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Jim Bevier

Health Care

Using Takt Time in Healthcare

A true understanding of workflow allows more pointed questions to improve performance

Published: Wednesday, June 3, 2015 - 11:09

A simple calculation—available time divided by demand—known as takt time, is a fuzzy concept for many people in healthcare. That’s understandable when you consider a hospital is open 24 hours a day, and you never know how many people are going to show up at the door. Let’s look at two concepts that help clarify the concept of takt time and how best to apply it.

1. Takt time for the whole operation isn’t very helpful in the day-to-day operation of a complex organization like a hospital. It becomes more understandable, applicable, and useful when we start drilling deeper into the operations of discrete departments and functions.

2. Takt time describes the pace at which the work needs to be done to meet demand. As an organization matures in its lean transformation, the importance and use of takt time evolves and increases. Takt time becomes the backbone for resource planning to match demand, and leaders are able to show the ultimate respect for their people by not demanding impossible performance or having them stand around with nothing to do.

As with many other lean concepts, an understanding of takt time helps you ask better and more pointed questions to improve performance. Let’s look at an example: Patient discharge from a medical surgical floor is frequently a bumpy, seemingly unplanned, and vexing process. It’s complicated, involving a minimum of four and usually more than 10 operators from multiple departments. How should we calculate the takt time for this floor?

First, understand and define the demand. How many discharges are handled on this floor, and when do they occur? For purposes of this exercise, we want to collect data that are as granular as possible. The number of discharges by day and by hour for the past three months would give us a solid starting point. If that breakdown isn’t readily available, discharges by day and by shift would suffice. Let’s start with a breakdown by shift (three 8-hour shifts, 7 a.m.–3 p.m., 3 p.m.–11 p.m., and 11 p.m.–7 a.m.) and record the highest central tendency (mean, median, or mode) of the data during the past three months.

What does this show us? We can look at the average demand by week, day, and shift and calculate a takt time for each period.

The weekly takt time is calculated as follows:

Available time = 7 days × 24 hours/day × 60 minutes/hour = 10,080 minutes divided by 68 discharges = 148 minutes, or 2 hours 28 minutes

This is the pace at which patients should be moving out the door if we were level loaded. That is, if we were able to distribute our demand evenly across a whole week, one patient would be discharged every 2 hours 28 minutes.

To make this weekly takt time calculation useful, we need to dive deeper. If we calculate the average takt time for each day of the week—24 hours/day × 60 minutes/hour = 1,440 minutes ÷ daily demand—we find average daily takt times as shown below. This helps us see the necessary work pace on each day.

Now let’s focus on one shift—evenings—and calculate the pace of production necessary to meet the average demand on each day of the week just for that shift (8 hours × 60 minutes/hour or 480 minutes). We come up with average takt times for the evening shift as shown below. Needing to discharge people at a pace of one person every 48 minutes (Fridays) will clearly feel different from a required pace of one person every 4 hours (Tuesdays and Wednesdays).

 

With this information we can start to ask the detailed questions that will help us address the variation in demand. How do we resource this unit to smooth out the workflow? How do we resource this unit so it can meet the demand? Is the day shift under-resourced, so demand gets pushed to evenings? Can we manage some of the demand to be on different days or shifts? Is the work required to discharge a patient being done on the day of discharge? Do we create batches of work, which unnecessarily stresses downstream departments, like patient transport or pharmacy, and causes waiting and delays? How about nursing home and rehabilitation partners? Nursing staff are generally resourced by census, which has no bearing on the demand for discharges. How are social workers and discharge planners scheduled? Studying admissions will provide similar information.

Knowing and understanding takt time is part of the story for your processes and value streams. It allows you to ask smart questions and to begin understanding the ebb and flow of your work in a quantified, understandable, and communicable format based on data. In order to resource to meet demand, you need to understand the cycles of work required for each discharge, who does that work, and how much time it takes. How much of the discharge work is actually adding value? What are the wastes in the process? Where are the wastes in the workflow? What other work is being done by the operators who are involved in the discharge process?

An organization that operates based on takt time, with staff doing value-added work that is high quality, has the shortest possible lead time, and expends only the necessary resources, demonstrates respect for both workers and patients.

First published February 2015, Rona Consulting Group blog.

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About The Author

Jim Bevier’s picture

Jim Bevier

Jim Bevier, principal at Rona Consulting Group, is a proven team builder and leader with a successful track record in several industries. He has a demonstrated ability to lead change, organize, and complete complex projects, and manage finances. Bevier has a strong commitment to developing subordinates, high ethical standards, and managerial courage. Flexible and innovative, Bevier is willing and able to think and work outside of the box. He is an experienced and Virginia Mason Production System (VMPS)-certified lean process improvement leader and is able to work collaboratively as a leader of leaders.