[MUSIC] In this next topic I'll be talking about a case study involving an Oncology Infusion Clinic. And I want to make the point that when we change something, we need to do that in context with all essential parts. So, with that as an introduction, let's consider a very simplified version of what needs to happen in a Chemotherapy Infusion Clinic. The chemotherapy needs to be ordered, it needs to be made and then it needs to be administered. We'll just simplify it looking at those three basic steps. And let's then measure the capacity for each of these steps so that in this example, we have the capacity to order ten orders per hour. We had the capacity to make ten an hour. We have the capacity to administer ten an hour, so the overall output of this system consisting of three major parts is ten per hour. And in this case, production is balanced. As an aside, you're going to be learning more about lean design of systems in a future lesson. So now let's say that upper administration says, we really need to increase the capacity of our Oncology Infusion Clinic and we want more patients to be able to be cycled through. No problem, so we're going to add Patient Chairs, Nurses, and Prescribers. So in this next scenario, what I've done is to say well, we've now given the resource, the capacity to write 30 orders an hour, we have the capacity now to administer 30 and hour. But we didn't add anything, we didn't change anything in the pharmacy. So they can't ratchet up their production to 30 an hour. As a matter of fact, they can work harder, harder than they should and increase it to 15 an hour but they're working faster than they should. So the overall output is dictated by the rate limiting step. And in this case, it's the pharmacy that can only make 15 an hour. So even though the capacity of ordering an administration has gone up, we still have an overall output only of 15 an hour. So we've increased throughput, we've increased output, but we've also increased errors. Because now we're causing a group, an essential component to work faster than it ought to. This next slide is something that's important to keep in mind. If you start seeing these symptoms in your staff, it's suggestive, that the time they have available, is less than the time needed to perform a task safely. So, when a staff member gets stressed, being asked to do something more than they're capable of doing, you start seeing symptoms, like feeling overwhelmed, surprised, fatigue, feeling time pressure, lack of teamwork, miscommunication, dissatisfaction, defects, errors. If you start seeing that, you really should be thinking about how to redesign the system in which those folks work. All right, so let's go back to our example. And this time, we become enlightened. And what we want to do is to do production leveling. Now there's a finite amount of resource. So instead of providing access resource to the ordering administering. We're going to not provide so much resource to them, and then provide some resource to the pharmacy. And now we've got a situation in this scenario where each has increased capacity to do 20 an hour. So we can order 20 an hour, we can now make 20 an hour, safely, and now we also have the resources in the nursing staff to administer 20 an hour. Notice that we're twice as many from baseline, by making sure that the production is leveled, so that we can provide our input, improve our output, and improve it safely.
