Deliver Fast Results and Feedback

“Any fool can make things… morecomplex... It takes a touch of genius - anda lot of courage to move in the oppositedirection…” e.g. E=mc2

In the Noise

Target

+ + =

Vs.

1.2.3.4.5.

Short time to Detect andCorrect



Many things can be improved,ensure you find the few that will have real impact

Approaches like Lean take years. With focus and alignment you get results now, not lots of

“training”

Most approaches look for waste, synchronize your team to deliver better

results



YES, BUT WHERE ARE THE TLS TOOLS?

They are There and They are ImportantBut, The Goal is to Organizations Improve - Not to Make Them a TOC One, or a Lean One or a Six Sigma OneIt’s Certainly Not to Implement the Various TLS Tools and TechniquesInstead of Starting With the Answer – TOC, Lean, Six Sigma or TLS Let’s Start With the Most Important Problems (2-3) Blocking ImprovementAnd Develop Strategies to Solve These Problems Using the Best Available Tools – Including Common Sense



HOW IT’S OFTEN DONE TODAY

Convince an Organization of The Power of Your Approach –TOC, Lean, Six Sigma, TLS, etc.Assemble a Consulting Team to Lead the EffortConduct Extensive Training – Management, Experts, EveryoneUse Experts (Internal and External) to Drive ImplementationExperts Often Focus on Applying the Tools That They Worked So Hard to Master



THE RESULTS

The Experts Often Work on the Wrong or Less Important ProblemsThe Experts Seek Places to Apply the Tools They Have Worked So Hard to MasterThe Rest of the Organization Waits for the Experts to Make Things BetterBottom Line Results are Slow in Coming, But Management is Told They Must Be Patient The Program Grinds On and Eventually Grinds DownManagement Points to Examples of Local Improvements to Justify Their Decision and Moves on to….



6© 2012 Viable Vision LLC.

CREATING A THROUGHPUT OPERATING STRATEGY (TOS)

Create a Simple Picture of the System You are Working With

Decide the Goals and Key Metrics of the System

Strategically Select the Control Point

Describe How Things Should Operate for Every Link in the Chain

Use This Picture to Drive the Most Important Changes First

(Tiger Teams)

Use This Picture to Continually Drive Local Improvements (Throughput Rounds)

“What Good Looks Like”



TOS – WHY IT SEEMS TO WORK

It Provides the Desired FOCUS for Everyone – What Good Looks Like (WGLL)The Measurements are - System MeasurementsTraining is Limited – No Time Consuming Training to Learn New, Often Complicated, Tools or TechniquesThe Organization is Responsible for Making Improvements – Not External and Internal ExpertsIt’s Focus is Positive – Produce More T It Ignores Common Criticisms Like – Waste is Everywhere



TOS – WHY IT SEEMS TO WORK

It Puts Improvement Efforts in the Hands of the Organization− In-House Tiger Teams for the 2-3 Most Important Issues−Throughput Rounds Led by Supervisors to Drive Local

Improvement EffortsIt Makes Work Fun Again – I Can See a Connection Between My Efforts and Results –”That Makes Me Feel Good”It Provides a Framework for Ongoing Improvement – The Powerful Tools of TOC, Lean and Six Sigma are Added When and Where Needed.



6

IMPROVEMENT CHALLENGE

Every Improvement Requires Some Change

Is Every Change An Improvement?BUT…

“If you want different results, you must do things differently”- Dr. Demming

Change

IMPROVEMENT NO IMPROVEMENT70% 30%

What if the percentages were

reversed?



EXCESS CAPACITY ABOUNDS

• MULTI-TASKING• LITTLE OR NO IMPROVEMENT PROJECTS

• MANAGEMENT ATTENTION• THREE STEPS VS FIVE



TOS – A BREAK THROUGH OR JUST ANOTHER TOOL?

YOUR DECISION!



TOS A BREAK THROUGH?

PURE CHUTZPAH?OR

REMOTE POSSIBILITY?



NOT CONVINCED YET

• Let’s Apply it to a Big Problem – Like Obama Care• Obama Care and the Mandate for Electronic Health Records

(EHR) has placed a Huge Burden on Doctors− They’re Now Required to Enter all Past and Future Patient

Information into EHR− Many Older Doctors are Not Computer Literate Nor Interested in

Becoming Competent− Causing More Doctors to Retire – Reducing a Critical Health Care

Resource as Demand is Expanding− Is There a Way to Deal with this Bottleneck Now – Training More

PA’s is Not a “Today Solution”?



MEDICAL SCRIBES

Medical Scribes Pair with Doctors as They are Treating Patients – Recording the Doctors Observations and Instructions on Their Portable Computers.They Assume a Variety of Other Duties, Like Scheduling Appointments and Ordering Prescriptions – Often During the Patient’s VisitNot Exactly a TOS, but They Strategically Selected the Control Point (Physicians) and Used Scribes to Exploit it – A Very Good Start



RESULTS

2012 Study – Cardiology Clinic Comparing Doctors with and without ScribesTreated 50% More Patients Per HourRevenue Increased SignificantlyPhysician- Patient Interaction ImprovedPhysician Quality of Life Much Better



A DO IT NOW SOLUTION

Medical Scribes – Training Takes 15-21 DaysCost to the Users - $10-25/hourVersus Training More Physicians Assistants

−Two Year Training Program−Much higher Cost

Use of Scribes Heavily Focused on Emergency RoomsWhy isn’t there a Nationwide Effort to Greatly Spread the Use of Scribes?



OBSTACLES TO SUCCESS

IMPROVEMENT EXPERTS− TOCers− Lean Advocates− Six Sigma Experts

LURE OF COMPLEXITYCONFLICT OF GOALS AND INCENTIVESCOST BASED MEASUREMENTSMISMATCH OF CREDIT AND RESPONSIBILITY



WAS POGO RIGHT?

ARE WE THE ENEMY?



THE END

[email protected]

tls – breakthrough or just another tool?tocico.net/2014_tocico webinar_v2-fox.pdf2 © 2014 tocico....

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