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This chapter is from the book

Adding Versus Subtracting (Patching)

In most industries there are process engineers, a professional role whose primary focus is to design operations processes from scratch, considering the needs of customers, linkages to suppliers, process activities, controls, and so on. This role is rare, if not entirely missing, in healthcare. Healthcare processes tend to evolve over time, and if very little is ever done to take them apart and streamline them, they grow ever more complex and unnavigable, forever being tweaked and added to.

To ensure the right level of performance, quality groups often take on a kind of “process police” role, belatedly tracking the symptoms and reacting when the process goes awry. As more and more is added to the process, the related burden of work content increases accordingly, and the encumbered staff find it harder and harder to focus on (or even see) the critical elements amid the process noise. When the focus is on people, patching occurs differently from unit to unit and shift to shift. This inconsistency, coupled with the higher complexity of an overburdened process, leads to decreased process reliability; that is, the same processes are executed differently between units, shifts, and personnel. Lower reliability in turn incurs extra policing, patching, and complexity, and the cycle repeats.

Simpler processes are more reliable. There is really only one process I can do reliably 100% of the time, and that is nothing.

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