Lean Thinking Questions for a Provider Delay Board

By Jon Miller Updated on March 26th, 2017

I recently joined a family member’s visit to a local medical center. A new visual control labeled “Provider Delay Board” was displayed prominently in the waiting area. The medical center in question is known for being a long-time practitioner of lean thinking and lean management so this caught my interest.

As one can see from the photo of this board, there are three columns. The first is “On Time” and the other two are organized in 2-by-3 grid. Each box of the grid is labeled “10 Min Delay”, 20 min delay, etc. in ten minute increments up to >60 min delay. It is a magnetic board. The photos of the physicians (healthcare providers) are glued to magnets and placed in the appropriate delay status box.

Within minutes of sitting down, a nurse came to the waiting area and moved a provider from “on time” to the line between 10 min and 20 min delay. This told me that this doctor was running about 15 minutes behind schedule and a patient would have to wait. Luckily, our doctor was one of the two magnets in the on time column and my family member did not wait long.

My 45-minute stay in the waiting area gave me time to ponder this board.

What’s the status now? There was no further action on the Provider Delay Board across the hour. Did the doctor remain 15 minutes behind schedule through the hour?

Who is on duty for urgent care? The empty pocket labeled “urgent care” suggests nobody was on duty. Is this a problem or a normal condition? Red or green? Clear is not a visual management color option.

What level of delay is considered a normal and acceptable? There was no red line, or standard. This is like taking a person’s vitals without knowing what constitutes sick or healthy.

Why are providers running late? Is this a chronic, systemic problem or was there a special circumstance causing provider delay? What problems have been identified, and what is being done about them? Are things getting better, worse or remaining the same?

Who does this board serve? Presumably the patient. The board was displayed in a way that showed intent to act as visual control in a customer-facing area. The assumption is probably that a known wait time is less stressful to the patient than an unknown wait time.

My provider is delayed, so what? As a patient, if I saw upon arrival at the clinic that my doctor was >60 minutes delayed, would I feel any better? Not really. Would the clinic encourage me to come back in an hour? Or could they alert me by text as soon as they knew the provider was running late, so that I can arrive later and avoid unnecessary waiting?

To be fair, the board was probably not intended as a lean management tool. But if so, it falls short. Empty of context, the board communicates delay status to the patients, but in a way that normalizes it. The board provides no context of its purpose to the patients and families in the waiting area. A few words of sincere intent such as, “Thank you for your patience when your provider experiences unavoidable delays” would go a long way.

  1. David

    March 27, 2017 - 6:50 am

    One more idea: a delay of 25 minutes could be posted if the 30 minute box and the 40 minute box were swapped. This creates a serpentine progression with stops along the way.

  2. Patrick Adams

    March 27, 2017 - 5:15 pm

    What is the problem they are trying to solve? If the problem is “unknown waitimes cause stress,” them the visual board may be doing its job…although we would need to be measuring stress levels of patients to confirm. Unfortunately, I do not think this is the case. It is interesting information but what value does it bring and does it justify the time spent keeping it updated. I like your last question, “so what?”

  3. Mark Graban

    March 27, 2017 - 8:13 pm

    I wonder if they are more focused on making the delay visual or if they’re working to reduce causes of delay over time? Can’t tell from one visit, right? But, having a “delay board” seems to suggest they think that is normal and unavoidable?

    • Jon Miller

      March 27, 2017 - 11:15 pm

      Right. The Delay Board seems to normalize delays as there is no suggestion that delays are the subject of a problem solving process.

  4. Tom

    March 28, 2017 - 4:14 pm

    When I walk into a Lean office and see something like this; I like to ask those closest to the work what purpose it serves. I had this same scenario when I out processed my military hospital. In every administration section were process maps and when I asked the workers what they were the response was the same: “I don’t know my boss told me to put it up. I guess maybe to help me work faster.” Not only is innovation closest to the work, but also the true status of the lean culture.

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